Cincinnati Children’s Hospital Medical Center, University of Cincinnati, William Rowe Division of Rheumatology, E 4010, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
Arthritis Care Res (Hoboken). 2013 Mar;65(3):372-81. doi: 10.1002/acr.21835.
To evaluate the reproducibility and validity of the Pediatric Automated Neuropsychological Assessment Metrics (Ped-ANAM) when used in childhood-onset systemic lupus erythematosus (cSLE).
Forty children with cSLE and 40 matched controls were followed for up to 18 months. Formal neuropsychological testing at baseline was repeated after 18 months of followup; overall cognitive performance and domain-specific cognition (attention, working memory, processing speed, and visuoconstructional ability) were measured and categorized as normal cognition, mild/moderate, or moderate/severe impairment. The 10 Ped-ANAM subtests were completed every 6 months and twice at baseline. Ped-ANAM performance was based on accuracy (AC), mean time to correct response (MNc), throughput, and coefficient of variation of the time required for a correct response (CVc) as a measure of response consistency.
Particularly, MNc scores demonstrated moderate to substantial reproducibility (intraclass correlation coefficients 0.47-0.80). Means of select Ped-ANAM scores (MNc, AC, CVc) differed significantly between children with different levels of cognitive performance and allowed for the detection of moderate or severe cognitive impairment with 100% sensitivity and 86% specificity. Six Ped-ANAM subtests significantly correlated with the change in overall cognitive function in cSLE (baseline versus 18 months; Spearman's correlation coefficient >0.4, P < 0.05; n = 24).
The Ped-ANAM has moderate to substantial reproducibility, criterion and construct validity, and may be responsive to change in cSLE. Additional research is required to confirm the outstanding accuracy of the Ped-ANAM in identifying cognitive impairment, as well as its usefulness in detecting clinically relevant changes in cognition over time.
评估儿科自动化神经心理评估指标（Ped-ANAM）在儿童发病系统性红斑狼疮（cSLE）中的可重复性和有效性。
40 名儿童发病的系统性红斑狼疮患儿和 40 名匹配的对照组接受了长达 18 个月的随访。在随访 18 个月后重复进行基线时的正式神经心理测试；测量并分类整体认知表现和特定领域认知（注意力、工作记忆、处理速度和视觉构建能力）为正常认知、轻度/中度或中度/重度损伤。10 项 Ped-ANAM 子测试每 6 个月完成一次，基线时完成两次。Ped-ANAM 表现基于准确性（AC）、正确反应的平均时间（MNc）、吞吐量以及正确反应所需时间的变异系数（CVc），以衡量反应一致性。
特别是，MNc 评分表现出中等至较大的可重复性（组内相关系数 0.47-0.80）。选择的 Ped-ANAM 评分（MNc、AC、CVc）的平均值在认知表现不同水平的儿童之间存在显著差异，并且可以以 100%的敏感性和 86%的特异性检测到中度或重度认知障碍。在 cSLE 中，6 项 Ped-ANAM 子测试与整体认知功能的变化显著相关（基线与 18 个月；Spearman 相关系数>0.4，P<0.05；n=24）。
Ped-ANAM 具有中等至较大的可重复性、标准和结构有效性，并且可能对 cSLE 的变化有反应。需要进一步的研究来确认 Ped-ANAM 在识别认知障碍方面的出色准确性，以及其在随时间检测认知方面的临床相关变化方面的有用性。
