Piquard Ambre, Derouesné Christian, Meininger Vincent, Lacomblez Lucette
Laboratoire Santé-Vieillissement, Université Versailles Saint Quentin, Hôpital Sainte Périne, Paris.
Psychol Neuropsychiatr Vieil. 2010 Sep;8(3):215-24; quiz 225-7. doi: 10.1684/pnv.2010.0220.
The questionnaire DEX was designed by Wilson et al. in 1996 to explore the disturbances of executive functions (EF) in activities of daily living (ADL).
This study was performed to explore the specificity of the DEX to evaluate executive dysfunction in ADL, and its contribution to the distinction between Alzheimer's disease (AD) and frontotemporal dementia (FTD).
13 patients with the frontal variant of FTD, 19 patients with FTD associated with amyotrophic lateral sclerosis, FTD/SLA, 18 patients with Alzheimer's disease, AD, and 24 controlled subjects.
The scores on the DEX completed by a proxy as well as those on two scales assessing ADL (the Cognitive Difficulties Scale by McNair & Kahn, and a composite scale (NADL) including the evaluation of basic (BADL) and instrumental (IADL) by the Lawton & Brody scales, and of social activities (SADL) from Katz & Lyerly) were compared to neuropsychological tests assessing EF (Behavioural Assessment of Dysexecutive Syndrome (BADS), Wisconsin Card Sorting Test, Stroop test, Trail Making Test B, lexical and categorical verbal fluencies, WAIS-III similarities).
No correlation was found between the scores on the DEX or the other ADL scales, and the BADS scores. Scores on DEX showed some weak correlations with some executive tasks, but no stronger than those found with the other ADL scales. Analysis of the most frequently perturbed DEX items failed to show a characteristic profile for EF dysfunction. No significant difference was found between patients with AD and DFT on the scores on the DEX as well as on other ADL scales, when adjusted for dementia severity (assessed by the Mattis Dementia Rating Scale (MDRS)). No difference was found between MA and DFT patients neither in the profile of the most frequently perturbed DEX items, nor in decreased awareness of the disorders assessed by comparison of the scores on the DEX completed by patients and familiars.
In this study, DEX does not appear as a specific tool for assessing EF dysfunction in ADL compared to other ADL scales. It was more related to global cognitive difficulties as assessed by the CDS and the MDRS. Scores on the DEX as well as on other ADL scales do not contribute to the distinction between AD and FTD.
问卷DEX由威尔逊等人于1996年设计，用于探索日常生活活动（ADL）中的执行功能（EF）障碍。
本研究旨在探讨DEX评估ADL中执行功能障碍的特异性，及其对区分阿尔茨海默病（AD）和额颞叶痴呆（FTD）的贡献。
13例额颞叶痴呆额叶变异型患者、19例与肌萎缩侧索硬化相关的额颞叶痴呆患者（FTD/SLA）、18例阿尔茨海默病患者（AD）和24名对照受试者。
将由代理人完成的DEX评分以及两个评估ADL的量表（麦克奈尔和卡恩的认知困难量表，以及一个综合量表（NADL），包括劳顿和布罗迪量表对基本（BADL）和工具性（IADL）的评估，以及卡茨和莱尔利的社会活动（SADL）评估）与评估EF的神经心理学测试（执行功能障碍综合征行为评估（BADS）、威斯康星卡片分类测试、斯特鲁普测试、连线测试B、词汇和分类语言流畅性、韦氏成人智力量表第三版相似性测试）进行比较。
DEX或其他ADL量表的评分与BADS评分之间未发现相关性。DEX评分与一些执行任务之间存在一些弱相关性，但不比其他ADL量表发现的相关性更强。对最常受干扰的DEX项目进行分析，未能显示出执行功能障碍的特征性概况。在根据痴呆严重程度（由马蒂斯痴呆评定量表（MDRS）评估）进行调整后，AD患者和DFT患者在DEX评分以及其他ADL量表评分上未发现显著差异。MA患者和DFT患者在最常受干扰的DEX项目概况上，以及通过比较患者及其家属完成的DEX评分来评估的对障碍的认识降低方面均未发现差异。
在本研究中，与其他ADL量表相比，DEX似乎不是评估ADL中执行功能障碍的特异性工具。它与CDS和MDRS评估的整体认知困难更相关。DEX评分以及其他ADL量表评分无助于区分AD和FTD。
