本文關(guān)鍵詞： 阿爾茨海默病 精神行為癥狀 標(biāo)準(zhǔn)化復(fù)制五邊形測(cè)試 認(rèn)知功能障礙　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)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(yán)重威脅著其的身心健康。AD的主要癥狀有記憶力下降、語(yǔ)言、執(zhí)行能力等障礙。在AD患者中,認(rèn)知功能障礙的研究已逐漸完善,而行為和精神癥狀在很長(zhǎng)一段時(shí)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(rèn)為其行為和精神癥狀能夠加快AD的認(rèn)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(duì)其進(jìn)行臨床管理的一個(gè)重要環(huán)節(jié)。因此,早期識(shí)別AD患者的精神異常傾向,及時(shí)對(duì)其進(jìn)行規(guī)范的干預(yù),對(duì)于減緩疾病進(jìn)展的速度有重要意義。然而目前對(duì)精神障礙的檢測(cè)量表均較復(fù)雜,耗時(shí)久,實(shí)施不便捷。常出現(xiàn)在簡(jiǎn)易精神狀態(tài)檢查(Minimum Mental State Examination,MMSE)及本德格式塔測(cè)驗(yàn)(Bender-Gestalt Test,BGT)等量表中的復(fù)制五邊形試驗(yàn)?zāi)軌驒z測(cè)患者的視覺-運(yùn)動(dòng)能力及認(rèn)知能力,但各量表對(duì)其應(yīng)用及得分計(jì)算較為簡(jiǎn)陋和粗糙,有研究者將其標(biāo)準(zhǔn)化后應(yīng)用在對(duì)精神分裂癥患者的檢測(cè)中,且其靈敏性及效度均較高,最為重要的是其檢測(cè)方便,耗時(shí)短。最近的研究顯示,老年群體的認(rèn)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(biāo)準(zhǔn)化復(fù)制五邊形測(cè)試(Standardised Copy of Pentagons Test,SCPT)對(duì)正常老年人、無(wú)精神行為癥狀的AD患者及有精神行為癥狀的AD患者進(jìn)行區(qū)分評(píng)價(jià)及效度檢測(cè),期望能夠通過該量表快捷有效的對(duì)AD病人的精神障礙進(jìn)行早期的識(shí)別,并給予及時(shí)的干預(yù),改善患者的生存質(zhì)量。研究方法:收集山東大學(xué)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(wú)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(jiǎn)易精神狀態(tài)檢查表(MMSE)及蒙特利爾認(rèn)知評(píng)估量表(MoCA)評(píng)價(jià)患者認(rèn)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(píng)價(jià)患者抑郁、焦慮等行為和精神障礙的嚴(yán)重程度,采用標(biāo)準(zhǔn)化復(fù)制五邊形測(cè)試(SCPT)對(duì)AD患者精神行為癥狀進(jìn)行區(qū)分和評(píng)價(jià)。運(yùn)用SPSS 19.0統(tǒng)計(jì)分析軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)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(wú)明顯差異,具有精神行為癥狀的AD病人簡(jiǎn)明精神狀況評(píng)價(jià)表(MMSE)及蒙特利爾認(rèn)知評(píng)價(jià)量表(MoCA)評(píng)分明顯低于無(wú)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(píng)分明顯高于無(wú)精神行為癥狀的AD病人,差異具有統(tǒng)計(jì)學(xué)意義。對(duì)三組間SCPT各條目及總分進(jìn)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(jì)學(xué)意義,其他條目無(wú)明顯差異,可信度Cronbach's a為0.701。對(duì)標(biāo)準(zhǔn)化復(fù)制五邊形測(cè)試(SCPT)進(jìn)行多因素分析提取出5個(gè)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(biāo)準(zhǔn)化復(fù)制五邊形測(cè)試(SCPT)量表進(jìn)行判別分析,對(duì)三組患者進(jìn)行類別判分,結(jié)果發(fā)現(xiàn),109例為正確判斷(79.56%);錯(cuò)分為正常組的有12例(8.76%);錯(cuò)分為無(wú)精神行為癥狀組的有11例(8.03%);錯(cuò)分為精神行為癥狀組的有5例(3.65%)。研究結(jié)論:標(biāo)準(zhǔn)化復(fù)制五邊形測(cè)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(shí)別其精神行為癥狀并給予及時(shí)干預(yù),該測(cè)試方法具有易實(shí)施,耗時(shí)少,管理方便的優(yōu)點(diǎn)。
[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(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.16

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