CAJ | 학술논문

目的通过系列神经心理学测试分析特发性正常压力脑积水(iNPH)患者认知功能损害的特点及各种测试方法对诊断的作用.方法运用神经心理学测试方法对18例iNPH患者、20例轻度阿尔茨海默病(AD)患者和20名健康对照者进行记忆力、注意力、执行功能、视空间能力评估,同时用受试者工作特征曲线分析这些测试方法对iNPH诊断的敏感度和特异度.结果与健康对照组比较,iNPH组和AD组的总体认知状态和各认知领域均有受损,差异均有统计学意义.iNPH组与AD组相比较[数值以中位数(四分位数间距)表示],在额叶功能评定量表评分[9.0(2.8)分与13.0(3.5)分]、言语流畅性测验评分[10.0(8.5)分与12.0(8.0)分]、斯特鲁普色词测验卡片A耗时数[65.0(20.8)s与52.0(24.5)s]、斯特鲁普色词测验卡片B耗时数[157.5(44.3)s与108.0(37.3)s]、斯特鲁普干扰量耗时数[68.5(67.0)s与50.0(25.8)s]、积木测试评分[5.0(3.3)分与6.5(3.5)分]方面差异均有统计学意义(Z =4.047、2.025、2.857、3.864、3.218、2.221,均P＜0.05),而AD评估量表中单词回忆和单词辨认、数字广度测验、画钟测验评分差异均无统计学意义.其中,斯特鲁普色词测验卡片A耗时数、斯特鲁普色词测验卡片B耗时数、斯特鲁普干扰量耗时数对iNPH诊断的受试者工作特征曲线下面积分别为0.874、0.929、0.869,敏感度和特异度分别为88.9％和75.0％,88.9％和85.0％,94.4％和72.5％.结论 iNPH患者亦有记忆力、执行功能、注意力、视空间能力损害,其中以执行功能障碍最为突出.另外,斯特鲁普色词测验对iNPH诊断具有很好的识别能力.
목적 통과계렬신경심이학측시분석특발성정상압력뇌적수(iNPH)환자인지공능손해적특점급각충측시방법대진단적작용.방법 운용신경심이학측시방법대18례iNPH환자、20례경도아이자해묵병(AD)환자화20명건강대조자진행기억력、주의력、집행공능、시공간능력평고,동시용수시자공작특정곡선분석저사측시방법대iNPH진단적민감도화특이도.결과 여건강대조조비교,iNPH조화AD조적총체인지상태화각인지영역균유수손,차이균유통계학의의.iNPH조여AD조상비교[수치이중위수(사분위수간거)표시],재액협공능평정량표평분[9.0(2.8)분여13.0(3.5)분]、언어류창성측험평분[10.0(8.5)분여12.0(8.0)분]、사특로보색사측험잡편A모시수[65.0(20.8)s여52.0(24.5)s]、사특로보색사측험잡편B모시수[157.5(44.3)s여108.0(37.3)s]、사특로보간우량모시수[68.5(67.0)s여50.0(25.8)s]、적목측시평분[5.0(3.3)분여6.5(3.5)분]방면차이균유통계학의의(Z =4.047、2.025、2.857、3.864、3.218、2.221,균P＜0.05),이AD평고량표중단사회억화단사변인、수자엄도측험、화종측험평분차이균무통계학의의.기중,사특로보색사측험잡편A모시수、사특로보색사측험잡편B모시수、사특로보간우량모시수대iNPH진단적수시자공작특정곡선하면적분별위0.874、0.929、0.869,민감도화특이도분별위88.9％화75.0％,88.9％화85.0％,94.4％화72.5％.결론 iNPH환자역유기억력、집행공능、주의력、시공간능력손해,기중이집행공능장애최위돌출.령외,사특로보색사측험대iNPH진단구유흔호적식별능력.
Objective To explore the characteristics of cognitive impairment in patients with idiopathic normal pressure hydrocephalus (iNPH) by a battery of neuropsychological tests and evaluate the role of these tests in diagnosis.Methods Eighteen iNPH patients,20 mild Alzheimer' s disease (AD) patients and 20 healthy volunteers underwent assessment of memory,attention,executive function and visuospatial ability using various common neuropsychological measures.The diagnostic specifity and sensitivity of these measures were analyzed by receiver operator characteristic curve.Results Compared with the healthy controls,iNPH patients and AD patients had significant loss of overall cognitive status and various cognitive domains.There were significant differences (Z =4.047,2.025,2.857,3.864,3.218,2.221,all P ＜ 0.05) between iNPH patients and AD patients in Frontal Assessment Battery (9.0 (2.8) scores vs 13.0(3.5) scores),Verbal Fluency Test (10.0 (8.5) scores vs 12.0 (8.0) scores),time of complete Stroop Color Word Test Card A(65.0(20.8) s vs 52.0(24.5) s),time of complete Stroop Color Word Test Card B(157.5(44.3) s vs 108.0(37.3) s),time of Stroop Interence Effects(68.5(67.0) s vs 50.0 (25.8) s) and Block Design Test (5.0 (3.3) scores vs 6.5 (3.5) scores).However,no significant differences were detected in word recall and word recognition subtests of the AD Assessment Scale,Digit Span Test and Clock Drawing Test.The areas under the receiver operator characteristic curve for diagnosis of iNPH by time of complete Stroop Color Word Test Card A,time of complete Stroop Color Word Test Card B and time of Stroop Interence Effects were 0.874,O.929 and 0.869,respectively.And the sensitivity and specifity of the three indexes were 88.9％ and 75.0％,88.9％ and 85.0％,94.4％ and 72.5％,respectively.Conclusions Patients with iNPH are impaired in various aspects of cognition involving memory,attention,executive function and visuospatial ability,the most prominent of which is the executive dysfunction.Additionally,Stroop Color Word Test is highly diagnostically discriminative for iNPH.