复杂汉字评估认知功能的初步探究

doi:10.16138/j.1673-6087.2021.05.010

摘要/Abstract

摘要：

目的：探索繁体字“biang”作为简易认知评估工具的可行性。方法：按照Rey-Osterrieth复杂图形测验（Rey-Osterrieth complex figure test, ROCF）评分标准,制定出总分28分的复杂汉字（complex Chinese character, CCC）评分系统。研究对象随机选取门诊年龄≥50岁患者,通过小样本研究初步评估CCC量表与ROCF、画钟测验（clock drawing test,CDT）、搜钟测验（bells test）,语言记忆评估（auditory verbal learning test,AVLT）量表、语言情景记忆评估（free and cued selective reminding test,FCSRT）量表,注意力及工作记忆相关量表数词广度试验（digital span test,DST）顺序、倒序的相关性。并通过组内相关系数（intraclass correlation coefficient,ICC）评估重测信度。从社区流调队列中纳入年龄≥50岁患者,通过探索性因子分析评估与其他单认知域量表[控制连线测验A 和B（trail making test A&B,TMT A&B）、词表（word list）、语言流利性]的相关性。并通过回归模型在矫正年龄、性别、文化程度的基础上,计算CCC量表的结构效度。结果：在门诊小样本（22例）研究中,CCC得分与语言性记忆更相关,CCC延迟20 min得分与FCSRT线索回忆指数相关性最高,Spearman相关系数为0.634（P=0.002）。通过ICC法（12例）,跨度6个月的临摹得分ICC为0.657,延迟回忆得分ICC为0.502,一致性较好。在大样本人群研究（583名）中, 发现CCC评分系统的临摹得分、延迟5 min得分、延迟20 min得分3个指标中,延迟20 min得分在语言性记忆因子中负荷最大。在矫正性别、年龄、文化程度后,20.6%的延迟20 min得分的方差能被13.3%语言性记忆存储功能（词表延迟回忆得分）和7.3%的语言性记忆检索功能（词表再认得分）所解释。招募轻度认知功能损害（mild cognitive impairment, MCI）患者42例,对照组40名,进行CCC量表测试,发现延迟20 min得分诊断MCI的灵敏度为67%,特异度为53%。结论：CCC量表具有较好的效度。CCC量表主要与语言性记忆有关,其中构成延迟20 min得分的认知域包括语言性记忆。

关键词: 复杂汉字, 语言性记忆, 认知筛查工具

Abstract:

Objective To explore the feasibility of complex Chinese Character (CCC) “biang” as a simple cognitive assessment tool. Methods According to the Rey-Osterrieth complex figure test (ROCF) scoring system, CCC scoring system with a total score of 28 points was developed. Randomized outpatients (≥50 years old) were enrolled. The correlation between CCC and other neuropsychological test, namely ROCF, clock drawing test (CDT), bells test, auditory verbal learning test (AVLT), free and cued selective reminding test (FCSRT), digital span test (forward and backward), was preliminarily assessed by small sample study. Intra-class correlation coefficients(ICC) method was applied to assess retest reliability of CCC. The elderly(≥50 years old) patients were randomly enrolled in the community epidemiological investigation cohort, and CCC and other cognitive scales (trail making test A&B, word list, semantic verbal fluency) were evaluated. The exploratory factor analysis(EFA) and multiple regression analysis were used to evaluate the construct validity of CCC. Results In a small sample of 22 outpatients, CCC score was more correlated with verbal memory, CCC delay 20 min score had the highest correlation with index of sensitivity of cueing, and Spearman correlation coefficient was 0.634(P=0.002). By ICC method(n=12), the correlation coefficient of copying score of 6 months in ICC group was 0.657, and the correlation coefficient of delayed recall score in ICC group was 0.502, showing good consistency. In the large sample cohort population study (n=583), exploratory factor analysis showed that among five indicators of CCC scoring system (copy score, delay 5 min score, delay 20 min score, delay 5 min retention score, delay 20 min retention score), delay 20 min score was the most loaded in verbal memory factor. After adjusting for gender, age and education, the variance of 20.6% delayed 20 min score could be explained by 13.3% verbal memory storage (word list delayed recall score) and 7.3% verbal memory retrieval (word list recognition score). A total of 42 mild cognitive impairment (MCI) patients and 40 controls were recruited for the CCC scale test, and it showed that the sensitivity of the CCC scale to diagnose MCI was 67% and the specificity was 53%. Conclusions CCC scale has good reliability and validity. CCC test is mainly related to verbal memory, and the delay 20 min score consists of verbal memory.

