华山版听觉词语学习测验在主观认知下降和轻度认知障碍患者中的应用初探

关键词：华山版听觉词语学习测验  主观认知下降  轻度认知障碍

Keywords:auditory verbal learning test-Huashan version  subjective cognitive decline  mild cognitive impairment

摘要：

      摘要 目的：探索华山版听觉词语记忆测验（auditory verbal learning test-Huashan version，AVLT-H）在主观认知下降（subjective cognitive decline， SCD）和轻度认知障碍（mild cognitive impairment，MCI）患者记忆功能障碍中的应用价值。 方法：筛查招募的老年人，根据入组标准分为三组，即正常组、SCD组和MCI组，并完成神经心理学测试简易智能精神状态检查（mini-mental status examination，MMSE）、北京版蒙特利尔认知评估量表（Montreal Cognitive Assessment-Beijing version，MoCA-BJ）及AVLT-H，从而获得MMSE、MOCA、AVLT-H的即刻回忆N1、N2、N3、延迟回忆N4、N5、线索回忆N6及再认N7得分； 结果：①三组老年人的神经心理学测试发现MMSE、MoCA及AVLT各项评分均存在显著性差异（P<0.0167）。采用Bonferroni法校正显著性水平的事后两两比较发现，MMSE和MoCA评分在SCD与NC之间（P<0.001）、MCI与NC之间（P<0.001）均有显著性差异，在MCI与SCD之间无显著性差异；N1评分在MCI与NC之间（P=0.013）、MCI与SCD之间（P=0.001）均有显著性差异，在SCD与NC之间无显著性差异；N2、N3、N4、N5、N6及N7评分在MCI与NC之间（P<0.001）、MCI与SCD之间（P<0.001）均有显著性差异，在SCD与NC之间无显著性差异。②分别以NC组和SCD组为状态变量对MMSE、MoCA和AVLT-H得分进行曲线下面积检测，发现对于区分MCI和SCD，AVLT-H各项得分具有较大的曲线下面积，且敏感度和特异度较高，N1和N7的敏感度最高；对于区分MCI和NC，AVLT-H和MoCA得分具有较大的曲线下面积，且敏感度和特异度均较高，N4、N6和N7的敏感度最高。 结论：AVLT-H可完善MMSE、MoCA对于MCI和SCD的界定诊断，值得将AVLT-H作为MCI和SCD的常规评估方法，即联合使用AVLT-H、MMSE或MoCA可提高其诊断的准确性。

Abstract:

      Abstract Objective：To explore the diagnostic value of auditory verbal learning test-Huashan version （AVLT-H） of memory impairment in patients with subjective cognitive decline （SCD） and mild cognitive impairment （MCI）. Method：According to the inclusion criteria, the recruited elderly were screened and divided into three groups: normal cognition （NC）， SCD and MCI group. The neuropsychological tests including mini-mental state examination （MMSE）， Montreal cognitive assessment-Beijing version （MOCA-BJ） and AVLT-H were completed after inclusion. The scores of MMSE，MoCA-B，AVLT-N2，N3，N4，N5，N6 and N7 were recorded and analyzed. Result：There were significant differences in the scores of MMSE， MoCA and AVLT-H among the three groups（P<0.0167）. The adjusted Bonferroni test was used to detect significant differences in post-hoc comparison. There were significant difference in MMSE and MoCA scores between SCD and NC （P<0.001） and between MCI and NC（P<0.001）. However， no significant difference between MCI and SCD was found. There were significant difference in N1 score between MCI and NC （P=0.013） and between MCI and SCD （P=0.001）， but there was no significant difference between SCD and NC. There were significant difference in AVLT-N2， N3， N4， N5， N6 and N7 scores between MCI and NC （P<0.001） and between MCI and SCD （P<0.001）， but there was no significant difference between SCD and NC. The area under the curve of MMSE， MoCA and AVLT-H scores were examined using NC group and SCD group as state variables, respectively. For differentiating MCI and SCD, eAVLT-H scores had a larger area under the curve with higher sensitivity and specificity，N1 and N7 had the highest sensitivity. For distinguishing MCI from NC， AVLT-H and MoCA scores had a larger area under the curve with higher sensitivity and specificity， N4， N6 and N7 had the highest sensitivity. Conclusion：AVLT-H， combined with MMSE and MoCA， can improve the defining diagnostic sensitivity of MCI and SCD from normal cognition. It is recommended to routinely use AVLT-H in a routine assessment for MCI and SCD patients.