Gwajin MemTrax Idan aka kwatanta da Ƙimar Ƙididdiga na Fahimtar Montreal na Ƙimar Fahimci Mai Sauƙi.
Nau'in labarin: MemTrax Bincike Mataki na ashirin da
Marubuta: van der Hoek, Marjanne D. | Nieuwenhuizen, Arie | Keijer, Jap | Ashford, J. Wesson
Haɗuwa: Stanford University, Stanford, CA, Amurka - Ma'aikatar Ilimin Halitta da Kimiyyar Halayyar Halitta, Cibiyar Nazarin Abinci da Kiwo, Jami'ar Van Hall Larenstein na Kimiyyar Kimiyya, Leeuwarden, Netherlands | Physiology na Dan Adam da Dabbobi, Jami'ar Wageningen, Wageningen, Netherlands | Cibiyar Nazarin Ciwon Ciwon Yaki da Rauni, VA Palo Alto HCS, Palo Alto, CA, Amurka
DOI: 10.3233/JAD-181003
Jaridar: Jaridar Cutar Alzheimer, kundi. 67, a'a. 3, shafi na 1045-1054, 2019
Abstract
Rashin hankali shine babban dalilin rashin aiki a cikin tsofaffi. Yaushe m rashin hankali (MCI) yana faruwa a cikin tsofaffi, sau da yawa yanayin prodromal ne ga lalata. Ƙididdigar Ƙwararren Ƙwararru na Montreal (MoCA) kayan aiki ne da aka saba amfani dashi don nunawa MCI. Koyaya, wannan gwajin yana buƙatar gudanar da ido-da-fuska kuma ya ƙunshi nau'ikan tambayoyi waɗanda aka haɗa martaninsu tare da ma'aunin don samar da maki wanda ainihin ma'anarsa ta kasance mai kawo rigima. An tsara wannan binciken don kimanta aikin na'ura mai kwakwalwa ƙwaƙwalwar ajiya (MemTrax), wanda shine daidaitawa na ci gaba da aiki na fitarwa, dangane da MoCA. Ana samar da matakan sakamako guda biyu daga Gwajin MemTrax: MemTraxspeed da MemTrax daidai. An gudanar da batutuwa da MoCA da Gwajin MemTrax. Dangane da sakamakon MoCA, an raba batutuwa zuwa ƙungiyoyi biyu na matsayi na fahimi: cognition na al'ada (n = 45) da MCI (n = 37). Makiyoyin MemTrax sun yi ƙasa da ƙasa sosai a cikin MCI fiye da ƙungiyar fahimta ta al'ada. Duk masu canjin sakamakon MemTrax an haɗa su da kyau tare da MoCA. Hanyoyi biyu, lissafin matsakaici An yi amfani da makin MemTrax da koma bayan layi don ƙididdige ƙimar yankewar gwajin MemTrax don gano MCI. Wadannan hanyoyin sun nuna cewa ga sakamakon MemTraxgudun maki ƙasa da kewayon 0.87 - 91 s-1 alama ce ta MCI, kuma ga sakamakon MemTraxdaidai maki da ke ƙasa da kewayon 85 – 90% nuni ne ga MCI.
GABATARWA
Al'ummar duniya, karkashin jagorancin Turai, Arewacin Amirka, da Arewacin Asiya, sun tsufa, yana haifar da karuwar yawan tsofaffi. Tare da karuwar shekaru, ana samun ingantaccen ci gaba, haɓaka haɓakar haɓakar rashin fahimta, lalata, da Alzheimer ta cutar (AD), wanda ke haifar da karuwa mai yawa a yawan mutanen da ke da waɗannan yanayi. Gano farkon da kuma gano cututtuka na hankali na iya inganta kulawar haƙuri, rage farashin kula da lafiya, kuma zai iya taimakawa wajen jinkirta farkon bayyanar cututtuka masu tsanani, don haka yana iya taimakawa wajen sauƙaƙe nauyin haɓaka da sauri na lalata da AD. Sabili da haka, ana buƙatar kayan aiki mafi kyau don saka idanu aikin fahimi a cikin tsofaffi.
Don yin gwaje-gwaje na asibiti game da fahimi da ayyuka na tsofaffi, likitoci da masu bincike sun haɓaka ɗaruruwan gwaje-gwaje da kayan aikin tantancewa, kuma gwaje-gwaje da yawa sun yi amfani da su. Ɗaya daga cikin kayan aikin da aka fi amfani da su akai-akai don kimantawa na asibiti na rashin fahimta mai sauƙi (MCI) a cikin saitunan ilimi shine Binciken Nazarin Montreal (MoCA).
MoCA tana kimanta ayyuka bakwai na fahimi: zartarwa, suna, hankali, harshe, abstraction, ƙwaƙwalwar ajiya/jinkirin tunawa, da daidaitawa. Ƙwaƙwalwar yanki / jinkirin tunawa da kuma daidaitawa na MoCA a baya an gano su a matsayin abubuwa masu mahimmanci ga farkon nau'in cutar Alzheimer-nau'in rashin fahimta, wanda ya haifar da ra'ayi cewa rikodin ƙwaƙwalwar ajiya shine ainihin abin da tsarin neuropathological AD ya kai hari. Sabili da haka, a cikin kayan aiki na asibiti don ƙididdige ra'ayoyin da ke hade da AD, ƙwaƙwalwar ajiya ita ce mahimmancin tunani na tsakiya don yin la'akari da shi, yayin da sauran cututtuka, ciki har da aphasia, apraxia, agnosia, da rashin aiki na zartarwa, ko da yake yawancin rikice-rikice ta AD, na iya zama dangantaka. zuwa rashin aiki na hanyoyin sarrafa ƙwaƙwalwar ƙwaƙwalwa na neuroplastic a cikin yankuna masu tallafawa neocortical.
