本文選題：阿爾茨海默病(AD) + 遺忘型輕度認知功能障礙(a-MCI)��； 參考：《西南醫(yī)科大學》2017年碩士論文

【摘要】：目的:阿爾茨海默病(AD)是以近記憶障礙為主,并伴有其他認知功能障礙的神經(jīng)系統(tǒng)退行性變性疾病,是老年癡呆中最常見的一種。輕度認知功能障礙(MCI)是指具有主觀或客觀的記憶或認知功能受損,未影響到日常生活能力,未達到癡呆診斷標準的一種臨床狀態(tài)。MCI多轉(zhuǎn)化為癡呆,其中以遺忘型MCI(a-MCI)與AD關(guān)系最為密切。早期識別MCI可以方便早期發(fā)現(xiàn)AD。近來研究表明中樞性聽理解障礙是早期認知功能下降的標志之一,可以用來監(jiān)測MCI到癡呆的進展。從臨床和基礎(chǔ)研究來看,AD和MCI的確會出現(xiàn)中樞性聽理解障礙。而既往的研究方法多通過言語和文字進行,非言語類的聲音如動物、音樂等則涉及較少。非言語類的聲音識別其實也是中樞聽理解內(nèi)容很重要的一部分。基于國外關(guān)于該方面的研究多通過對周圍環(huán)境聲音分類、命名,識別音樂旋律、節(jié)奏、判斷愉悅性等,即涉及非言語聲音的語義和音樂方面,故本研究中也設(shè)置了相關(guān)的測試項目。通過這些測試對AD與非言語聽理解之間進行探討,分析a-MCI,AD患者是否會出現(xiàn)非言語聽理解障礙,在各項測試中各階段的AD患者有什么不同的表現(xiàn)及各項測試對AD,甚至a-MCI有無鑒別診斷價值。方法:該研究為橫斷面性研究。1、從2016年1月至12月,選取在四川省人民醫(yī)院以記憶減退為主訴的患者,陪護人員和附近的小區(qū)居民作為研究對象。根據(jù)納入及排除標準分為正常組、a-MCI組、輕度AD組和中度AD組。2、參閱國內(nèi)外相關(guān)資料,制定中樞性非言語聽理解系列測試項目,包括根據(jù)聲音分類(簡稱聲音分類),對旋律情感的判斷(簡稱情感判斷),對旋律節(jié)奏的判斷(簡稱節(jié)奏判斷),根據(jù)聲音命名(簡稱聲音命名)四項,其中聲音分類和命名主要涉及非言語語義方面,情感和節(jié)奏判斷主要涉及音樂方面。3、受試者均行聲音分類、情感判斷、節(jié)奏判斷、聲音命名各項測試。4、采集并記錄好各組受試者年齡、性別、文化及各項測試的數(shù)據(jù)結(jié)果,通過spss20軟件進行統(tǒng)計學處理。結(jié)果:1、四組受試者在年齡、性別、文化上均無明顯統(tǒng)計學意義(p0.05),具有可比性,在mmse和moca組間差異分析中有統(tǒng)計學意義(p0.05)。2、mmse、moca得分分別與非言語聽理解系列測試總分、聲音分類、情感判斷、節(jié)奏判斷、聲音命名各項測試得分呈中等強度以上的正相關(guān)(rs0.4,p0.01),其中聲音命名和聲音分類與mmse、moca相關(guān)性較好,而節(jié)奏判斷、情感判斷居其次。3、在聲音分類、情感判斷、節(jié)奏判斷、聲音命名測試中,四組受試者得分均為正常組a-mci組輕度ad組中度ad組,組間差異具有統(tǒng)計學意義(p0.05)。兩兩對比后,a-mci與正常組在聲音命名上有統(tǒng)計學差異(p0.008);輕度ad較正常組、a-mci組除在情感判斷無差異外(p0.008),在聲音分類、節(jié)奏判斷、聲音命名上均有統(tǒng)計學差異(p0.008);中度ad較正常組、a-mci組在非言語聽理解系列測試中均有統(tǒng)計差異(p均0.008),而較輕度ad只在情感判斷、節(jié)奏判斷、聲音命名上有差異(p0.008)。4、在診斷價值上,聲音命名能較好的鑒別出a-mci和正常組(roc=0.851,p0.001),聲音分類、節(jié)奏判斷和聲音命名能較好鑒別出輕度ad和正常組,其中聲音分類、聲音命名診斷價值較好(roc=0.912,p0.001;roc=0.971,p0.001),節(jié)奏判斷居其次(roc=0.730,p=0.003)。在鑒別輕度ad和a-mci時,聲音分類和聲音命名也有較好的鑒別診斷價值(roc=0.836,p0.001;roc=0.858,p0.001),而節(jié)奏判斷診斷價值降低(roc=0.719,p=0.004)。情感判斷、節(jié)奏判斷、聲音命名可以用來觀察輕度ad到中度ad的進展,其中聲音命名大于節(jié)奏判斷、情感判斷(ROC=0.867,P0.001;ROC=0.796,P0.001;ROC=0.694,P=0.017),情感判斷價值較低。結(jié)論:1、AD甚至a-MCI可以出現(xiàn)非言語聽理解障礙,且隨著認知障礙程度加重而加重。2、AD在涉及非言語語義方面的聽理解能力較涉及音樂方面的聽理解能力衰退更為明顯。3、非言語聽理解系列測試可以用來協(xié)助診斷AD,甚至a-MCI,可以用來觀察AD的進展。其中涉及非言語語義方面的測試項目較涉及音樂方面的測試項目診斷價值更高,尤其是聲音命名。4、非言語聽理解測試能部分排除語言和文化差異干擾,尤其適用于有視力障礙的AD患者,具有較好的研究前景。
[Abstract]:Objective: Alzheimer's disease (AD) is a neurodegenerative disorder characterized by near memory impairment and other cognitive impairment. It is the most common type of Alzheimer's disease. Mild cognitive impairment (MCI) refers to a subjective or objective memory or cognitive function that does not affect daily living ability and does not reach dementia. A clinical state of the diagnostic criteria,.MCI, is mostly transformed into dementia, of which amnestic MCI (a-MCI) is most closely related to AD. Early identification of MCI can facilitate early detection of AD.. Recent studies show that central hearing impairment is one of the markers of early cognitive decline, which can be used to monitor the progression of MCI to dementia. Clinical and basic research As a result, AD and MCI do have central auditory comprehension disorders. Previous research methods are mostly carried out through speech and text, nonverbal sounds such as animals and music are less involved. Nonverbal sound recognition is also an important part of central listening comprehension. Environmental sound classification, naming, recognition of music melody, rhythm, and judging pleasure are related to the semantic and musical aspects of nonverbal sounds, so the relevant testing items are also set up in this study. Through these tests, the AD and nonverbal listening comprehension are explored to analyze whether patients with a-MCI and AD will have non-verbal Listening Comprehension Barriers, The different manifestations of AD patients at each stage and the value of differential diagnosis for AD and even a-MCI. Methods: the study was a cross-sectional study of.1, from January 2016 to December, selected patients with memory impairment in Sichuan Provincial People's Hospital, escorts and neighborhood residents as research