發(fā)布時間：2018-02-24 09:05

  本文關(guān)鍵詞： 阿爾茨海默病 精神行為癥狀 標準化復制五邊形測試 認知功能障礙　出處：《山東大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究目的:阿爾茨海默病(Alzheimer's disease AD)是在老年人群中較為常見的中樞神經(jīng)系統(tǒng)變性疾病,嚴重威脅著其的身心健康。AD的主要癥狀有記憶力下降、語言、執(zhí)行能力等障礙。在AD患者中,認知功能障礙的研究已逐漸完善,而行為和精神癥狀在很長一段時間內(nèi)都沒有引起臨床及研究領(lǐng)域的足夠重視�，F(xiàn)在的研究認為其行為和精神癥狀能夠加快AD的認知功能下降,并且造成AD病人及其照料者生存質(zhì)量的降低。改善AD病人的行為和精神癥狀,是對其進行臨床管理的一個重要環(huán)節(jié)。因此,早期識別AD患者的精神異常傾向,及時對其進行規(guī)范的干預,對于減緩疾病進展的速度有重要意義。然而目前對精神障礙的檢測量表均較復雜,耗時久,實施不便捷。常出現(xiàn)在簡易精神狀態(tài)檢查(Minimum Mental State Examination,MMSE)及本德格式塔測驗(Bender-Gestalt Test,BGT)等量表中的復制五邊形試驗能夠檢測患者的視覺-運動能力及認知能力,但各量表對其應用及得分計算較為簡陋和粗糙,有研究者將其標準化后應用在對精神分裂癥患者的檢測中,且其靈敏性及效度均較高,最為重要的是其檢測方便,耗時短。最近的研究顯示,老年群體的認知能力與一些精神障礙癥狀在一定程度上具有非常密切的相關(guān)性。因此,本研究通過標準化復制五邊形測試(Standardised Copy of Pentagons Test,SCPT)對正常老年人、無精神行為癥狀的AD患者及有精神行為癥狀的AD患者進行區(qū)分評價及效度檢測,期望能夠通過該量表快捷有效的對AD病人的精神障礙進行早期的識別,并給予及時的干預,改善患者的生存質(zhì)量。研究方法:收集山東大學齊魯醫(yī)院神經(jīng)內(nèi)科門診就診的89例AD患者(包括具有精神行為癥狀組58例,無精神行為癥狀組31例),以及同期就診或接受社區(qū)健康篩查的48名年齡、性別及受教育年限等匹配的正常受試者,采用簡易精神狀態(tài)檢查表(MMSE)及蒙特利爾認知評估量表(MoCA)評價患者認知情況、漢密爾頓抑郁量表(HAMD)、漢密爾頓焦慮量表(HAMA)及神經(jīng)精神問卷(NPI)評價患者抑郁、焦慮等行為和精神障礙的嚴重程度,采用標準化復制五邊形測試(SCPT)對AD患者精神行為癥狀進行區(qū)分和評價。運用SPSS 19.0統(tǒng)計分析軟件對數(shù)據(jù)進行統(tǒng)計學分析。研究結(jié)果:分析結(jié)果顯示,三組間年齡、受教育程度無明顯差異,具有精神行為癥狀的AD病人簡明精神狀況評價表(MMSE)及蒙特利爾認知評價量表(MoCA)評分明顯低于無精神行為癥狀的AD患者,且具有精神行為癥狀的AD病人其漢密爾頓抑郁量表(HAMD)、漢密爾頓焦慮量表(HAMA)及神經(jīng)精神問卷(NPI)評分明顯高于無精神行為癥狀的AD病人,差異具有統(tǒng)計學意義。對三組間SCPT各條目及總分進行組間比較,結(jié)果顯示條目SCPT1、2、3、6、7、14、15、16及SCPT總得分存在明顯差異,有統(tǒng)計學意義,其他條目無明顯差異,可信度Cronbach's a為0.701。對標準化復制五邊形測試(SCPT)進行多因素分析提取出5個分量表,分量表能提供的解析的變異分別為23.78%、14.78%、11.23%、8.02%、7.55%。用標準化復制五邊形測試(SCPT)量表進行判別分析,對三組患者進行類別判分,結(jié)果發(fā)現(xiàn),109例為正確判斷(79.56%);錯分為正常組的有12例(8.76%);錯分為無精神行為癥狀組的有11例(8.03%);錯分為精神行為癥狀組的有5例(3.65%)。研究結(jié)論:標準化復制五邊形測試(SCPT)量表能夠有效區(qū)分AD患者是否合并精神行為癥狀,可以較早識別其精神行為癥狀并給予及時干預,該測試方法具有易實施,耗時少,管理方便的優(yōu)點。
[Abstract]:Objective: Alzheimer's disease (Alzheimer's disease AD) is more common in the elderly population in the central nervous system degenerative disease, a serious threat to the health of the main symptoms of.AD have decreased memory, language, executive ability and other obstacles. In patients with AD, admitted research dysfunction has been gradually improved, and the behavior and spirit the symptoms for a long time have not attracted enough attention to clinical and research fields. Now the research that the behavioral and psychological symptoms can accelerate the cognitive function of AD decreased, and the cause of AD patients and their care quality of life decreased. The improvement of behavioral and psychological symptoms of AD patients, it is an important part in the clinical management of it. Therefore, early identification of AD patients with abnormal mental tendency, timely norms for its interventions, has important significance to slow down the rate of progression. However, The detection scale for mental disorders are complex, time-consuming, the implementation is not convenient. Often appear in the mini mental state examination (Minimum Mental State Examination, MMSE) and Bender Gestalt Test (Bender-Gestalt Test, BGT) copy the Pentagon scale in test can be detected in patients with visual motor and cognitive ability. But the scale of its application and calculation is simple and rough, researchers will be standardized and then applied in the detection of patients with schizophrenia, and its sensitivity and validity were higher, the most important is its