Ashendorf Lee, Alosco Michael L, Bing-Canar Hanaan, Chapman Kimberly R, Martin Brett, Chaisson Christine E, Dixon Diane, Steinberg Eric G, Tripodis Yorghos, Kowall Neil W, Stern Robert A
Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.
Arch Clin Neuropsychol. 2018 Aug 1;33(5):530-540. doi: 10.1093/arclin/acx100.
Neuropsychological test performance can provide insight into functional abilities in patients with dementia, particularly in the absence of an informant. The relationship between neuropsychological measures and instrumental activities of daily living (IADLs) is unclear due to hetereogeneity in cognitive domains assessed and neuropsychological tests administered. Practical and ecologically valid performance-based measures of IADLs are also limited. The Neuropsychological Assessment Battery (NAB) is uniquely positioned to provide a dual-purpose assessment of cognitive and IADL function, as it includes Daily Living tests that simulate real-world functional tasks. We examined the utility of select NAB tests in predicting informant-reported IADLs in mild cognitive impairment and dementia.
The sample of 327 participants included 128 normal controls, 97 individuals with mild cognitive impairment, and 102 individuals with Alzheimer's disease dementia from the Boston University Alzheimer's Disease Center research registry. Informants completed the Lawton Brody Instrumental Activities of Daily Living Scale, and study participants were administered selected NAB tests that were complementary to the existing protocol.
ROC curves showed strongest prediction of IADL (AUC > 0.90) for memory measures (List Learning delayed recall and Daily Living Memory delayed recall) and Daily Living Driving Scenes. At a predetermined level of specificity (95%), List Learning delayed recall (71%) and Daily Living Memory delayed recall (88%) were the most sensitive. The Daily Living Memory and Driving Scenes tests strongly predicted IADL status, and the other Daily Living tests contributed unique variance.
NAB memory measures and Daily Living Tests may have clinical utility in detecting informant-rated functional impairment in dementia.
神经心理学测试表现能够为痴呆患者的功能能力提供深入了解，尤其是在缺乏 informant 的情况下。由于所评估的认知领域和所实施的神经心理学测试存在异质性，神经心理学测量与日常生活工具性活动（IADL）之间的关系尚不清楚。基于 IADL 的实用且具有生态效度的基于表现的测量方法也很有限。神经心理学评估量表（NAB）具有独特的地位，能够对认知和 IADL 功能进行双重目的评估，因为它包括模拟现实世界功能任务的日常生活测试。我们研究了 NAB 特定测试在预测轻度认知障碍和痴呆患者中 informant 报告的 IADL 方面的效用。
327 名参与者的样本包括来自波士顿大学阿尔茨海默病中心研究登记处的 128 名正常对照者、97 名轻度认知障碍个体和 102 名阿尔茨海默病痴呆个体。Informant 完成了 Lawton Brody 日常生活工具性活动量表，研究参与者接受了与现有方案互补的选定 NAB 测试。
ROC 曲线显示，记忆测量（列表学习延迟回忆和日常生活记忆延迟回忆）和日常生活驾驶场景对 IADL 的预测最强（AUC > 0.90）。在预定的特异性水平（95%）下，列表学习延迟回忆（71%）和日常生活记忆延迟回忆（88%）最敏感。日常生活记忆和驾驶场景测试强烈预测 IADL 状态，其他日常生活测试贡献了独特的方差。
NAB 记忆测量和日常生活测试在检测痴呆患者中 informant 评定的功能损害方面可能具有临床效用。