objects. According to the inclusion and exclusion criteria, the normal group, the a-MCI group, the mild AD group and the moderate AD group.2, refer to the relevant information at home and abroad, and make a series of central non-verbal listening comprehension test items, including the judgment of the melody emotion according to the classification of sound (referred to as the sound classification), the melody rhythm judgment (short of rhythm judgment), and the root of the rhythm. According to the four items, the classification and naming of sound mainly involve the non verbal meaning. The judgment of emotion and rhythm mainly involves the.3 of the music. The subjects all perform the sound classification, emotional judgment, rhythm judgment, and sound naming test.4. The collection and recording of the age, sex, culture and various tests of the subjects are well collected and recorded. The results of the test were statistically processed by spss20 software. Results: 1, the four groups had no significant statistical significance (P0.05) in age, sex and culture (P0.05), and were statistically significant (P0.05).2, MMSE, MOCA scores and non-verbal listening comprehension test scores respectively, and sound classification in MMSE and MOCA groups. Emotional judgment, rhythm judgment, and sound naming test scores are positive correlation (rs0.4, P0.01), among which sound naming and sound classification have good correlation with MMSE and Moca, while rhythm judgment and emotional judgment are next to.3. In sound classification, emotion judgment, rhythm judgment, and sound naming test, the scores of four subjects are all positive. There was a significant difference between group a-MCI in group a-MCI and mild AD group (P0.05). After 22 contrast, there was a statistical difference between a-MCI and normal group (p0.008), while mild AD was more than normal group, a-MCI group had no difference in emotional judgment (p0.008), and there were statistical differences in sound classification, rhythm judgment and sound naming (p0.008). The moderate AD was compared with the normal group, and the a-MCI group had statistical differences in the nonverbal listening comprehension series (P 0.008), while the mild AD was only in emotional judgment, rhythm judgment, and voice naming difference (p0.008).4. In the diagnostic value, sound naming could identify a-MCI and normal group (roc=0.851, p0.001), sound classification, rhythm judgment and sound. Nomenclature can better identify mild AD and normal groups, among which sound classification, sound naming diagnostic value is better (roc=0.912, p0.001; roc=0.971, p0.001), rhythm judgment is second (roc=0.730, p=0.003). In the identification of mild AD and a-MCI, sound classification and sound naming also have better differential diagnostic value (roc=0.836, p0.001; roc=0.858, etc.), Rhythm judgment diagnostic value (roc=0.719, p=0.004). Emotional judgment, rhythm judgment, sound naming can be used to observe the progress of mild AD to moderate AD, in which the naming of sound is greater than rhythm judgment, emotional judgment (ROC=0.867, P0.001; ROC=0.796, P0.001; ROC=0.694, P=0.017), and the value of emotion judgment is low. Conclusion: 1, AD even a-MCI can appear. Nonverbal listening comprehension disorders, and with the aggravation of cognitive impairment, aggravated.2, AD is more.3 in the decline of auditory comprehension involving nonverbal semantics than in music, and non-verbal listening comprehension tests can be used to help diagnose AD and even a-MCI, which can be used to observe the progress of AD. The semantic testing projects are more valuable for the diagnosis of the music test projects, especially the sound naming.4. The nonverbal listening comprehension test can partly eliminate the interference of language and cultural differences, especially for the AD patients with visual impairment, which has a good research prospect.
【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.16

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