Sylvestre G, Chopard G, Tio G, Magnin E, Rumbach L, Vandel P, Galmiche J
Service de Neurologie,Centre Mémoire de Ressources et de Recherche de Franche-Comté, CHU Jean-Minjoz, 3 Boulevard Alexander-Fleming, 25000 Besançon, France.
Rev Neurol (Paris). 2011 Jun-Jul;167(6-7):495-504. doi: 10.1016/j.neurol.2010.12.004. Epub 2011 Apr 6.
The aim of this study was to propose diagnostic norms for the rapid neuropsychological battery, in the detection of cognitive impairment due to Alzheimer's disease.
Three hundred and fifty-two control subjects (mean MMSE : 27.3 ± 2.5) and 676 patients with Alzheimer's disease (mean MMSE : 22.9 ± 2.6) at a mild stage (CDR = 1) were selected according to age (60-69, 70-79 and 80-89 years) and educational level (French primary Education Certificate or lower versus Certificate of Professional Aptitude or the School Leaving Certificate versus the Baccalaureate or higher). Age and education-adjusted cut-off scores were calculated using Receiver Operating Characteristic curves so as to determine the discriminative ability (sensitivity, specificity) of each test from the RAPID neuropsychological battery. Cut-off scores with a specificity set at least at 90% were also proposed.
The Free and Cued Recall Test exhibited good sensitivity (from 87% to 100% for free recall and from 85% to 98% for total recall) and specificity (from 85% to 96% for free recall and from 86% to 100% for total recall). For the other tests, sensitivities and specificities were lower.
The use of these two types of cut-off scores should help the clinician in the diagnosis of Alzheimer's disease by limiting the risk of false positives and false negatives. The choice of the cut-off scores will depend on the patient's individual clinical context.
本研究的目的是提出快速神经心理成套测验的诊断标准，用于检测阿尔茨海默病所致的认知障碍。
根据年龄（60 - 69岁、70 - 79岁和80 - 89岁）和教育水平（法国小学教育证书及以下、职业能力证书或中学毕业证书、学士学位及以上），选取了352名对照受试者（平均简易精神状态检查表[MMSE]：27.3 ± 2.5）和676名轻度阿尔茨海默病患者（平均MMSE：22.9 ± 2.6；临床痴呆评定量表[CDR]=1）。使用受试者工作特征曲线计算年龄和教育程度调整后的临界值分数，以确定快速神经心理成套测验中每项测试的辨别能力（敏感性、特异性）。还提出了特异性至少设定为90%的临界值分数。
自由及线索回忆测验表现出良好的敏感性（自由回忆为87%至100%，总回忆为85%至98%）和特异性（自由回忆为85%至96%，总回忆为86%至100%）。对于其他测试，敏感性和特异性较低。
使用这两种类型的临界值分数应有助于临床医生诊断阿尔茨海默病，通过限制假阳性和假阴性的风险。临界值分数的选择将取决于患者的个体临床情况。