Kodayake ana amfani da MoCA sosai don tantance MCI, gudanar da MoCA ana yin shi gaba-da-gaba, wanda ke ɗaukar lokaci kuma yana buƙatar saduwa ta asibiti kuma saboda haka yana buƙatar farashi mai yawa ga kowace gwamnati. A yayin da ake yin kima, lokacin da ake buƙata don gudanar da gwaji yana ƙaruwa da daidaiton ƙima, don haka abubuwan da zasu faru nan gaba dole ne suyi la'akari da wannan dangantakar don haɓaka gwaje-gwaje masu inganci.
Batu mai mahimmanci a cikin wannan yanki shine abin da ake buƙata don kimanta fahimi akan lokaci. Ƙimar canje-canje a kan lokaci shine mahimmanci don ganowa da kuma ƙayyade ci gaban rashin ƙarfi, ingancin jiyya, da kuma kimanta ayyukan bincike na warkewa. Yawancin irin waɗannan kayan aikin da ake da su ba su dace ba kuma ba a tsara su don manyan matakan daidaito ba kuma ba za a iya sarrafa su cikin sauƙi akai-akai ba. An ba da shawarar maganin inganta haɓakar ƙima don zama na'ura mai kwakwalwa, amma yawancin irin waɗannan ƙoƙarin sun ba da kyauta fiye da na'ura mai kwakwalwa na gwaje-gwajen neuropsychological da aka saba amfani da su, kuma ba a samar da su ba don magance batutuwa masu mahimmanci na ƙima da ake bukata don fahimta da wuri. dementia da ci gabanta. Don haka, sabbin kayan aikin tantance fahimi yakamata su kasance cikin na'ura mai kwakwalwa kuma bisa tushen gwaji mara iyaka, waɗanda ba su iyakance ta harshe ko al'ada ba, waɗanda ke ba da matakan daidaito, daidaito, da aminci waɗanda za a iya haɓaka su gabaɗaya. Bugu da ƙari, irin waɗannan gwaje-gwajen dole ne su kasance masu daɗi da nishadantarwa, ta yadda za a ɗauki maimaita gwajin a matsayin tabbatacce maimakon ƙwarewa mai wahala. Gwajin kan layi, musamman, yana ba da damar da za a iya biyan wannan buƙatu, yayin da ke ba da saurin tattarawa da nazarin bayanai, da ba da amsa nan da nan ga daidaikun mutane, likitoci, da masu bincike.
An tsara wannan binciken na yanzu don tantance amfanin daidaitawar kan layi na tsarin aiki mai ci gaba (CRT), don tantance aikin fahimi a cikin yawan mutanen da ke zaune a cikin al'umma waɗanda ba a gano suna da ciwon hauka ba. Ana amfani da tsarin CRT sosai a cikin ilimi karatun ƙwaƙwalwar ajiya hanyoyin. An fara aiwatar da tsarin CRT a matsayin kayan aikin nunin masu sauraro wanda ke ba da bayanai akan mutanen da suke sha'awar matsalolin ƙwaƙwalwar ajiya. Daga baya, an aiwatar da wannan gwajin akan layi ta wani kamfani na Faransa (HAPPYneuron, Inc.); ta wani kamfani na Amurka, MemTrax, LLC (http://www.memtrax.com); ta Brain Health Rijista da Dr. Michael Weiner, UCSF, da tawagarsa suka haɓaka don tallafawa daukar ma'aikata don nazarin rashin fahimta; da wani kamfanin kasar Sin SJN Biomed, LTD). Wannan gwajin, tun daga watan Yuni 2018, ya sami bayanai daga masu amfani sama da 200,000, kuma yana cikin gwaji a ƙasashe da yawa.
A cikin binciken yanzu, MemTrax (MTX), gwajin tushen CRT, an gudanar da shi tare da MoCA a cikin tsofaffi masu zaman kansu a arewacin Netherlands. Manufar wannan binciken shine don ƙayyade alakar da ke tsakanin aiki akan wannan aiwatar da CRT da MoCA. Tambayar ita ce ko MTX zai kasance da amfani don ƙididdige ayyukan fahimi da MoCA ta tantance, wanda zai iya nuna yiwuwar amfani da asibiti.
KAYA DA MATAKAI
Masanin binciken
Tsakanin Oktoba 2015 da Mayu 2016, an gudanar da wani nazari mai zurfi tsakanin tsofaffi mazauna mazauna a arewacin Netherlands. An tattara batutuwa (≥75y) ta hanyar rarraba wasiƙa da kuma yayin taron rukuni da aka shirya don tsofaffi. An ziyarci batutuwa masu yuwuwa a gida don tantance ƙa'idodin haɗawa da keɓancewa kafin a sanya su cikin wannan binciken. Abubuwan da suka sha wahala daga (rahoton kansu) ko kuma waɗanda ke da rauni sosai ga hangen nesa ko ji wanda zai tasiri gudanar da gwaje-gwajen fahimi ba a yarda su shiga cikin wannan binciken ba. Bugu da ƙari, batutuwa suna buƙatar samun damar yin magana da fahimtar yaren Dutch kuma kada su zama jahilai. An gudanar da binciken bisa ga sanarwar Helsinki na 1975 kuma duk mahalarta sun sanya hannu kan takardar sanar da izini form bayan samun cikakken bayani na binciken.
