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[用于诊断痴呆的简易神经心理学测试]

[Neuropsychological tests of simple application for diagnosing dementia].

作者信息

Nitrini R, Lefèvre B H, Mathias S C, Caramelli P, Carrilho P E, Sauaia N, Massad E, Takiguti C, Da Silva I O, Porto C S

机构信息

Departamentos de Neurologia, Faculdade de Medicina da Universidade de São Paulo, Brasil.

出版信息

Arq Neuropsiquiatr. 1994 Dec;52(4):457-65. doi: 10.1590/s0004-282x1994000400001.

Abstract

Thirty patients with dementia defined by DSM-III-R criteria (Alzheimer's disease (22), vascular dementia (3), Parkinson's disease, frontal lobe dementia, possible diffuse Lewy body dementia, normal pressure hydrocephalus and uncertain diagnosis), with scores below 24 points in the Mini-Mental Status Examination and more than 4 years of education were submitted to a neuropsychological evaluation. The scores in the neuropsychological tests were compared to those obtained by thirty normal volunteers paired for age, sex and education. Sensitivity, specificity and accuracy of the tests in the distinction of demented and normal volunteers were determined. The accuracies were calculated using ROC curves. Blessed's information-memory-concentration test showed greatest accuracy, followed by copy of simple figures, delayed memory of 10 figures (after 5 minutes), recognition of 10 figures and verbal fluency test (animals). A linear discriminant function, composed by 6 tests: visual perception, incidental memory, delayed memory (after 5 minutes), drawing of a clock, verbal fluency (animals) and calculation tests, was able to discriminate all controls from patients and only one patient was wrongly classified as normal control. These tests were chosen because they can be applied in less than 10 minutes and are very easy to interpret. This discriminant function must be applied in another group of patients and controls in order to demonstrate its value. When associated to the MMSE it may be useful to discriminate patients with dementia from normal people in epidemiological studies.

摘要

30名符合DSM-III-R标准的痴呆患者(阿尔茨海默病22例、血管性痴呆3例、帕金森病、额叶痴呆、可能的弥漫性路易体痴呆、正常压力脑积水以及诊断不明确),简易精神状态检查表得分低于24分且接受过4年以上教育,接受了神经心理学评估。将神经心理学测试的得分与30名年龄、性别和教育程度相匹配的正常志愿者的得分进行比较。确定了这些测试在区分痴呆患者和正常志愿者方面的敏感性、特异性和准确性。使用ROC曲线计算准确性。Blessed信息-记忆-注意力测试显示出最高的准确性,其次是简单图形临摹、10个图形的延迟记忆(5分钟后)、10个图形的识别以及言语流畅性测试(动物)。由6项测试组成的线性判别函数:视觉感知、偶发记忆、延迟记忆(5分钟后)、画钟、言语流畅性(动物)和计算测试,能够区分所有对照组和患者,只有1名患者被错误地归类为正常对照。选择这些测试是因为它们可以在不到10分钟内完成且非常易于解读。该判别函数必须应用于另一组患者和对照组以证明其价值。在流行病学研究中,当与简易精神状态检查表相结合时,它可能有助于区分痴呆患者和正常人。

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