Litwin Zucker Center for Research in Alzheimer's Disease and Memory Disorders, Feinstein Institute for Medical Research, 350 Community Dr., Manhassett, NY 11030, USA.
Am J Psychiatry. 2010 Jul;167(7):845-53. doi: 10.1176/appi.ajp.2010.09050692. Epub 2010 Apr 1.
The view that everyday function is preserved in mild cognitive impairment may be problematic. The objectives of this study were to determine the magnitude of impairment in everyday function in patients with mild cognitive impairment and Alzheimer's disease using a novel sensitive performance-based measure (the UCSD Performance-Based Skills Assessment; UPSA), contrast it with use of an informant-based measure (the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory; ADCS-ADL), and model the relationship between cognitive measures and the performance-based measure.
Fifty cognitively normal elders, 26 patients who met criteria for amnestic mild cognitive impairment, and 22 patients who suffered from mild to moderate Alzheimer's disease were assessed on the UPSA, the ADCS-ADL, and a battery of neurocognitive tests.
Patients with mild cognitive impairment had significant impairments on the UPSA but not on the ADCS-ADL. The magnitude of the effect size between the cognitively healthy and the mild cognitive impairment group for the UPSA was large (d=0.86). A strong and significant relationship was observed between cognitive performances in speed (R(2)=0.37), episodic memory (R(2)=0.10), and semantic processing (R(2)=0.03) and UPSA score using multiple regression models. The psychometric properties of the UPSA were acceptable, as were its sensitivity and specificity in contrasts between cognitively normal elders and patients with mild cognitive impairment and between the latter group and patients with Alzheimer's disease.
These findings indicate that performance-based measures of function may be a sensitive tool in studies of Alzheimer's disease and mild cognitive impairment and suggest the need for a reconceptualization of the relationship between cognition and function in mild cognitive impairment so that they can be usefully aligned.
认为轻度认知障碍患者日常功能保持不变的观点可能存在问题。本研究的目的是使用一种新的敏感基于表现的测量方法（圣地亚哥表现技能评估；UPSA）来确定轻度认知障碍和阿尔茨海默病患者日常功能受损的程度，将其与使用基于告知者的测量方法（阿尔茨海默病合作研究-日常生活活动量表；ADCS-ADL）进行对比，并对认知测量方法与基于表现的测量方法之间的关系进行建模。
50 名认知正常的老年人、26 名符合遗忘型轻度认知障碍标准的患者和 22 名患有轻度至中度阿尔茨海默病的患者接受了 UPSA、ADCS-ADL 和一系列神经认知测试。
轻度认知障碍患者在 UPSA 上有明显的障碍，但在 ADCS-ADL 上没有。在 UPSA 上，认知健康者与轻度认知障碍者之间的效应大小的大小（d=0.86）非常大。使用多元回归模型，观察到认知表现（速度（R(2)=0.37）、情节记忆（R(2)=0.10）和语义处理（R(2)=0.03））与 UPSA 评分之间存在强烈而显著的关系。UPSA 的心理测量学特性是可以接受的，其在认知正常老年人与轻度认知障碍患者之间以及后者与阿尔茨海默病患者之间的对比中的敏感性和特异性也是可以接受的。
这些发现表明，功能的基于表现的测量方法可能是阿尔茨海默病和轻度认知障碍研究中的一种敏感工具，并表明需要重新概念化轻度认知障碍中认知与功能之间的关系，以便能够有效地将其对齐。
