【摘要】：目的：1、初步制訂用于診斷老年期癡呆的PRO評價量表,為老年期癡呆的臨床診斷分級提供一種新的、實用性的手段。2、引入PRO理念為更為定量化評價中醫(yī)藥對于老年期癡呆的療效提供依據(jù)。 方法：結(jié)合癡呆的國際診斷標(biāo)準(zhǔn)收集符合納入標(biāo)準(zhǔn)的60例老年患者,根據(jù)國際公認(rèn)的MMSE、MoCA及CDR量表分為輕度認(rèn)知障礙組21例,輕度癡呆組24例,中、重度癡呆組15例,對其進行A、B卷的測評,并統(tǒng)計分析A、B卷的信度、效度、區(qū)分度及應(yīng)答率,驗證了老年期癡呆患者臨床診斷分級的PRO量表,并通過判別分析建立數(shù)學(xué)模型初步制訂出評價標(biāo)準(zhǔn)。 結(jié)果：本次研究共納入病例60例,其中男性25例,女性35例,平均年齡在72.05±8.05歲,共分為三組,其中輕度認(rèn)知障礙組21例,占35.0%；輕度癡呆組24例,占40.0%；中、重度癡呆組15例,占25.0%。 1、信度檢驗 以克朗巴赫a系數(shù)為指標(biāo),A卷為0.789,B卷為0.908,具有良好的內(nèi)部一致性信度。分半信度提示將A、B卷分別拆分成前后兩部分后,兩部分均具有很好的相關(guān)性,故可認(rèn)為A、B卷具有良好的分半信度。 2、效度檢驗 本次調(diào)研所使用的PRO評價量表(A、B卷)是經(jīng)過前期文獻調(diào)研、科學(xué)探討以及專家論證等工作而形成的,從編制過程看具有內(nèi)容效度。經(jīng)Spearman相關(guān)系數(shù)檢驗,PRO量表A、B卷得分與MMSE、MoCA及CDR得分具有較高的直線相關(guān)性,可認(rèn)為具有很好的標(biāo)準(zhǔn)關(guān)聯(lián)效度。采用因子分析法檢驗A、B卷的結(jié)構(gòu)效度,所提取的三個公因子可解釋A卷總變異的46.373%,B卷總變異的73.565%,經(jīng)方差最大法正交旋轉(zhuǎn)得到旋轉(zhuǎn)因子載荷矩陣,提示B卷具有較好的結(jié)構(gòu)效度�？紤]到A卷為患者自評的問卷,而癡呆患者對自身能力辨別存在偏差,所得公因子解釋所有變量信息較低,但經(jīng)因子分析后A卷與預(yù)期設(shè)計符合度尚可,待進一步擴大樣本調(diào)研后再次驗證。 3、區(qū)分度檢驗 對各組病例的A、B卷總得分分別做Kruskal-Wallis檢驗,結(jié)果均提示p0.01,提示三組的得分情況具有顯著差異,故認(rèn)為A、B卷具有良好的區(qū)分度。 4、應(yīng)答率檢驗 檢驗患者對A、B卷各條目的陽性反應(yīng)率,顯示A卷條目a21應(yīng)答率較低,且B卷的總體應(yīng)答率高于A卷。 5、判別分析 以A卷與B卷的得分作為判別指標(biāo)變量,以組別為類別變量,進行多分類判別分析,建立了一組判別函數(shù)模型,正確率為82.6%,對于各組別的正確判斷率分別為84.6%、78.3%和90.0%。 6、各組A、B卷總分范圍 觀察能夠進行正確有效判別的個案A、B卷得分情況,初步總結(jié)出各組別A卷及B卷的得分大致范圍。結(jié)論：1、前期工作制定出的癡呆PR0量表(A、B卷)賦予分值后用于臨床評價老年患者的認(rèn)知程度具有較好的信度、效度及區(qū)分度。2、以A、B卷的得分為判別指標(biāo)所建立的判別函數(shù)模型可以初步判別老年認(rèn)知障礙患者的認(rèn)知受損程度,具有較好的準(zhǔn)確率。3、通過進一步的完善工作將使該量表作為一種實用的手段應(yīng)用于癡呆患者的臨床診斷分級中,并為定量化評價中醫(yī)藥治療癡呆的療效提供新的依據(jù)。
[Abstract]:Objective: 1, to establish a PRO evaluation scale for the diagnosis of senile dementia, and to provide a new and practical means of.2 for the diagnosis and classification of senile dementia, and introduce the concept of PRO to evaluate the curative effect of traditional Chinese medicine for senile dementia more quantitatively.
Methods: combined with the international diagnostic criteria for dementia, 60 elderly patients were collected in accordance with the inclusion criteria. According to the internationally recognized MMSE, MoCA and CDR scales, 21 cases were divided into mild cognitive impairment group, 24 cases of mild dementia, 15 cases of moderate and severe dementia, the evaluation of A, B volume, and statistical analysis of the reliability, validity, differentiation and response rate of A, B volume, and test. The PRO scale for clinical diagnosis of senile dementia was identified, and a mathematical model was established by discriminant analysis, and the evaluation criteria were preliminarily worked out.
Results: 60 cases were included in this study, including 25 males and 35 females, with an average age of 72.05 + 8.05 years, which were divided into three groups, of which 21 cases were mild cognitive impairment, 35%, 24 in mild dementia, 40%, 15 in severe dementia group, 25.0%..
1, reliability test
With the Krone Bach a coefficient as the index, the A volume is 0.789, the B volume is 0.908, it has good internal consistency reliability. The half reliability indicates that the A and B volume are split into two parts respectively, and the two parts have good correlation. Therefore, A, B volume has good semi reliability.
2, validity test
The PRO evaluation scale used in this survey (A, B volume) is formed by previous literature research, scientific discussion and expert demonstration. It has the content validity from the compilation process. After the Spearman correlation coefficient test, the PRO scale A, the B volume score has a high linear correlation with MMSE, MoCA and CDR scores, which can be considered as a good standard. Quasi correlation validity. The structural validity of A and B volumes was tested by factor analysis. The three common factors extracted could explain 46.373% of the total variation in A volumes, 73.565% of the total variation of B volumes, and the rotation factor load matrix was obtained by the orthogonal rotation of variance. It was suggested that the B volume had a better structural efficiency. Considering the A volume as a self-assessment questionnaire for patients, and dementia There is a deviation in the identification of its own ability, and the information of all variables is low, but the coincidence of A volume with the expected design after factor analysis is still available, and it should be further verified after the further expansion of the sample survey.
3, distinction test
The total score of A and B volume in all cases were tested by Kruskal-Wallis test respectively. The results were all P0.01, suggesting that the scores of the three groups were significantly different. Therefore, A and B volume had good division.
4, the test of response rate
The positive response rate of each item in A and B volumes was tested, showing that A21 response rate of A volume item was lower, and the total response rate of B volume was higher than that of A volume.
5, discriminant analysis
Taking the scores of A volume and B volume as discriminant index variables, taking group as category variables, multi classification discriminant analysis is carried out, and a set of discriminant function models are established, the correct rate is 82.6%, and the correct judgment rate for each group is 84.6%, 78.3% and 90.0%., respectively.
6, A, B volume range of each group
The case A and B volume score were observed and the scores of A volume and B volume of each group were preliminarily summarized. Conclusion: 1, the dementia PR0 scale established by the earlier work (A, B volume) was given a good reliability, the validity and the division degree.2 for the clinical evaluation of the elderly patients, with A and B volumes. The discriminant function model, divided into discriminant index, can preliminarily distinguish the degree of cognitive impairment in the elderly patients with cognitive impairment, and has a good accuracy rate of.3. Through further improvement, the scale will be used as a practical means in the clinical diagnosis of dementia patients, and the quantitative evaluation of Chinese medicine for the treatment of dementia. The curative effect provides a new basis.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R749.1

