血管性痴呆和阿尔茨海默病中简易精神状态检查表五边形的定性分析：一项纵向探索性研究

Qualitative Analysis of Mini Mental State Examination Pentagon in Vascular Dementia and Alzheimer's Disease: A Longitudinal Explorative Study.

作者信息

Lo Buono Viviana, Bonanno Lilla, Corallo Francesco, Foti Maria, Palmeri Rosanna, Marra Angela, Di Lorenzo Giuseppe, Todaro Antonino, Bramanti Placido, Bramanti Alessia, Marino Silvia

机构信息

IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.

出版信息

J Stroke Cerebrovasc Dis. 2018 Jun;27(6):1666-1672. doi: 10.1016/j.jstrokecerebrovasdis.2018.01.021. Epub 2018 Mar 2.

DOI:10.1016/j.jstrokecerebrovasdis.2018.01.021

PMID:29503167

Abstract

BACKGROUND

Vascular dementia and Alzheimer's disease are the most diffuse forms of dementia. Sometimes, they are difficult to distinguish due to overlaps in symptomatology, pathophysiology, and comorbidity. Visual constructive apraxia is very common in dementia and impairment in these abilities can provide clinical information for differential diagnosis.

MATERIALS AND METHODS

All patients underwent Mini Mental State Examination (MMSE) at basal visit (T0) and after 1 year (T1). We analyzed differences in Qualitative Scoring Method for the Pentagon Copying Test and we explored the visual constructive apraxia evolution in these 2 types of dementia.

RESULTS

In intragroup analysis, we found a significant difference in each group between T0 and T1 in MMSE score (P < .001) and total qualitative scores (P < .001). In intergroup analysis, at T0, we found significance difference in total qualitative scores (P < .001), in numbers of angles (P = .005), in distance/intersection (P < .001), in closure/opening (P = .01), in rotation (P < .001), and in closing-in (P < .001). At T1, we found significance difference in total qualitative scores (P < .001), in particular, in numbers of angles (P < .001), in distance/intersection (P < .001), in closure/opening (P < .001), in rotation (P < .001), and in closing-in (P < .001). The total score showed the highest classification accuracy (.90, 95%CI = .81-0.96) in differentiating patients with Alzheimer's disease from patients with vascular dementia. The optimal threshold value was k = 5. with .84 (95%CI = .69-0.93) sensitivity and .81 (95%CI = .64-0.93) specificity.

CONCLUSION

Patients with vascular dementia showed more accuracy errors and graphic difficulties than patients with Alzheimer's disease. Qualitative analysis of copy provided a sensitive measure of visual constructive abilities in differentiating dementias, underlining a particularly vulnerability of visuoconstructive functions in vascular dementia compared with Alzheimer's disease.

摘要

背景

血管性痴呆和阿尔茨海默病是最常见的痴呆形式。有时，由于症状学、病理生理学和合并症方面的重叠，它们难以区分。视觉构建性失用症在痴呆中非常常见，这些能力的损害可为鉴别诊断提供临床信息。

材料与方法

所有患者在基线访视时（T0）和1年后（T1）均接受简易精神状态检查表（MMSE）检查。我们分析了五边形临摹测试定性评分方法的差异，并探讨了这两种类型痴呆中视觉构建性失用症的演变。

结果

在组内分析中，我们发现每组在T0和T1之间的MMSE评分（P <.001）和总定性评分（P <.001）存在显著差异。在组间分析中，在T0时，我们发现总定性评分（P <.001）、角度数量（P =.005）、距离/交叉点（P <.001）、闭合/开口（P =.01）、旋转（P <.001）和向内闭合（P <.001）存在显著差异。在T1时，我们发现总定性评分（P <.001）存在显著差异，特别是在角度数量（P <.001）、距离/交叉点（P <.001）、闭合/开口（P <.001）、旋转（P <.001）和向内闭合（P <.001）方面。总分在区分阿尔茨海默病患者和血管性痴呆患者方面显示出最高的分类准确率（.90，95%CI =.81 - 0.96）。最佳阈值为k = 5，敏感性为.84（95%CI =.69 - 0.93），特异性为.81（95%CI =.64 - 0.93）。