Hanyar karatu
Bayan yin rajista a cikin binciken, an gudanar da babban tambayoyin, wanda ya haɗa da tambayoyi game da abubuwan da suka shafi alƙaluma, kamar shekaru da shekarun ilimi (farawa daga makarantar firamare), tarihin likita, da shan barasa. Bayan kammala tambayoyin, an gudanar da gwaje-gwajen MoCA da MTX a cikin bazuwar tsari.
MemTrax - Cibiyar Kiwon Lafiyar Bincike
A matsayin ladabi na MemTrax, LLC (Redwood City, CA, Amurka), an ba da cikakkun nau'ikan gwajin MTX kyauta. A cikin wannan gwajin, ana nuna jerin hotuna 50 na tsawon daƙiƙa uku kowanne. Lokacin da ainihin maimaita hoto ya bayyana (25/50), an umurci batutuwa da su mayar da martani ga maimaita hoton da wuri-wuri ta danna maballin sararin samaniya (wanda aka nuna ta tef mai launin ja). Lokacin da batun ya mayar da martani ga hoto, an nuna hoton na gaba nan da nan. Bayan kammala gwajin, shirin yana nuna adadin daidaitattun martani (MTXdaidai) da matsakaicin lokacin amsawa a cikin daƙiƙa don maimaita hotuna, wanda ke nuna lokacin da ake buƙata don danna mashigin sararin samaniya lokacin gane maimaita hoto. Don daidaita girman waɗannan matakan biyu, an canza lokacin amsawa zuwa saurin amsawa (MTXgudun) ta hanyar rarraba 1 ta lokacin amsawa (watau 1/MTXlokacin amsawa). Tarihin gwajin duk makin MemTrax da ingancinsu an ajiye su ta atomatik akan layi a cikin asusun gwajin. An duba ingancin duk gwaje-gwajen da aka yi, suna buƙatar 5 ko ƙananan amsoshi na gaskiya na ƙarya, 10 ko fiye daidai ganewa, da matsakaicin lokacin fitarwa tsakanin 0.4 da 2 seconds, kuma gwaje-gwaje masu inganci kawai aka haɗa a cikin bincike.
Kafin a gudanar da ainihin gwajin MTX, an yi bayanin gwajin dalla-dalla kuma an ba da gwajin aiki ga batutuwa. Wannan ya haɗa da ba kawai gwajin kanta ba, har ma da umarni da shafuka masu ƙidayawa don barin ɗan takara ya saba da tsarin rukunin yanar gizon da ayyukan farko da ake buƙata, kafin fara gwajin. Don guje wa maimaita hotuna a lokacin gwaji na ainihi, an yi amfani da hotunan da ba a haɗa su a cikin bayanan MemTrax don gwajin aiki ba.
Ƙimar fahimi na Montreal kayan aiki
An sami izini daga Cibiyar MoCA & Clinique (Quebec, Kanada) don amfani da MoCA don wannan bincike. MoCA na Yaren mutanen Holland yana samuwa a cikin nau'i uku, waɗanda aka gudanar da su ba da gangan ba ga batutuwa. Makin MoCA shine jimlar aiki akan kowane yanki na fahimi da aka tantance kuma yana da matsakaicin maki 30. Dangane da shawarar hukuma, an ƙara ƙarin batu idan ɗan takara yana da shekaru ≤12 na ilimi (idan <30 maki). An yi amfani da umarnin gwaji na hukuma azaman jagora yayin gudanar da gwaje-gwajen. Kwararrun masu bincike uku ne suka gudanar da gwaje-gwajen kuma gudanar da gwaji guda ya ɗauki kimanin mintuna 10 zuwa 15.
Binciken Bayanan MemTrax
Dangane da sakamakon MoCA, wanda aka gyara don ilimi, an raba batutuwa zuwa ƙungiyoyi biyu na matsayi na fahimta: al'ada cognition (NC) tare da rashin fahimta mai sauƙi (MCI). An yi amfani da maki na MoCA na 23 a matsayin yankewa ga MCI (maki 22 da ƙasa an yi la'akari da MCI), kamar yadda aka nuna cewa wannan makin ya nuna gabaɗaya 'mafi kyawun bincike a cikin kewayon sigogi' idan aka kwatanta da farkon shawarar da aka ba da shawarar. 26 ko ƙimar 24 ko 25. Don duk nazarin, an yi amfani da madaidaicin MoCA da aka gyara kamar yadda ake amfani da wannan maki a cikin saitunan asibiti.
Gwajin MTX yana ba da sakamako biyu, wato MTXlokacin amsawa, wanda aka canza zuwa MTXgudun ta 1/MTXlokacin amsawa, da MTXdaidai.
An gudanar da nazarin ƙididdiga ta amfani da R (Sigar 1.0.143, Rstudio Team, 2016). An duba al'ada ga duk masu canji ta gwajin Shapiro-Wilk. Bambance-bambancen duka yawan yawan binciken, da kuma na NC da ƙungiyoyin MCI, an ruwaito su azaman ma'anar ± daidaitaccen daidaituwa (SD), tsaka-tsaki da kewayon tsaka-tsaki (IQR) ko azaman lamba da kashi. Samfurin T-gwaji masu zaman kansu da gwaje-gwaje na Wilcoxon Sum Rank don ci gaba da sauye-sauye da gwaje-gwajen Chi-squared don ma'auni masu mahimmanci an yi su don kwatanta halaye na ƙungiyar NC da MCI. An yi amfani da gwajin Kruskal-Wallis marasa daidaituwa don tantance ko nau'ikan MoCA guda uku da masu gudanarwa uku sun shafi sakamakon MoCA. Bugu da ƙari, an yi gwajin T-test mai zaman kansa ko Wilcoxon Sum Rank don sanin ko tsarin gudanarwa na MoCA da MTX ya yi tasiri ga sakamakon gwajin (misali, ƙimar MoCA, MTX).daidai, da MTXgudun). Anyi wannan ta hanyar tantance idan ma'aunin ma'aunin ya bambanta ga batutuwa waɗanda suka karɓi MoCA da farko sannan MemTrax ko waɗanda suka karɓi MTX da farko sannan MoCA.