【相似文獻】

相關(guān)期刊論文 前10條

1 王少峰;夏志娜;王曉清;;老年期癡呆患者一級親屬生活質(zhì)量的調(diào)查分析[J];中國健康心理學(xué)雜志;2011年08期

2 王秀芳;朱君;;奧氮平治療老年期癡呆行為和精神障礙對照研究[J];臨床精神醫(yī)學(xué)雜志;2011年03期

3 侯春蘭;侯凌峰;張東升;董繼雪;;利培酮口服液治療老年期癡呆精神行為癥狀的對照研究[J];中國健康心理學(xué)雜志;2011年09期

4 方宇;張璐;朱紅燦;魏建科;談頌;羅志毅;;腦脊液磷酸化tau蛋白及β淀粉樣蛋白檢測在老年期癡呆患者早期鑒別診斷中的價值[J];中國老年學(xué)雜志;2011年13期

5 ;何謂老年性癡呆[J];老友;2011年07期

6 黃乾坤;張艷欣;張晨;諸秉根;;利培酮口服液在老年期癡呆患者中的應(yīng)用[J];精神醫(yī)學(xué)雜志;2011年03期

7 賈建平;王樹英;;血管性癡呆臨床診斷標(biāo)準(zhǔn)探討[J];中國神經(jīng)免疫學(xué)和神經(jīng)病學(xué)雜志;2010年06期

8 孫長友;李國輝;湯光宗;楊建林;李洪濤;宋桂清;孫愛玲;羅海峰;陳強慶;魏芳艷;楊蘇萍;王培芳;許紅麗;張劍利;余鋰鐳;;老年期癡呆74例腦CT徑線測量與神經(jīng)心理測評觀察[J];實用老年醫(yī)學(xué);2011年03期