Key words: Complex Chinese character test, Verbal memory, Cognitive screening tool

中图分类号:

R741.04

周蓉, 罗琪, 陈捷, 王佩, 马建芳. 复杂汉字评估认知功能的初步探究[J]. 内科理论与实践, 2021, 16(05): 337-343.

ZHOU Rong, LUO Qi, CHEN Jie, WANG Pei, MA Jianfang. A preliminary study on evaluation of cognitive functions using complex Chinese characters[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(05): 337-343.

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参考文献 17

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项目	临摹得分	延迟回忆20 min得分
1.走之底（2分）	0 1 2	0 1 2
2.宝盖头（2分）	0 1 2	0 1 2
3.月（2分）	0 1 2	0 1 2
4.镰刀（2分）	0 1 2	0 1 2
5.言（2分）	0 1 2	0 1 2
6.幺（左）（2分）	0 1 2	0 1 2
7.幺（右）（2分）	0 1 2	0 1 2
8.馬（4分）	0 1 2 3 4	0 1 2 3 4
9.長（左）（4分）	0 1 2 3 4	0 1 2 3 4
10.長（右）（4分）	0 1 2 3 4	0 1 2 3 4
11.心（2分）	0 1 2	0 1 2
总分
计时

其他认知阈量表	临摹得分		延迟20 min得分
其他认知阈量表	r	P	r	P
视空间能力
ROCF临摹得分	0.126	0.575	0.058	0.798
ROCF延迟20 min得分	0.165	0.463	0.102	0.652
CDT（5分法）	0.083	0.712	0.020	0.930
搜钟测验	0.467	0.028	0.015	0.948
语言性记忆
AVLT延迟5 min	0.402	0.063	0.454	0.034
AVLT延迟20 min	0.364	0.096	0.444	0.038
AVLT再认	0.306	0.166	0.123	0.586
FCSRT总自由回忆数	0.170	0.450	0.496	0.019
FCSRT总回忆数	0.107	0.635	0.608	0.003
线索回忆灵敏度指数	0.072	0.751	0.631	0.002
注意力、工作记忆
DST顺序	0.477	0.025	-0.264	0.236
DST倒序	0.305	0.168	-0.088	0.698

因子	临摹			延迟5 min			延迟20 min
因子	1	2	3	1	2	3	1	2	3
临摹	0.615	0.428	-0.135	-	-	-	-	-	-
延迟5 min	-	-	-	0.750	0.141	0.019	-	-	-
延迟20 min	-	-	-	-	-	-	0.762	0.108	-0.009
词表延迟5 min	0.683	-0.159	0.063	0.757	-0.056	0.006	0.764	-0.045	0.016
词表再认	0.653	-0.128	0.053	0.716	-0.017	-0.021	0.740	0.006	-0.010
语言流利性	0.658	-0.049	0.003	0.514	-0.134	-0.030	0.492	-0.145	-0.017
TMT-A	-0.099	0.904	-0.263	-0.015	0.961	-0.345	-0.015	0.961	-0.341
TMT-B	-0.039	0.761	0.504	0.009	0.824	0.435	0.007	0.823	0.439
TMT-B/A	0.031	-0.101	0.989	-0.011	-0.087	0.998	-0.010	-0.085	0.998
KMO	0.376			0.411			0.421
Barlett球形检验	0.000			0.000			0.000
可解释方差比例（%)	32.176	18.292	16.768	34.478	18.702	16.409	35.091	18.579	16.441

相关量表	临摹				延迟5 min				延迟20 min
相关量表	标准化系数β	t	P	可被变量解释的方差	标准化系数β	t	P	可被变量解释的方差	标准化系数β	t	P	可被变量解释的方差
词表延迟回忆个数	0.088	1.892	0.059	0.011	0.291	6.760	0.000	0.110	0.306	7.257	0.000	0.126
再认	0.023	0.498	0.619	0.002	0.157	3.706	0.000	0.057	0.199	4.805	0.000	0.069
1 min动物名字	0.141	3.204	0.001	0.023	0.047	1.164	0.245	0.009	0.026	0.649	0.517	0.005
TMT-A耗时	0.000	-0.001	0.999	0.000	-0.144	-1.692	0.091	0.024	-0.129	-1.550	0.122	0.024
TMT-B耗时	0.061	0.626	0.531	-0.002	0.119	1.313	0.190	-0.015	0.078	0.887	0.375	-0.013
TMT-B/A	-0.079	-1.017	0.309	0.005	-0.09	-1.245	0.214	0.001	-0.087	-1.231	0.219	0.003

项目	标准化系数β	t	P
临摹年龄	-0.095	-2.290	0.022
延迟5 min 性别	0.097	2.337	0.020
延迟20 min 年龄	-0.122	-2.921	0.004
文化程度	0.122	2.920	0.004
性别	0.086	2.018	0.044