Pearson daidaitawa an ƙididdige gwaje-gwaje don tantance alaƙa tsakanin MTX da MoCA da tsakanin duka MemTrax sakamakon gwajin, misali, MTXspeed da MTX daidai. Ƙididdigar girman samfurin da aka aiwatar a baya ya nuna cewa don gwajin haɗin gwiwar Pearson mai wutsiya ɗaya (iko = 80 % , α = 0.05), tare da zato na matsakaicin matsakaicin sakamako (r = 0.3), ana buƙatar ƙaramin samfurin n = 67. An ƙididdige gwaje-gwajen haɗin gwiwar polyserial don tantance alaƙa tsakanin sakamakon gwajin MTX da keɓantattun wuraren MoCA ta amfani da kunshin psych a cikin R.
An ƙididdige madaidaicin makin MoCA na makin MemTrax ta hanyar lissafta matsakaicin makin MemTrax na kowane makin MoCA mai yuwuwa da koma bayan layin da aka yi don ƙididdige ma'auni masu alaƙa da waɗannan matakan. Bugu da ƙari, don ƙayyade ƙimar yankewa na gwajin MemTrax don MCI da aka auna ta MoCA, da daidaitattun hankali da ƙayyadaddun ƙididdiga, an gudanar da bincike na mai karɓar Mai aiki (ROC) ta amfani da kunshin pROC a cikin R. Non-parametric stratified bootstrapping (n) = 2000) an yi amfani da shi don kwatanta yankin da ke ƙarƙashin magudanar ruwa (AUCs) da madaidaicin tazarar amincewa. An ƙididdige madaidaicin makin yankewa tare da hanyar Youden, wanda ke haɓaka ingantattun ingantattun ingantattun abubuwa yayin da ake rage ƙimar ƙarya.
Don duk ƙididdigar ƙididdiga, p-darajar mai gefe biyu na <0.05 an yi la'akari da shi azaman kofa don mahimmancin ƙididdiga, ban da bincike don tantance alaƙar da ke tsakanin MTX da MoCA (watau nazarin daidaitawa da sauƙi mai sauƙi) wanda ɗaya- p-darajar gefe na <0.05 an ɗauke shi azaman mahimmanci.
Sakamakon MemTrax
batutuwa
Gabaɗaya, an haɗa batutuwa 101 a cikin wannan binciken. An cire bayanan mutane 19 daga bincike, saboda sakamakon gwajin MemTrax daga batutuwa 12 ba a cece su ta hanyar shirin ba, batutuwa 6 suna da sakamakon gwajin MemTrax mara inganci, kuma jigo ɗaya yana da maki na MoCA na maki 8, yana nuna rashin fahimta mai tsanani, wanda ya kasance. ma'auni na keɓancewa. Saboda haka, an haɗa bayanai daga batutuwa 82 a cikin bincike. Ba a sami bambance-bambance masu mahimmanci a cikin sakamakon gwajin MoCA tsakanin nau'ikan MoCA daban-daban da tsakanin masu gudanarwa ba. Bugu da kari, tsarin gudanar da gwajin ba shi da wani tasiri mai mahimmanci akan kowane maki gwajin (MoCA, MTXgudun, MTXdaidai). Dangane da sakamakon gwajin MoCA, an sanya batutuwa a cikin ƙungiyar NC ko MCI (misali, MoCA ≥ 23 ko MoCA <23, bi da bi). Halayen batutuwa don jimlar yawan binciken, kuma an gabatar da ƙungiyoyin NC da MCI a cikin Table 1. Babu wani bambance-bambance masu mahimmanci a tsakanin ƙungiyoyi, sai dai matsakaicin MoCA (25 (IQR: 23-26) da 21 (IQR: 19-22). ) maki, Z = -7.7, p <0.001).
Tebur 1
Abubuwan halaye
| Jimlar yawan binciken (n = 82) | NC (n = 45) | MCI (n = 37) | p | |
| Shekaru (y) | 83.5 ± 5.2 | 82.6 ± 4.9 | 84.7 ± 5.4 | 0.074 |
| Mace, A'a. (%) | 55 (67) | 27 (60) | 28 (76) | 0.133 |
| Ilimi (y) | 10.0 (8.0 - 13.0) | 11.0 (8.0 - 14.0) | 10.0 (8.0 - 12.0) | 0.216 |
| Shan barasa (# gilashin/mako) | 0 (0 - 4) | 0 (0 - 3) | 0 (0 - 5) | 0.900 |
| Makin MoCA (# maki) | 23 (21 - 25) | 25 (23 - 26) | 21 (19 - 22) | da kyau |
Ana bayyana dabi'u azaman ma'anar ± sd, matsakaici (IQR) ko azaman lamba tare da kashi.
Matsayin fahimi wanda MemTrax ya auna
An auna matsayin fahimi ta gwajin MTX. Hoto na 1 yana nuna sakamakon gwajin fahimi Sakamakon batutuwan NC da MCI. Matsakaicin makin MTX (misali, MTXgudun da MTXdaidai) sun bambanta sosai tsakanin ƙungiyoyin biyu. Abubuwan NC (0.916 ± 0.152 s-1) yana da gagarumin saurin amsawa da sauri idan aka kwatanta da batutuwa na MCI (0.816 ± 0.146 s-1); t (80) = 3.01, p = 0.003) (Fig. 1A). Bugu da kari, batutuwan NC sun sami mafi kyawun maki akan MTXdaidai m fiye da batutuwa na MCI (91.2 ± 5.0% da 87.0 ± 7.7% bi da bi; tw (59) = 2.89, p = 0.005) (Fig. 1B).
