Complex activities of daily living in mild cognitive impairment: conceptual and diagnostic issues
Complex activities of daily living in mild cognitive impairment: conceptual and diagnostic issues
复制标题
DOI：
10.1093/ageing/afj054
复制
发表时间：
2006-05-01
期刊：
影响因子：
6.7
通讯作者：
Kurz, A
中科院分区：
文献类型：
--
作者：
Perneczky, R;Pohl, C;Kurz, A
背景：认知障碍对日常生活能力(ADL)的影响被用作区分轻度认知障碍(MCI)和痴呆的主要标准。然而，区分MCI和痴呆症的ADL阈值的概念似乎不太可能，原因有几个。目的：确定MCI患者复杂的ADL是否受损；检查ADL损害评估对MCI诊断的有用性；目的：采用横断面研究。地点：大学门诊。研究对象：45例符合研究诊断标准的老年MCI患者和30例年龄匹配的认知正常对照。方法：临床评估-阿尔茨海默病评定量表、认知功能评定量表(ADAS-COG)用于评估认知功能，阿尔茨海默病合作研究量表(ADCS-MCI-ADL)用于评估复杂ADL的损害。统计学评估--Mann-Whitney U检验认知和日常功能测量的显著差异。日常生活能力与认知能力之间关联的非参数相关。受试者操作员曲线(ROC)分析，以确定ADCS-MCI-ADL和ADAS-COG量表上的最佳界值，以区分MCI患者和对照组。结果：患者ADAS-COG评分显著高于对照组，ADCS-MCI-ADL评分显著低于对照组。MCI患者上述各量表评分均呈显著负相关(r=-0.46，P<；0.01)。ADCS-MCI-ADL：最佳临界值52分，灵敏度0.89，特异度0.97；ADAS-COG：最佳临界值10分，灵敏度0.78，特异度1.0。对于Logistic回归中的线性预测因素，两种工具都是诊断金标准的强预测因素(ADCS-MCI-ADL：P=0.002；ADAS-COG：P=0.041)。结论：MCI患者已存在日常生活能力障碍。因此，完整的ADL不能作为定义MCI证候的标准，也不能作为区分轻度痴呆的标准。综合ADL的评估可能有助于MCI的诊断。
Background: the impact of cognitive impairment on activities of daily living (ADL) is being used as a major criterion for differentiating between mild cognitive impairment (MCI) and dementia. The concept of an ADL threshold that separates MCI from dementia, however, appears to be improbable for several reasons.Objectives: to determine whether complex ADL are impaired in patients with MCI; to examine the usefulness of the assessment of ADL impairment for the diagnosis of MCI; to explore whether both cognitive testing and assessment of impaired ADL are significant predictors of the diagnosis according to the diagnostic gold standard of MCI.Design: cross-sectional study.Setting: university-based outpatient clinic.Subjects: a total of 45 elderly MCI patients diagnosed according to research diagnostic criteria and 30 age-matched cognitively unimpaired controls.Methods: clinical assessment - Alzheimer's disease Assessment scale, cognitive subscale (ADAS-cog) for the assessment of cognitive functions, Alzheimer's disease Cooperative Study scale for ADL in MCI (ADCS-MCI-ADL) for the assessment of impairments of complex ADL. Statistical evaluation - Mann-Whitney U tests for significant differences on measures of cognition and everyday functioning. Non-parametric correlations for associations between ADL and cognitive ability. Receiver operator curve (ROC) analyses to identify optimal cut-off scores on the ADCS-MCI-ADL and ADAS-cog scales to differentiate between MCI patients and controls. Binary logistic regression analyses to predict the diagnosis of MCI on the basis of the above-mentioned instruments.Results: patients scored significantly higher than controls on the ADAS-cog scale and significantly lower on the ADCS-MCI-ADL scale. There was a significant negative correlation of the above-mentioned scales in MCI patients (r = -0.46, P < 0.01). Both instruments discriminated well between patients and controls (ADCS-MCI-ADL: optimal cut-off 52 points, sensitivity 0.89, specificity 0.97; ADAS-cog: optimal cut-off 10 points, sensitivity 0.78, specificity 1.0). With regard to the linear predictor in the logistic regression built, both instruments were strong predictors of the diagnosis according to the diagnostic gold standard (ADCS-MCI-ADL: P = 0.002; ADAS-cog: P = 0.041).Conclusion: impairment of ADL is already present in MCI. Therefore, intact ADL cannot be used as a criterion to define the syndrome of MCI and to distinguish it from mild dementia. The assessment of complex ADL is probably useful for the diagnosis of MCI.