高龄轻度阿尔茨海默病患者执行功能状况的研究

A study on executive function status of octogenarians with mild Alzheimer’s disease

目的研究高龄轻度阿尔茨海默病(Alzheimer’s disease,AD)患者执行功能状况。方法选择2013年6月—2014年12月在复旦大学附属华山医院神经内科“记忆障碍”门诊连续就诊的高龄轻度AD患者(AD组)47例。对照组为在医院体检中心进行健康体格检查的人群中随机抽取的认知正常的老年人或部分患者家属(74例)。根据受试者接受教育年限分类,中学文化程度(教育年限≤12年)39例,其中AD组20例、对照组19例;大学文化程度(教育年限>12年)82例,其中AD组27例、对照组55例。比较两组患者的一般资料,以及神经心理学测试[简明精神状态量表(MMSE),执行功能评估采用记忆与执行筛查量表(MES)测验、斯特鲁普色词测验(SCWT)和连线测验(TMT)]结果。结果两组间患者的性别构成、年龄、受教育年限、退休前从事工作情况的差异均无统计学意义(P值均>0.05)。AD组MMSE和MES总分均显著低于对照组(P值均<0.05),SCWT卡片A、B、C耗时均显著长于对照组(P值均<0.05),SCWT卡片C正确阅读数显著少于对照组(P<0.05),TMT-A、TMT-B耗时均显著长于对照组(P值均<0.05)。中学文化程度受试者中,AD组MMSE总分、MES总分均显著低于对照组(P值均<0.05),TMT耗时均显著长于对照组(P值均<0.05),MES执行因子分和言语流畅性、手指连续动作、扣指(1)矛盾刺激、扣指(2)敲-不敲得分均显著低于对照组(P值均<0.05)。大学文化程度受试者中,AD组MMSE总分、MES总分均显著低于对照组(P值均<0.05),SCWT耗时、TMT耗时均显著长于对照组(P值均<0.05),SCWT卡片C正确阅读数显著少于对照组(P<0.05),MES记忆因子分、执行因子分和手指连续动作、左手完成正确、右手完成正确、扣指(1)矛盾刺激、扣指(2)敲-不敲得分均显著低于对照组(P值均<0.05)。结论高龄轻度AD患者的执行功能明显减退,表现为任务完成速度减慢和准确性下降,大学文化程度的轻度AD患者记忆和执行功能损害可被MES量表的因子分检测出来。

Objective To explore the executive function status of elderly patients(octogenarians)with mild Alzheimer disease(AD).Methods A total of 47 elderly patients with mild AD(AD group)who were consecutively hospitalized in the“memory disorder”clinic of Huashan Hospital affiliated to Fudan University from June 2013 to December 2014 were selected.Meanwhile,74 cognition-normal elderly people for physical examination or family members of some patients were assigned to normal control(NC)group.Of them,39 had middle school education(education years≤12 years,20 in AD group and 19 in NC group),and 82 had college education(education years>12 years,27 in AD group and 55 in NC group).Their basic demographic information was recorded and cognitive function assessment results were analyzed,including the mini mental state examination(MMSE),memory and executive screening scale(MES),Stroop color-word test(SCWT),and trail making test(TMT).Results There was no significant difference in the gender composition,age,educational level,or work before retirement between the two groups(all P>0.05).The total scores of the MMSE and MES in the AD group were significantly lower than those in the NC group(both P<0.05).Compared with the NC group,the time-consuming on Stroop A,B,C and TMT-A and TMT-B tests in the AD group was significantly longer,while the correct reading number of SCWT C was less(all P<0.05).Among the subjects with middle school education,the total scores of MMSE and MES in AD group were significantly lower than those in NC group(both P<0.05),TMT time in AD group was significantly longer than that in NC group(all P<0.05),and the correct number of MES executive functions,speech fluency,continuous finger movements,finger clasping(1)contradictory stimulus,and finger clasping(2)knock-not-knock scores in AD group were significantly lower than those in NC group(all P<0.05).Among the subjects with college education,the total scores of MMSE and MES in AD group were significantly lower than those in NC group(both P<0.05),the SCWT time and TMT time in AD group were significantly longer than those in NC group(P<0.05),the correct reading number of SCWT C was significantly less than that in NC group(all P<0.05),the correct number of MES memory function,correct number of MES executive function,continuous finger movements,correct completion of the left hand,correct completion of the right hand,finger clasping(1)contradictory stimulus,and finger clasping(2)knock-not-knock scores in AD group were significantly lower than those in NC group(all P<0.05).Conclusion The octogenarians with mild AD show a decline in the speed and accuracy of Stroop task.Both memory and executive impairments can be detected by the subtests of MES,especially for mild AD patients with high education level.