Fig.1
Akwatin sakamakon gwajin MTX don ƙungiyoyin NC da MCI. A) MTXgudun sakamakon gwajin da B) MTXdaidai sakamakon gwaji. Dukansu masu canjin sakamako na gwaje-gwajen MTX sun yi ƙasa sosai a cikin ƙungiyar MCI idan aka kwatanta da NC. Launin launin toka mai haske yana nuna batutuwan NC, yayin da launin toka mai duhu yana nuna batutuwan MCI.
Akwatin sakamakon gwajin MTX don ƙungiyoyin NC da MCI. A) Sakamakon gwajin MTXspeed da B) MTX daidai sakamakon gwajin. Dukansu masu canjin sakamako na gwajin MemTrax sun ragu sosai a cikin ƙungiyar MCI idan aka kwatanta da NC. Launin launin toka mai haske yana nuna batutuwan NC, yayin da launin toka mai duhu yana nuna batutuwan MCI.
Daidaita tsakanin MemTrax da MOCA
Ƙungiyoyin tsakanin makin gwajin MTX da MoCA an nuna su a cikin siffa 2. Dukansu masu canji na MTX suna da alaƙa da alaƙa da MoCA. MTXgudun kuma MoCA ya nuna mahimmancin haɗin gwiwa na r = 0.39 (p = 0.000), da kuma haɗin kai tsakanin MTXdaidai kuma MoCA ya kasance r = 0.31 (p = 0.005). Babu wata alaƙa tsakanin MTXgudun da MTXdaidai.
Fig.2
Ƙungiyoyi tsakanin A) MTXgudun da kuma MoCA; B) MTXdaidai da kuma MoCA; C) MTXdaidai da MTXgudun. Abubuwan NC da MCI ana nuna su tare da dige-dige da triangles bi da bi. A kusurwar dama na kowane jadawali ana nuna rho da ƙimar p daidai da daidaito tsakanin masu canji biyu.
Ƙungiyoyi tsakanin A) MTXspeed da MoCA; B) MTX daidai kuma MoCA; C) MTX daidai kuma MTXspeed. Abubuwan NC da MCI ana nuna su tare da dige-dige da triangles bi da bi. A kusurwar dama na kowane jadawali ana nuna rho da ƙimar p daidai da daidaitawa tsakanin masu canji biyu.
Ƙungiyoyi tsakanin A) MTXspeed da MoCA; B) MTX daidai kuma MoCA; C) MTX daidai kuma MTXspeed. Abubuwan NC da MCI ana nuna su tare da dige-dige da triangles bi da bi. A kusurwar dama ta ƙasa na kowane jadawali ana nuna rho da ƙimar p daidai da daidaito tsakanin masu canji biyu.[/taken magana]
An ƙididdige haɗin gwiwar polyserial tsakanin makin gwajin MemTrax da yankunan MoCA don ƙayyade haɗin kowane yanki tare da ma'aunin MemTrax. Ana nuna alaƙar polyserial a cikin Teburin 2. Yawancin yankuna na MoCA an haɗa su sosai tare da MTXgudun . Yankin "abstraction" ya nuna mafi girman alaƙa, kodayake matsakaici, tare da MTXgudun (r = 0.35, p = 0.002). Yankunan "suna" da "harshe" sun nuna rashin ƙarfi zuwa matsakaici mai mahimmanci tare da MTXgudun (r = 0.29, p = 0.026 da r = 0.27, p = 0.012, bi da bi). MTXdaidai ba a haɗa shi da mahimmanci ga yankunan MoCA ba, sai dai don rashin daidaituwa tare da yankin "visuospatial" (r = 0.25, p = 0.021).
Tebur 2
Abubuwan haɗin gwiwar polyserial na sakamakon gwajin MTX tare da yankunan MoCA
| MTXgudun | MTXdaidai | |||
| r | p | r | p | |
| Visuospatial | 0.22 | 0.046 | 0.25 | 0.021 |
| ambata sunayen | 0.29 | 0.026 | 0.24 | 0.063 |
| hankali | 0.24 | 0.046 | 0.09 | 0.477 |
| Harshe | 0.27 | 0.012 | 0.160 | 0.165 |
| Abstraction | 0.35 | 0.002 | 0.211 | 0.079 |
| tuna | 0.15 | 0.159 | 0.143 | 0.163 |
| Wayarwa | 0.21 | 0.156 | 0.005 | 0.972 |
Lura: Ana nuna mahimman alaƙa cikin ƙarfi.
Makin MemTrax da ƙididdige ƙimar yankewa ga MCI
Don tantance madaidaitan maki na MemTrax da MoCA, an daidaita makin MemTrax na kowane makin MoCA kuma an ƙididdige koma baya na layi don tsinkayar alaƙa da daidaitattun daidaito. Sakamakon komawar layin layi ya nuna cewa MTXgudun ya bayyana 55% na bambance-bambance a cikin MoCA (R2 = 0.55, p = 0.001). Canje-canje a cikin MTXdaidai ya bayyana 21% na bambance-bambance a cikin MoCA (R2 = 0.21, p = 0.048). Dangane da ma'auni na waɗannan alaƙa, an ƙididdige makin MoCA daidai don ƙimar MTX, waɗanda aka nuna a cikin Tebur 3. Dangane da waɗannan ma'auni, madaidaitan ƙimar yanke (misali, maki MoCA na maki 23) don MTXgudun da MTXdaidai ku 0.87s-1 kuma 90%. Bugu da kari, an yi koma-baya na layi mai yawa akan duka MemTrax masu canji, amma MTX mai canzawadaidai bai ba da gudummawa sosai ga samfurin ba don haka ba a nuna sakamakon ba.
