Addenbrooke′s认知功能检查-Ⅲ在老年性聋相关认知障碍筛查中的应用研究

Application of the Chinese version of the Addenbrooke's cognitive examination-Ⅲ in presbycusis with mild cognitive impairment

目的探讨中文版Addenbrooke认知功能检查-Ⅲ(ACE-Ⅲ)在老年性聋患者轻度认知障碍中应用的效度和信度及其最佳临界值,为其在国内临床应用提供客观依据.方法选择2016年1月至2017年10月在扬州大学附属医院耳鼻咽喉科门诊就诊的老年性聋患者104例,其中老年性聋伴轻度认知障碍患者43例(MCI组)、无轻度认知障碍者61例(NCI组)及60例健康老年人(对照组)进行严格测试.使用中文版简易精神状态评定量表(MMSE)、蒙特利尔认知评估量表(MoCA)及中文版ACE-Ⅲ量表评估受试者的认知能力,使用SPSS 21.0软件考核中文版ACE-Ⅲ量表的信度、效度;应用受试者工作曲线(ROC)的方法,确定该问卷诊断ACE-Ⅲ的截点及其在老年性聋轻度认知功能障碍诊断中的价值.结果中文版ACE-Ⅲ量表具有良好的可行性:接受率、回收率和有效率分别为100.0%、100.0%和94.9%;量表具有良好的信度、效度和反应性:Cronbach'sα=0.870(P<0.05),分半信度=0.874(P<0.05),重测信度=0.880(P<0.05).使用中文版ACE-Ⅲ发现MCI组患者在注意/定向、记忆、语言流利性、语言及视空间得分均低于NCI组及对照组,差异有统计学意义(F=48.042,P<0.001;F=46.594,P<0.001;F=35.442,P<0.001;F=19.374,P<0.001;F=256.19, P<0.001;F=140.319,P<0.001).中文版ACE-Ⅲ量表总体评分与MMSE量表评分相关性良好(r=0.808, P<0.001);因素分析显示量表26个项目可以提取出5个维度,能有效区分老年性聋伴轻度认知功能障碍者和认知功能正常的人群(P<0.05).中文版ACE-Ⅲ量表总体评分与MoCA评分相关性良好( r=0.802,均P<0.001).当ACE-Ⅲ得分为86.5分时诊断老年性聋的ROC曲线面积最大0.98(95%CI:0.897~0.996),灵敏度及特异度分别为100.0%和95.0%.结论中文版ACE-Ⅲ量表具有良好的内部一致性、信度和效度,适用于筛查老年性聋患者的认知功能.当问卷评分≥86.5分时,可考虑老年性聋患者存在认知功能障碍.

Objective To explore the reliability, validity and best cut-off value of Chinese version Addenbrooke's cognitive examination-Ⅲ(ACE-Ⅲ) in presbycusis patients with mild cognitive impairment(MCI). Methods A total of 43 presbycusis patients with mild cognitive impairment, 61 presbycusis patients with normal cognitive impairment and 60 healthy controls treated in outpatient clinic of department of otolaryngology in the Affiliated Hospital of Yangzhou University from January 2016 to October 2017 were enrolled.The Chinese version of mini mental state examination(MMSE), Montreal cognitive assessment(MoCA) and ACE-Ⅲ were used to evaluate cognitive function of subjects.The reliability and validity of the ACE-Ⅲ were analyzed with the SPSS 21.0, and the cut-off point was confirmed with the receiver operating characteristic(ROC) curve analysis, and the value of the scale questionnaire in the diagnosis of presbycusis patients with MCI was assessed. Results Chinese version of ACE-Ⅲ had betler feasiblity, and the receiving rate, recovery rate and effivience were 100.0%, 100.0% and 94.9%, respetively.The Cronbach's alpha, split-half reliability and intraclass correlation coefficient were 0.870(P<0.05), 0.874(P<0.05) and 0.880(P<0.05), respectively.The patients in MCI group got a lower score in the sub-scale of attention/orientation, memory, verbal fluency, language and visual space of ACE-Ⅲ compared with those in NCI group and healthy control group, and the differences were statistically significant (F=48.042, 46.594, 35.442, 19.374, 256.19, 140.319, all P<0.001). The criteria validity calculated between the Chinese version of ACE-Ⅲ and MMSE was 0.802 (P<0.001). Factor analysis of the construct validity showed that the 26 items were classed into five domains.Every domain was sensitive and effective to discriminate between patients and healthy individuals(P<0.05). The Chinese version of ACE-Ⅲ showed significantly correlation with the total scores of MoCA(r=0.802, P<0, 001). When the cut-off value for diagnosis was 86.5, the largest area under the ROC curve for the Chinese version of ACE-Ⅲ was 0.98(95% CI: 0.897-0.996). The relative sensitivity and specificity were 100.0% and 95.0%, respectively. Conclusion The Chinese version of ACE-Ⅲ had better internal consistency, reliability and validity, and is applicable for MCI assessment in elderly patients with presbycusis.Patients with presbycusis can be considered to have cognitive dysfunction with score of 86.5 by using this questionnaire.