convenient detection, short time. Recent studies show that the cognitive ability of the elderly and some of the symptoms of mental disorders have a very close correlation in some extent. Therefore, this study through a standard copy test (Standardised Copy of Pentagons Pentagon Test, SCPT) of the normal elderly, no spirit Behavioral symptoms in AD patients and AD patients with behavioral and psychological symptoms to distinguish between evaluation and validity, the scale is expected to pass on AD patients with mental disorders and quick effective early recognition and timely intervention, improve the quality of life of patients. Methods: 89 cases of AD patients from Qilu Hospital of Shandong University Department of neurology outpatients (including mental symptoms group of 58 patients without neuropsychiatric symptoms group 31 cases), and the corresponding treatment or acceptance of community health screening 48 age, gender and normal subjects, such as education, using the mini mental state examination (MMSE) and Montreal cognitive assessment scale (MoCA) in patients with cognitive evaluation, Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and neuropsychiatric inventory (NPI) evaluation of patients with depression, anxiety and other mental disorders and serious behavior The degree of using the standard copy Pentagon test (SCPT) to distinguish and evaluation of patients with behavioral and psychological symptoms of AD. Using SPSS 19 statistical analysis software for statistical analysis. Results: the analysis showed that the three groups had no significant difference in age, educational level, mental health evaluation table concise AD patients with behavioral and psychological symptoms the (MMSE) and Montreal cognitive assessment scale (MoCA) score was significantly lower than that without behavioral and psychological symptoms of AD patients with behavioral and psychological symptoms of AD patients with the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and neuropsychological questionnaire (NPI) score was significantly higher than that of non mental symptoms AD patients, the difference was statistically significant. For each item of the SCPT between the three groups and the total score were compared between the two groups. Results showed that SCPT1,2,3,6,7,14,15,16 and SCPT have separate entries in significant differences statistically Meaning, there were no differences in the other entries, Cronbach's a for 0.701. on the credibility of standard copy Pentagon test (SCPT) multi factor analysis extracted 5 subscales, variance component table analysis can provide were 23.78%, 14.78%, 11.23%, 8.02%, 7.55%. with standard copy Pentagon test (SCPT) scale discriminant analysis of category judgment, three groups of patients were found in 109 cases (79.56%); the wrong judgment were divided into normal group with 12 cases (8.76%); the wrong divided into behavioral and psychological symptoms of group 11 cases (8.03%); the wrong for behavioral and psychological symptoms of group 5 cases (3.65%). Conclusion: the standard copy Pentagon test (SCPT) scale can effectively distinguish whether AD patients with mental and behavioral symptoms, early recognition of the behavioral and psychological symptoms and give timely intervention, the method is easy to implement, less time consuming, easy management advantages.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.16

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