Tebur 3
Shawarwari daidai makin MoCA don ƙimar MemTrax da aka bayar
| MoCA (maki) | Daidai MTXgudun (s-1)a | CI na tsinkaya tare da MTXgudun (maki) | Daidai MTXdaidai (%)b | CI na tsinkaya tare da MTXdaidai (maki) |
| 15 | 0.55 | 7 - 23 | 68 | 3 - 28 |
| 16 | 0.59 | 8 - 24 | 71 | 5 - 28 |
| 17 | 0.63 | 10 - 24 | 73 | 6 - 28 |
| 18 | 0.67 | 11 - 25 | 76 | 8 - 28 |
| 19 | 0.71 | 12 - 26 | 79 | 9 - 29 |
| 20 | 0.75 | 13 - 27 | 82 | 11 - 29 |
| 21 | 0.79 | 14 - 28 | 84 | 12 - 30 |
| 22 | 0.83 | 15 - 29 | 87 | 13 - 30 |
| 23 | 0.87 | 16 - 30 | 90 | 14 - 30 |
| 24 | 0.91 | 17 - 30 | 93 | 15 - 30 |
| 25 | 0.95 | 18 - 30 | 95 | 16 - 30 |
| 26 | 0.99 | 19 - 30 | 98 | 16 - 30 |
| 27 | 1.03 | 20 - 30 | 100 | 17 - 30 |
| 28 | 1.07 | 21 - 30 | 100 | 17 - 30 |
| 29 | 1.11 | 21 - 30 | 100 | 17 - 30 |
| 30 | 1.15 | 22 - 30 | 100 | 17 - 30 |
aDaidaiton da aka yi amfani da shi: 1.1 + 25.2 *MTXgudun; b Daidaiton da aka yi amfani da shi: –9.7 + 0.36 *MTXdaidai.
Bugu da ƙari, ƙimar yankewar MTX da madaidaicin hankali da ƙayyadaddun ƙayyadaddun an ƙaddara ta hanyar nazarin ROC. An gabatar da maƙallan ROC na masu canji na MemTrax a cikin siffa 3. AUCs na MTXgudun da MTXdaidai su ne, bi da bi, 66.7 (CI: 54.9 - 78.4) da 66.4% (CI: 54.1 - 78.7). AUC na masu canji na MemTrax da aka yi amfani da su don tantance MCI da MoCA ya kafa ba su da bambanci sosai. Tebur 4 yana nuna azanci da ƙayyadaddun wuraren yanke yanke daban-daban na masu canjin MemTrax. Mafi kyawun makin yankewa, wanda ya haɓaka ƙimar gaskiya yayin da yake rage ƙimar ƙarya, don MTXgudun da MTXdaidai sun kasance 0.91 s-1 (hankali = 48.9% takamaiman = 78.4%) da 85% (hankali = 43.2%; takamaiman = 93.3%), bi da bi.
Fig.3
ROC masu lankwasa na sakamakon gwajin MTX don tantance MCI da MoCA ya ƙima. Layin mai digo yana nuna MTXgudun da kuma m line MTXdaidai. Layin launin toka yana wakiltar layin tunani na 0.5.
ROC masu lankwasa na sakamakon gwajin MTX don tantance MCI da MoCA ya ƙima. Layin dige-dige yana nuna saurin MTX da ingantaccen layin MTX daidai. Layin launin toka yana wakiltar layin tunani na 0.5.
Tebur 4
MTXgudun da MTXdaidai maki yanke da takamaiman takamaiman da hankali
| Wurin yankewa | Tp (#) | tn (#) | Fp (#) | Fn (#) | Musamman (%) | Hankali (%) | |
| MTXgudun | 1.20 | 37 | 1 | 44 | 0 | 2.2 | 100 |
| 1.10 | 36 | 7 | 38 | 1 | 15.6 | 97.3 | |
| 1.0 | 33 | 13 | 32 | 4 | 28.9 | 89.2 | |
| 0.90 | 28 | 22 | 23 | 9 | 48.9 | 75.7 | |
| 0.80 | 18 | 34 | 11 | 19 | 75.6 | 48.6 | |
| 0.70 | 9 | 41 | 4 | 28 | 91.1 | 24.3 | |
| 0.60 | 3 | 45 | 0 | 34 | 100 | 8.1 | |
| MTXdaidai | 99 | 36 | 3 | 42 | 1 | 97.3 | 6.7 |
| 95 | 31 | 11 | 34 | 6 | 83.8 | 24.4 | |
| 91 | 23 | 23 | 22 | 14 | 62.2 | 51.1 | |
| 89 | 20 | 28 | 17 | 17 | 54.1 | 62.2 | |
| 85 | 16 | 42 | 3 | 21 | 43.2 | 93.3 | |
| 81 | 8 | 44 | 1 | 29 | 21.6 | 97.8 | |
| 77 | 3 | 45 | 0 | 34 | 8.1 | 100 |
tp, tabbataccen gaskiya; tn, rashin gaskiya na gaskiya; fp, tabbataccen ƙarya; fn, karya mara kyau.
