Tan Yuyan, Liu Weiguo, Du Juanjuan, Hou Miaomiao, Yu Cuiyu, Liu Yang, Cui Shishuang, Yan Lei, Lu Yizhou, Lv Hong, Han Lijun, Wang Xi, Zha Shengyu, Luo Xiaoguang, Tang Huidong, Chen Shengdi
Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Department of Neurology, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
Parkinsons Dis. 2020 Feb 19;2020:5289136. doi: 10.1155/2020/5289136. eCollection 2020.
There is a high prevalence of mild cognitive impairment (MCI) and dementia in Parkinson's disease (PD) patients, but a Chinese version of cognitive rating scale that is specific and sensitive to PD patients is still lacking. The aims of this study are to test the reliability and validity of a Chinese version of Parkinson's disease-cognitive rating scale (PD-CRS), establish cutoff scores for diagnosis of Parkinson's disease dementia (PDD) and PD with mild cognitive impairment (PD-MCI), explore cognitive profiles of PD-MCI and PDD, and find cognitive deficits suggesting a transition from PD-MCI to PDD. PD-CRS was revised based on the culture background of Chinese people. Ninety-two PD patients were recruited in three PD centers and were classified into PD with normal cognitive function (PD-NC), PD-MCI, and PDD subgroups according to the cognitive rating scale (CDR). Those PD patients underwent PD-CRS blind assessment by a separate neurologist. The PD-CRS showed a high internal consistency (Cronbach's Alpha = 0.840). Intraclass Correlation coefficient (ICC) of test-retest reliability reached 0.906 (95% CI 0.860-0.935, < 0.001). ICC of inter-rater reliability was 0.899 (95% CI 0.848-0.933, < 0.001). PD-CRS had fair concurrent validity with MDRS (ICC = 0.731, 95% CI 0.602-0.816). All the frontal-subcortical items showed significant decrease in PD-MCI compared with the PD-NC group ( ≤ 0.001), but the instrument cortical items did not (confrontation naming =0.717, copying a clock =0.620). All the frontal-subcortical and instrumental-cortical functions showed significant decline in PDD compared with the PD-NC group ( ≤ 0.001). The cutoff value for diagnosis of PD-MCI is 80.5 with the sensitivity of 75.7% and the specificity of 75.0%, and for diagnosis of PDD is 73.5 with the sensitivity of 89.2% and the specificity of 98.9%. Revised Chinese version of PD-CRS is a reliable, acceptable, valid, and useful neuropsychological battery for assessing cognition in PD patients.
帕金森病（PD）患者中轻度认知障碍（MCI）和痴呆的患病率较高，但仍缺乏一种针对PD患者的特异性和敏感性较高的中文版认知评定量表。本研究的目的是检验中文版帕金森病认知评定量表（PD-CRS）的信度和效度，确定帕金森病痴呆（PDD）和轻度认知障碍帕金森病（PD-MCI）的诊断界值，探索PD-MCI和PDD的认知特征，并找出提示从PD-MCI向PDD转变的认知缺陷。PD-CRS是根据中国人的文化背景修订的。在三个PD中心招募了92例PD患者，并根据认知评定量表（CDR）将其分为认知功能正常的PD（PD-NC）、PD-MCI和PDD亚组。这些PD患者由另一位神经科医生进行PD-CRS盲法评估。PD-CRS显示出较高的内部一致性（Cronbach's Alpha = 0.840）。重测信度的组内相关系数（ICC）达到0.906（95%CI 0.860-0.935，<0.001）。评分者间信度的ICC为0.899（95%CI 0.848-0.933，<0.001）。PD-CRS与MDRS具有较好的并行效度（ICC = 0.731，95%CI 0.602-0.816）。与PD-NC组相比，PD-MCI组所有额叶-皮质下项目均显著下降（≤0.001），但工具性皮质项目未下降（对物命名=0.717，画钟试验=0.620）。与PD-NC组相比，PDD组所有额叶-皮质下和工具性皮质功能均显著下降（≤0.001）。PD-MCI的诊断界值为80.5，敏感性为75.7%，特异性为75.0%；PDD的诊断界值为73.5，敏感性为89.2%，特异性为98.9%。修订后的中文版PD-CRS是一种可靠、可接受、有效且有用的神经心理测验工具，用于评估PD患者的认知功能。