9 徐衛(wèi)剛;浦裕美;徐偉民;沈渝;;腦卒中后遺癥老人醫(yī)院獲得性肺炎的危險因素[J];中國老年學(xué)雜志;2011年13期

10 張海峰;宣麗華;侯群;毋振華;;粗針治療血管性癡呆療效評價[J];中國中醫(yī)藥科技;2011年04期

相關(guān)會議論文 前10條

1 柳建楸;;老年期癡呆病人的護理[A];全國第六屆老年護理學(xué)術(shù)交流專題講座會議論文匯編[C];2003年

2 閆芳;李淑然;李碩;邵鈞;;北京某社區(qū)65例老年期癡呆10年隨訪研究[A];中華醫(yī)學(xué)會精神病學(xué)分會第九次全國學(xué)術(shù)會議論文集[C];2011年

3 賈玉潔;成海燕;于濤;于建春;韓景獻;;老年期癡呆的西醫(yī)治療概況[A];2010年中國針灸學(xué)會腦病專業(yè)委員會、中國針灸學(xué)會循證針灸專業(yè)委員會學(xué)術(shù)大會論文集[C];2010年

4 劉計;彭洪興;;老年期癡呆患者的精神癥狀及治療分析[A];全國第十一次精神衛(wèi)生高級論壇論文匯編[C];2011年

5 田金洲;張新卿;秦斌;解恒革;畢齊;李繼梅;劉建平;時晶;管小亭;李麗;陳楓;王蔭華;高利;倪敬年;;老年期癡呆中西醫(yī)結(jié)合臨床實踐指南[A];2011全國老年癡呆與衰老相關(guān)疾病學(xué)術(shù)會議第三屆山東省神經(jīng)內(nèi)科醫(yī)師（學(xué)術(shù)）論壇論文匯編[C];2011年

6 郝偉平;;老年期癡呆患者的精神和行為癥狀特點分析[A];2011全國老年癡呆與衰老相關(guān)疾病學(xué)術(shù)會議第三屆山東省神經(jīng)內(nèi)科醫(yī)師（學(xué)術(shù)）論壇論文匯編[C];2011年

7 楊惠敏;;對12例住院老年期癡呆病人的觀察和護理[A];第五屆全國老年醫(yī)學(xué)進展學(xué)術(shù)會議論文集[C];2005年

8 王玲;何麗娜;;老年期癡呆病人的情緒反應(yīng)與健康教育[A];中華護理學(xué)會健康教育研討會暨講習(xí)班論文集[C];2000年

9 程安龍;沈曉艷;;神經(jīng)肌肉促通儀治療老年期癡呆臨床研究[A];中國康復(fù)醫(yī)學(xué)會第三次康復(fù)治療學(xué)術(shù)大會論文匯編[C];2002年

10 程安龍;沈曉艷;;神經(jīng)肌電促通儀治療老年期癡呆療效觀察[A];繼往開來 與時俱進——2003年康復(fù)醫(yī)學(xué)發(fā)展論壇暨慶祝中國康復(fù)醫(yī)學(xué)會成立20周年學(xué)術(shù)大會論文集[C];2003年

相關(guān)重要報紙文章 前10條

1 首都醫(yī)科大學(xué)宣武醫(yī)院神經(jīng)內(nèi)科副主任醫(yī)師、醫(yī)學(xué)博士 閔寶權(quán);早防早治老年期癡呆[N];中國醫(yī)藥報;2005年

2 鐘媛;中醫(yī)治療早期血管性老年期癡呆有進展[N];光明日報;2000年

3 四川大學(xué)華西醫(yī)院老年科副教授 鄧玨琳;畫鐘識別老年癡呆[N];健康報;2007年

4 本報記者 林江艷;progress：踴躍在Internet浪潮之顛[N];計算機世界;2000年

5 健康時報記者 趙晴晴　特約記者 俞忠良;每天徒步走防癡呆[N];健康時報;2008年

6 電腦商報評測實驗室 崔劍;源科創(chuàng)新Pro IV系列固態(tài)硬盤評測[N];電腦商報;2009年

7 超微;AMD VISION Pro技術(shù)助力企業(yè)贏得競爭優(yōu)勢[N];人民郵電;2010年

8 沈三民;如何預(yù)防老年癡呆[N];西安日報;2000年

9 曉明;精神分裂癥等4種疾病是當(dāng)前精神衛(wèi)生防治重點[N];中國中醫(yī)藥報;2007年

10 朱忠良譯 譯者單位：全國人大財經(jīng)委調(diào)研室;中華人民共和國政府采購法（三）[N];中國財經(jīng)報;2002年

相關(guān)博士學(xué)位論文 前10條

1 張s，

本文編號：2137226