DISCUSSION
An saita wannan binciken don bincika kayan aikin MemTrax akan layi, gwajin tushen CRT, ta amfani da MoCA azaman tunani. An zaɓi MoCA saboda a halin yanzu ana amfani da wannan gwajin don tantance MCI. Koyaya, mafi kyawun wuraren yankewa na MoCA ba a bayyana a fili ba [28]. Kwatancen ma'auni na kowane mutum na MemTrax tare da MoCA sun nuna cewa gwaji mai sauƙi, gajere, kan layi na iya ɗaukar wani muhimmin kashi na bambancin aiki na fahimi da rashin fahimta. A cikin wannan bincike, an ga tasirin mafi ƙarfi don ma'aunin sauri. Ma'aunin daidaitaccen ya nuna alaƙa mai ƙarancin ƙarfi. Wani muhimmin bincike shi ne cewa ba a sami alaƙa tsakanin saurin MTX da matakan daidaitawa ba, wanda ke nuna cewa waɗannan masu canji suna auna sassa daban-daban na tushen. aikin sarrafa kwakwalwa. Don haka, ba a sami wata alama ta saurin-daidaitaccen ciniki a cikin batutuwa ba. Bugu da ƙari, an yi amfani da hanyoyi daban-daban guda biyu don ƙididdige ƙimar yankewar gwajin ƙwaƙwalwar MemTrax don gano MCI. Waɗannan hanyoyin sun nuna cewa don saurin sakamako da daidaito, ƙima a ƙasa da jeri na 0.87 - 91 s.-1 kuma 85 - 90% nuni ne cewa mutanen da suka ci ƙasa da ɗaya daga cikin waɗannan jeri sun fi samun MCI. "Binciken cancantar farashi" zai nuna a wane lokaci ya kamata a shawarci mutum don tuntubar likita game da yin ƙarin cikakkun gwaje-gwaje don nunawa ga MCI [8-35].
A cikin binciken da aka yi a yanzu, an gano cewa yankunan "suna", "harshe", da "abstraction" da aka auna ta hanyar MoCA suna da dangantaka mafi girma tare da ɗaya daga cikin sakamakon MemTrax, kodayake haɗin gwiwar sun kasance masu rauni zuwa matsakaici. Wannan ya bambanta da abin da ake tsammani, tun da binciken da aka yi a baya ya nuna a cikin nazarin Jarabawar Karamar Hankali na Jiha ta amfani da Ka'idar Amsa Abu, cewa yankunan "tunawa / jinkirin tunawa" da "daidaitawa" sun kasance mafi mahimmanci ga farkon AD [12]. A wannan sosai farkon mataki na rashin fahimta, ya bayyana cewa alamun MoCA na rashin lahani a cikin suna, harshe, da abstraction sun fi kulawa da MCI fiye da ma'auni na ƙwaƙwalwar ajiya da daidaitawa, daidai da binciken da ya gabata a cikin Binciken Ka'idar Amsa Abu na MoCA [36]. Bugu da ari, da Ma'aunin MemTrax na saurin ganewa yana bayyana yana nuna wannan rashin ƙarfi na farko kafin ƙwaƙwalwar ajiya kamar yadda aka auna ta MTX (wanda ke da tasiri mai mahimmanci). Wannan ƙungiyar taurari ta Sakamakon yana nuna cewa hadaddun abubuwan da ke tattare da cututtukan da ke haifar da MCI suna nuna kwakwalwar farko canje-canje waɗanda ke da wahalar fahimta tare da hanyoyi masu sauƙi na neurocognitive kuma suna iya zahiri nuna ci gaban da ke tattare da neuropathology [37].
Mahimman bayanai a cikin binciken yanzu shine cewa girman samfurin (n = 82) ya fi dacewa don gano alaƙa tsakanin MoCA da MTX a cikin wannan tsohuwar yawan jama'a. Bugu da kari, an gudanar da gwajin aiki ga dukkan batutuwa, ta yadda tsofaffi wadanda ba su amfani da na'urar kwamfuta sun sami damar daidaita yanayin gwaji da kayan aiki. Idan aka kwatanta da MoCA, batutuwa sun nuna cewa MemTrax ya fi jin daɗi don yin, yayin da MoCA ta ji kamar jarrabawa. Shekarun batutuwa da 'yancin kai na al'umma sun iyakance mayar da hankali ga binciken ga wannan rukunin mutane masu girman kai, amma wannan rukunin yana cikin mafi wahala ga gano nakasu.
Na bayanin kula, ko da yake an yi la'akari da daidaitaccen gwajin gwaji, MoCA gwaji ne kawai don nuna yiwuwar kasancewar MCI, ba kayan aikin bincike ba ko cikakkiyar ma'auni na rashin aiki na hankali. Don haka, bisa ga haka, kwatancen MoCA da MTX dangi ne, kuma ko dai yana yiwuwa ya sami bambance-bambance mai zaman kansa a cikin tantancewar MCI. Saboda haka, wani muhimmin al'amari a cikin wallafe-wallafen shine ƙoƙari na ayyana amfanin MoCA [38], ingancinsa [39], kafa ƙididdiga na al'ada [40], kwatanta tare da wasu taƙaitaccen kimantawa na fahimi [41-45]. , da kuma amfaninsa azaman kayan aikin nunawa don MCI [46] (bita ta Carson et al., 2017 [28]), da kuma amfani da sigar lantarki [47]. Irin waɗannan nazarin sun haɗa da nazarin hankali da ƙayyadaddun ƙayyadaddun bayanai, yawanci ta yin amfani da bincike na ROC tare da ma'auni na "yankin da ke ƙarƙashin lanƙwasa", da kuma shawarar yankewa don "ganewa". Koyaya, idan babu wata hanya don tantance cikakken inda mutum yake kwance akan ci gaba da rauni mai rauni, tare da babban canji a cikin abubuwan da ke ciki. ayyukan kwakwalwa yana ba da gudummawa ga wannan lahani, duk irin waɗannan kayan aikin na iya ba da ƙima mai yiwuwa kawai. Samar da alaƙa tsakanin ma'auni daban-daban kawai yana nuna cewa ana magance yanayin da ke ƙasa daidai, amma ainihin yanayin halitta ba za a iya bayyana daidai da wannan hanyar ba. Ko da yake bincike mafi girma na iya zama da amfani a zahiri a cikin yanayin asibiti, kafa irin wannan kayan aiki yana buƙatar ƙarin la'akari da abubuwa huɗu: yawan yanayin a cikin jama'a; Farashin gwaji, farashin sakamako mai kyau na karya, da fa'idar kayan aiki na ingantaccen ganewar asali [8, 35].
