标准化复制五边形测试（SCPT）对阿尔茨海默病患者精神行为症状的评价研究

发布时间：2018-02-24 09:05

本文关键词： 阿尔茨海默病精神行为症状标准化复制五边形测试认知功能障碍　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:阿尔茨海默病(Alzheimer's disease AD)是在老年人群中较为常见的中枢神经系统变性疾病,严重威胁着其的身心健康。AD的主要症状有记忆力下降、语言、执行能力等障碍。在AD患者中,认知功能障碍的研究已逐渐完善,而行为和精神症状在很长一段时间内都没有引起临床及研究领域的足够重视。现在的研究认为其行为和精神症状能够加快AD的认知功能下降,并且造成AD病人及其照料者生存质量的降低。改善AD病人的行为和精神症状,是对其进行临床管理的一个重要环节。因此,早期识别AD患者的精神异常倾向,及时对其进行规范的干预,对于减缓疾病进展的速度有重要意义。然而目前对精神障碍的检测量表均较复杂,耗时久,实施不便捷。常出现在简易精神状态检查(Minimum Mental State Examination,MMSE)及本德格式塔测验(Bender-Gestalt Test,BGT)等量表中的复制五边形试验能够检测患者的视觉-运动能力及认知能力,但各量表对其应用及得分计算较为简陋和粗糙,有研究者将其标准化后应用在对精神分裂症患者的检测中,且其灵敏性及效度均较高,最为重要的是其检测方便,耗时短。最近的研究显示,老年群体的认知能力与一些精神障碍症状在一定程度上具有非常密切的相关性。因此,本研究通过标准化复制五边形测试(Standardised Copy of Pentagons Test,SCPT)对正常老年人、无精神行为症状的AD患者及有精神行为症状的AD患者进行区分评价及效度检测,期望能够通过该量表快捷有效的对AD病人的精神障碍进行早期的识别,并给予及时的干预,改善患者的生存质量。研究方法:收集山东大学齐鲁医院神经内科门诊就诊的89例AD患者(包括具有精神行为症状组58例,无精神行为症状组31例),以及同期就诊或接受社区健康筛查的48名年龄、性别及受教育年限等匹配的正常受试者,采用简易精神状态检查表(MMSE)及蒙特利尔认知评估量表(MoCA)评价患者认知情况、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及神经精神问卷(NPI)评价患者抑郁、焦虑等行为和精神障碍的严重程度,采用标准化复制五边形测试(SCPT)对AD患者精神行为症状进行区分和评价。运用SPSS 19.0统计分析软件对数据进行统计学分析。研究结果:分析结果显示,三组间年龄、受教育程度无明显差异,具有精神行为症状的AD病人简明精神状况评价表(MMSE)及蒙特利尔认知评价量表(MoCA)评分明显低于无精神行为症状的AD患者,且具有精神行为症状的AD病人其汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及神经精神问卷(NPI)评分明显高于无精神行为症状的AD病人,差异具有统计学意义。对三组间SCPT各条目及总分进行组间比较,结果显示条目SCPT1、2、3、6、7、14、15、16及SCPT总得分存在明显差异,有统计学意义,其他条目无明显差异,可信度Cronbach's a为0.701。对标准化复制五边形测试(SCPT)进行多因素分析提取出5个分量表,分量表能提供的解析的变异分别为23.78%、14.78%、11.23%、8.02%、7.55%。用标准化复制五边形测试(SCPT)量表进行判别分析,对三组患者进行类别判分,结果发现,109例为正确判断(79.56%);错分为正常组的有12例(8.76%);错分为无精神行为症状组的有11例(8.03%);错分为精神行为症状组的有5例(3.65%)。研究结论:标准化复制五边形测试(SCPT)量表能够有效区分AD患者是否合并精神行为症状,可以较早识别其精神行为症状并给予及时干预,该测试方法具有易实施,耗时少,管理方便的优点。
[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.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.16

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