Visual association test to detect early dementia of the Alzheimer type
Visual association test to detect early dementia of the Alzheimer type
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DOI：
10.1136/jnnp.73.2.126
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发表时间：
2002-08-01
影响因子：
11
通讯作者：
Jonker, C
中科院分区：
文献类型：
--
作者：
Lindeboom, J;Schmand, B;Jonker, C
背景：视觉关联测试（VAT）是一项基于图像助记符的简短学习任务。测试材料由六对相互作用的物体或动物的线条图组成，例如，一只拿着雨伞的猿。要求受试者说出每个物体的名称，然后向受试者展示一对物体中的一个，并要求说出另一个物体的名称。 目的：验证该任务是否会引发稳健的偶然或轻松学习（研究 1），并研究该测试作为阿尔茨海默型早期痴呆 (DAT) 和非痴呆患者（研究 2）以及非 DAT 类型痴呆（研究 3）的鉴别器的效率。方法： 研究 1：两组老年志愿者被征收增值税。刺激以交互方式呈现给 A 组，例如一只撑着雨伞的猴子 (n=83)，并排呈现给 B 组，例如单独的猴子和单独的雨伞的单独图片 (n=79)。 B 组接受了学习指导，但 A 组没有。研究2：从基于人群的随访研究中选择了三组受试者：发生DAT病例（n = 24）、未诊断为痴呆的认知能力下降受试者（n = 21）和稳定的非痴呆受试者（n = 204）。将非痴呆组基线时的测试表现与诊断时患有 DAT 的患者、诊断前一年患有 DAT 的患者以及非痴呆衰退受试者基线时的测试表现进行比较。研究3：受试者是因疑似痴呆而转诊进行神经心理学评估的患者。他们是根据各种痴呆综合症的共识标准进行诊断的。 结果：研究1：A组的回忆能力是B组的两倍多。因此，即使在没有学习指导的情况下，交互式演示也能增强学习效果。研究 2：在 97.5% 的特异性水平下，VAT 对诊断时的 DAT 病例的敏感性为 87.5%，诊断前一年的敏感性为 66.7%。认知能力下降的组在基线时的增值税得分显着低于非痴呆组。 VAT 的区分效果比 MMSE 和 CAMCOG 的六项图片学习任务更有效。研究3：DAT患者（n=48）的VAT评分显着低于血管性痴呆患者（n=37）、额颞叶痴呆（n=9）或皮质下痴呆（n=15）患者，但不低于路易体痴呆患者（n=7）。这些组的平均简易精神状态检查分数没有显着差异。 VAT 比散文回忆测试更有效地将 DAT 患者与其他类型痴呆症患者区分开来。敏感性为 79%，特异性为 69%。结论：VAT 在诊断前一年以高特异性检测出相当大比例的 DAT 患者，而低 VAT 评分在非 DAT 痴呆患者中相对罕见。
Background: The visual association test (VAT) is a brief learning task based on imagery mnemonics. The test materials consist of six line drawings of pairs of interacting objects or animals-for example, an ape holding an umbrella. The person is asked to name each object and, later, is presented with one object from the pair and asked to name the other.Objective: To verify that the task induces robust incidental or effortless learning (study 1), and to study the efficiency of the test as a discriminator between early dementia of the Alzheimer type (DAT) and non-demented people (study 2) and non-DAT types of dementia (study 3).Methods: Study 1: two groups of elderly volunteers were administered the VAT. The stimuli were presented in the interactive fashion to group A-for example, a monkey carrying an umbrella (n=83)-and side by side to group B-for example, separate pictures of a monkey alone and an umbrella alone (n=79). Group B received learning instructions, but group A did not. Study 2: three groups of subjects were selected from a population based follow up study: incident DAT cases (n=24), cognitively declining subjects not diagnosed with dementia (n=21), and stable non-demented subjects (n=204). Test performance of the non-demented group at baseline was compared with that of patients with DAT at the time of their diagnosis, of patients with DAT a year before their diagnosis, and of non-demented declining subjects at baseline. Study 3: subjects were patients referred for neuropsychological assessment because of suspected dementia. They were diagnosed by consensus criteria of various dementia syndromes.Results: Study 1 : recall was more than twice as high in group A as in group B. Thus interactive presentation, even in the absence of learning instructions, enhances learning. Study 2: at a level of 97.5% specificity, the VAT had a sensitivity of 87.5% for DAT cases at the time of diagnosis and 66.7% one year before diagnosis. The cognitively declining group scored significantly lower on the VAT at baseline than the non-demented group. The VAT discriminated more effectively than both the MMSE and the six item picture learning task from the CAMCOG. Study 3: VAT scores were significantly lower in patients with DAT (n=48) than in patients with vascular dementia (n=37), frontotemporal dementia (n=9), or subcortical dementia (n=15), but not lower than in patients with Lewy body dementia (n=7). Mean mini mental state examination scores of these groups were not significantly different. The VAT discriminated patients with DAT from patients with other types of dementia more effectively than a prose recall test. Sensitivity was 79% and specificity 69%.Conclusions: The VAT detects with high specificity a sizeable proportion of patients with DAT a year before the diagnosis, and a low VAT score is relatively uncommon in patients with non-DAT dementia.