Babban Wani ɓangare na matsalar a kimanta AD da rashin fahimtarsa da ke tattare da shi shine cewa babu ainihin "matakai" [48], amma a maimakon haka ci gaba na ɗan lokaci [8, 17, 49]. Bambancin "na al'ada" daga MCI yana da matukar wahala fiye da bambanta ɗayan waɗannan yanayi daga m. ciwon hauka hade da AD [50, 51]. Yin amfani da manufar "Ka'idar Gwaji ta Zamani", batun ya zama ƙayyadaddun inda a kan ci gaba mai yiwuwa mutum ya kasance a cikin kewayon tazara na amincewa, wanda aka ba da ƙimar gwaji ta musamman. Don yin irin waɗannan ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙima, ana buƙatar ƙarin ingantattun ƙima fiye da waɗanda aka bayar ta mafi yawan taƙaitaccen gwajin fahimi, amma irin waɗanda MTX ke bayarwa. Ingantacciyar daidaito da kawar da son zuciya tare da gwajin kwamfuta hanya ce mai ban sha'awa. Hakanan, gwajin na'ura mai kwakwalwa, kamar MemTrax, yana ba da yuwuwar ƙididdige adadin gwaje-gwaje mara iyaka, wanda ke rage bambance-bambancen kimanta nakasu. Bugu da ari, bisa ƙa'ida, gwajin kwamfuta na iya gwada yawancin wuraren da ke da alaƙa da ƙwaƙwalwar ajiya wanda AD ya shafa. Wannan binciken bai kwatanta MTX da ɗimbin gwaje-gwajen kwamfuta da aka ƙirƙira ba (duba gabatarwar), amma babu ɗaya daga cikin waɗanda ake da su a yanzu da ke amfani da ƙaƙƙarfan tsarin da CRT ke bayarwa. Ci gaba da haɓaka gwajin na'urar kwamfuta muhimmin yanki ne don ƙarin kulawa da tallafi. Daga karshe, tasirin horo za a iya ƙididdige su a cikin nazari.
A wannan lokacin, gwajin kan layi na kwamfuta ba shine kafaffen hanya ba allo don ciwon hauka, tantance rashin fahimta, ko yin kowane ganewar asibiti. Koyaya, iko da yuwuwar wannan hanyar, musamman amfani da CRT, don kimanta ƙwaƙwalwar ƙwaƙwalwa (na ɗan gajeren lokaci), yana da girma kuma yana iya zama mai mahimmanci a aikace-aikace na kimanta fahimi na gaba, gami da duban ciwon hauka da kimantawa, saka idanu rikicewar bayan aiki, kafa ikon tunani don yanke shawara, gano ƙarancin rikicewar rikice-rikice, da ƙididdige yiwuwar rashin ƙarfi don amincin tuki. A cikin wannan binciken, an nuna cewa MemTrax na iya ɗaukar kaso mai mahimmanci na bambancin rashin fahimta. Bugu da ƙari, ana gabatar da ƙimar yankewa don masu canjin MTX waɗanda suka yi daidai da makin yanke yanke na MoCA na MCI. Don bincike na gaba, an ba da shawarar yin bincike a cikin mafi girma, mafi ƙayyadadden ma'anar yawan jama'a don kafa MemTrax azaman kayan aikin tantancewa don MCI. Irin wannan yawan ya kamata ya haɗa da samfurori na asibiti inda za'a iya bayyana batutuwan bincike kamar yadda zai yiwu kuma ana iya bin batutuwa cikin lokaci tare da MTX da sauran gwaje-gwajen fahimi. Irin waɗannan nazarin na iya ƙayyade bambance-bambance a cikin abubuwan da ke haifar da raguwar fahimi, waɗanda ke da alaƙa da tsufa na al'ada da kuma yanayin cututtukan cututtuka daban-daban. Yayin da gwajin na'ura mai kwakwalwa da rajista ke haɓaka, ƙarin bayani game da matakan kiwon lafiya zai zama samuwa kuma babu shakka zai haifar da babban ci gaba a cikin kiwon lafiya da fatan hanyoyin da za a bi don hana irin waɗannan yanayi kamar AD.
ACKNOWLEDGMENTS
Muna so mu gode wa Anne van der Heijden, Hanneke Rasing, Esther Sinnema, da Melinda Lodders don aikin da suka yi a wannan binciken. Bugu da kari, muna so mu gode wa MemTrax, LLC don samar da cikakkun nau'ikan gwajin MemTrax kyauta. Wannan aikin wani ɓangare ne na shirin bincike, wanda Lardin Fryslân (01120657), Netherlands da Alfasigma Nederland BV (gudunmawar kai tsaye don bayar da lambar 01120657). An buga: 12 Fabrairu 2019
nassoshi
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Mahimman kalmomi: cutar Alzheimer, aikin ci gaba da aiki, lalata, tsofaffi, ƙwaƙwalwar ajiya, rashin hankali mai laushi, nunawa
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