Department of Neurology, The First People's Hospital of Chenzhou, Chenzhou, Hunan 423000, China.
Center for Hyperbaric Oxygen and Neurorehabilition, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, Guangdong 510000, China.
Chin Med J (Engl). 2017 Oct 5;130(19):2283-2290. doi: 10.4103/0366-6999.215326.
BACKGROUND: Nonlinguistic cognitive impairment has become an important issue for aphasic patients, but currently there are few neuropsychological cognitive assessment tests for it. To get more information on cognitive impairment of aphasic patients, this study aimed to develop a new cognitive assessment test battery for aphasic patients, the Non-language-based Cognitive Assessment (NLCA), and evaluate its utility in Chinese-speaking patients with aphasia. METHODS: The NLCA consists of five nonverbal tests, which could assess five nonlinguistic cognitive domains such as visuospatial functions, attention test, memory, reasoning, and executive functions of aphasic patients. All tests are modified from the nonverbal items of the current existed tests with some changes to the characteristics of Chinese culture. The NLCA was tested in 157 participants (including 57 aphasic patients, 50 mild cognitive impairment (MCI) patients, and 50 normal controls), and was compared with other well-established relative neuropsychological tests on the reliability, validity, and utility. RESULTS: The NLCA was fully applicable in the MCI patients and the normal controls, almost working in the aphasic patients (57/62 patients, 91.9%). The NLCA scores were 66.70 ± 6.30, 48.67 ± 15.04, and 77.58 ± 2.56 for the MCI group, the aphasic group, and the control group, respectively , and a significant difference was found among three groups (F = 118.446, P < 0.001). The Cronbach's alpha of the NLCA as an index of internal consistency was 0.805, and the test-retest and interrater reliability was adequate (r=0.977 and r= 0.970, respectively). The correlations of the cognitive subtests and their validation instruments were between 0.540 and 0.670 (all P < 0.05). Spearman's correlation analysis indicated that the coefficient of internal consistency of each subtest itself was higher than other subtests. When choosing the Montreal Cognitive Assessment score of <26 as the diagnostic criteria of cognitive impairment, the area under the curve for all participants in the control and MCI groups was 0.942 (95% confidence interval: 0.895-0.989), and an optimal cutoff point of 75.00 seemed to provide the best balance between sensitivity and specificity. Age (r = -0.406, P < 0.001) was the main influence factor for the NLCA. CONCLUSIONS: The NLCA could efficiently differentiate the cognitive impairment patients from the normal controls and is a reliable and valid cognitive assessment test battery to specially find nonlinguistic cognitive function for aphasic patients.
背景:非语言认知障碍已成为失语症患者的一个重要问题,但目前针对该问题的神经心理学认知评估测试较少。为了获取更多关于失语症患者认知障碍的信息,本研究旨在开发一种新的失语症患者认知评估测试工具,即非语言认知评估(NLCA),并评估其在中国失语症患者中的应用价值。
方法:NLCA 由五个非言语测试组成,可评估失语症患者的五个非语言认知领域,如视空间功能、注意力测试、记忆、推理和执行功能。所有测试均从现有测试的非言语项目中修改而来,针对中国文化的特点进行了一些调整。NLCA 在 157 名参与者(包括 57 名失语症患者、50 名轻度认知障碍(MCI)患者和 50 名正常对照者)中进行了测试,并与其他经过验证的相关神经心理学测试进行了可靠性、有效性和实用性的比较。
结果:NLCA 完全适用于 MCI 患者和正常对照组,几乎适用于失语症患者(57/62 例,91.9%)。MCI 组、失语症组和对照组的 NLCA 评分为 66.70±6.30、48.67±15.04 和 77.58±2.56,三组间差异有统计学意义(F=118.446,P<0.001)。NLCA 作为内部一致性指标的克朗巴赫 α 系数为 0.805,重测信度和评分者间信度良好(r=0.977 和 r=0.970)。认知子测试与其验证工具的相关性在 0.540 至 0.670 之间(均 P<0.05)。Spearman 相关分析表明,各子测试自身的内部一致性系数均高于其他子测试。当选择蒙特利尔认知评估得分<26 作为认知障碍的诊断标准时,对照组和 MCI 组所有参与者的曲线下面积为 0.942(95%置信区间:0.895-0.989),75.00 的最佳截断点似乎在灵敏度和特异性之间提供了最佳平衡。年龄(r=-0.406,P<0.001)是 NLCA 的主要影响因素。
结论:NLCA 可有效地将认知障碍患者与正常对照组区分开来,是一种可靠且有效的认知评估测试工具,可专门用于发现失语症患者的非语言认知功能。
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