阿尔茨海默病与非言语听理解障碍的相关性研究

发布时间：2018-06-19 06:13

本文选题：阿尔茨海默病(AD) + 遗忘型轻度认知功能障碍(a-MCI)　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:阿尔茨海默病(AD)是以近记忆障碍为主,并伴有其他认知功能障碍的神经系统退行性变性疾病,是老年痴呆中最常见的一种。轻度认知功能障碍(MCI)是指具有主观或客观的记忆或认知功能受损,未影响到日常生活能力,未达到痴呆诊断标准的一种临床状态。MCI多转化为痴呆,其中以遗忘型MCI(a-MCI)与AD关系最为密切。早期识别MCI可以方便早期发现AD。近来研究表明中枢性听理解障碍是早期认知功能下降的标志之一,可以用来监测MCI到痴呆的进展。从临床和基础研究来看,AD和MCI的确会出现中枢性听理解障碍。而既往的研究方法多通过言语和文字进行,非言语类的声音如动物、音乐等则涉及较少。非言语类的声音识别其实也是中枢听理解内容很重要的一部分。基于国外关于该方面的研究多通过对周围环境声音分类、命名,识别音乐旋律、节奏、判断愉悦性等,即涉及非言语声音的语义和音乐方面,故本研究中也设置了相关的测试项目。通过这些测试对AD与非言语听理解之间进行探讨,分析a-MCI,AD患者是否会出现非言语听理解障碍,在各项测试中各阶段的AD患者有什么不同的表现及各项测试对AD,甚至a-MCI有无鉴别诊断价值。方法:该研究为横断面性研究。1、从2016年1月至12月,选取在四川省人民医院以记忆减退为主诉的患者,陪护人员和附近的小区居民作为研究对象。根据纳入及排除标准分为正常组、a-MCI组、轻度AD组和中度AD组。2、参阅国内外相关资料,制定中枢性非言语听理解系列测试项目,包括根据声音分类(简称声音分类),对旋律情感的判断(简称情感判断),对旋律节奏的判断(简称节奏判断),根据声音命名(简称声音命名)四项,其中声音分类和命名主要涉及非言语语义方面,情感和节奏判断主要涉及音乐方面。3、受试者均行声音分类、情感判断、节奏判断、声音命名各项测试。4、采集并记录好各组受试者年龄、性别、文化及各项测试的数据结果,通过spss20软件进行统计学处理。结果:1、四组受试者在年龄、性别、文化上均无明显统计学意义(p0.05),具有可比性,在mmse和moca组间差异分析中有统计学意义(p0.05)。2、mmse、moca得分分别与非言语听理解系列测试总分、声音分类、情感判断、节奏判断、声音命名各项测试得分呈中等强度以上的正相关(rs0.4,p0.01),其中声音命名和声音分类与mmse、moca相关性较好,而节奏判断、情感判断居其次。3、在声音分类、情感判断、节奏判断、声音命名测试中,四组受试者得分均为正常组a-mci组轻度ad组中度ad组,组间差异具有统计学意义(p0.05)。两两对比后,a-mci与正常组在声音命名上有统计学差异(p0.008);轻度ad较正常组、a-mci组除在情感判断无差异外(p0.008),在声音分类、节奏判断、声音命名上均有统计学差异(p0.008);中度ad较正常组、a-mci组在非言语听理解系列测试中均有统计差异(p均0.008),而较轻度ad只在情感判断、节奏判断、声音命名上有差异(p0.008)。4、在诊断价值上,声音命名能较好的鉴别出a-mci和正常组(roc=0.851,p0.001),声音分类、节奏判断和声音命名能较好鉴别出轻度ad和正常组,其中声音分类、声音命名诊断价值较好(roc=0.912,p0.001;roc=0.971,p0.001),节奏判断居其次(roc=0.730,p=0.003)。在鉴别轻度ad和a-mci时,声音分类和声音命名也有较好的鉴别诊断价值(roc=0.836,p0.001;roc=0.858,p0.001),而节奏判断诊断价值降低(roc=0.719,p=0.004)。情感判断、节奏判断、声音命名可以用来观察轻度ad到中度ad的进展,其中声音命名大于节奏判断、情感判断(ROC=0.867,P0.001;ROC=0.796,P0.001;ROC=0.694,P=0.017),情感判断价值较低。结论:1、AD甚至a-MCI可以出现非言语听理解障碍,且随着认知障碍程度加重而加重。2、AD在涉及非言语语义方面的听理解能力较涉及音乐方面的听理解能力衰退更为明显。3、非言语听理解系列测试可以用来协助诊断AD,甚至a-MCI,可以用来观察AD的进展。其中涉及非言语语义方面的测试项目较涉及音乐方面的测试项目诊断价值更高,尤其是声音命名。4、非言语听理解测试能部分排除语言和文化差异干扰,尤其适用于有视力障碍的AD患者,具有较好的研究前景。
[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.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.16

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