Mayeso a MemTrax Poyerekeza ndi Mayeso a Montreal Cognitive Assessment of Mild Cognitive Impairment

Mtundu wankhani: MemTrax Research nkhani

Olemba: van der Hoek, Marjanne D. | Nieuwenhuizen, Arie | Keijer, Jaap | Ashford, J. Wesson

Kuyanjana:  Sukulu ya Stanford, Stanford, CA, USA - Dipatimenti ya Psychiatry and Behavioral Sciences, Applied Research Center Food and Dairy, Van Hall Larenstein University of Applied Sciences, Leeuwarden, Netherlands | Human and Animal Physiology, Wageningen University, Wageningen, Netherlands | War Related Illness and Injury Study Center, VA Palo Alto HCS, Palo Alto, CA, USA

DOI: 10.3233/JAD-181003

Journal: Journal of Matenda a Alzheimer's, vol. 67, ayi. 3, pp. 1045-1054, 2019

Kudalirika

Kusokonezeka kwa chidziwitso ndizomwe zimayambitsa kusokonekera kwa okalamba. Liti kuwonongeka kwachidziwitso pang'ono (MCI) amapezeka mwa okalamba, nthawi zambiri amakhala prodromal condition to dementia. The Montreal Cognitive Assessment (MoCA) ndi chida chomwe chimagwiritsidwa ntchito kwambiri powonera MCI. Komabe, mayesowa amafunikira kuyang'anira maso ndi maso ndipo amapangidwa ndi mafunso osiyanasiyana omwe mayankho awo amawonjezedwa palimodzi ndi wowerengera kuti apereke chigoli chomwe tanthauzo lake lenileni lakhala lotsutsana. Phunziroli linapangidwa kuti liwunikire momwe makompyuta amagwirira ntchito kuyesa kukumbukira (MemTrax), yomwe ndikusintha kwa ntchito yodziwika mosalekeza, molingana ndi MoCA. Zotsatira ziwiri zimapangidwa kuchokera ku Mayeso a MemTrax: MemTraxspeed ndi MemTraxcorrect. Maphunziro adayendetsedwa ndi MoCA ndi Mayeso a MemTrax. Malingana ndi zotsatira za MoCA, maphunziro adagawidwa m'magulu awiri a chidziwitso: chidziwitso chachibadwa (n = 45) ndi MCI (n = 37. Kutanthauza kuti MemTrax ambiri anali otsika kwambiri mu MCI kusiyana ndi gulu lodziwika bwino. Zotsatira zonse za MemTrax zinali zogwirizana ndi MoCA. Njira ziwiri, kuwerengera pafupifupi Kupambana kwa MemTrax ndi kusinthika kwa mzere kunagwiritsidwa ntchito kuyerekezera miyeso ya mayeso a MemTrax. kuti azindikire MCI. Njirazi zidawonetsa kuti pazotsatira za MemTrax_liwiro mphambu pansi pa 0.87 - 91 s^-1 ndi chisonyezo cha MCI, ndi zotsatira za MemTrax_zolondola mphambu pansi pa 85 - 90% ndi chisonyezo cha MCI.

MAU OYAMBA

Chiwerengero cha anthu padziko lonse lapansi, motsogozedwa ndi Europe, North America, ndi Northern Asia, chikukalamba, zomwe zikuchititsa chiwonjezeko chofulumira cha okalamba. Ndi kukula kwa msinkhu, pali kuwonjezeka kwachidziwitso, kuwonjezeka kwachidziwitso kwachidziwitso, dementia, ndi matenda a Alzheimer (AD), zomwe zikupangitsa kuti chiwonjezeko chachikulu cha anthu omwe ali ndi vutoli. Kuzindikira koyambirira ndi kuzindikira matenda a chidziwitso kungathandize kuti chisamaliro cha odwala chikhale bwino, kuchepetsa mtengo wa chithandizo chamankhwala, ndipo kungathandize kuchepetsa kuyambika kwa zizindikiro zoopsa kwambiri, motero zingathandize kuchepetsa kulemedwa msanga kwa dementia ndi AD. Chifukwa chake, zida zabwino zimafunikira kuyang'anira ntchito yachidziwitso mwa okalamba.

Kuti awonetsere zachipatala zokhudzana ndi chidziwitso ndi machitidwe a okalamba, asing'anga ndi ochita kafukufuku apanga mazana a zida zowunikira komanso zowunikira mwachidule, ndipo mayeso angapo agwiritsidwa ntchito mofanana. Chimodzi mwa zida zomwe zimagwiritsidwa ntchito pafupipafupi pakuwunika kwachipatala za kufooka kwa chidziwitso (MCI) m'maphunziro amaphunziro ndi Montreal Cognitive Assessment (MoCA).

MoCA imawunika ntchito zisanu ndi ziwiri zachidziwitso: wamkulu, kutchula dzina, chidwi, chilankhulo, mawu, kukumbukira / kukumbukira mochedwa, ndi malingaliro. Madera kukumbukira / kuchedwa kukumbukira ndi kuwongolera kwa MoCA kudazindikirika kale kuti ndi zinthu zomwe zimakhudzidwa kwambiri ndi zovuta zachidziwitso zamtundu wa Alzheimer's, zomwe zidatsogolera ku lingaliro lakuti kukumbukira kukumbukira ndiye chinthu chofunikira kwambiri chomwe chidawukiridwa ndi AD neuropathological process. Choncho, mu chida chachipatala chowunika kuwonongeka kwa chidziwitso chokhudzana ndi AD, kukumbukira ndi chinthu chapakati cha chidziwitso choyenera kuganizira, pamene zofooka zina, kuphatikizapo aphasia, apraxia, agnosia, ndi kusagwira bwino ntchito, ngakhale kuti nthawi zambiri zimasokonezedwa ndi AD, zingakhale zogwirizana. ku kukanika kwa ma neuroplastic memory processing njira m'magawo othandizira a neocortical.

Ngakhale kuti MoCA imagwiritsidwa ntchito kwambiri poyesa MCI, kuyang'anira MoCA kumachitika maso ndi maso, zomwe zimatenga nthawi ndipo zimafuna kukumana ndi zachipatala ndipo chifukwa chake zimafunika ndalama zambiri pa kayendetsedwe kake. Pakuwunika, nthawi yofunikira popereka mayeso imawonjezera kulondola kwa kafukufukuyu, kotero kuti zomwe zikuchitika m'tsogolomu ziyenera kuganizira za ubalewu kuti apange mayeso oyenerera.

Mfundo yofunika kwambiri m'derali ndiyofunika kuunika kwachidziwitso pakapita nthawi. Kuwunika kwa kusintha kwa nthawi ndi zofunika kuzizindikira ndikuzindikira kupitilira kwa kuwonongeka, mphamvu ya chithandizo, komanso kuunika kwa kafukufuku wochizira. Zida zambiri zotere zomwe zilipo sizoyenera kapena zopangidwira kuti zikhale zolondola kwambiri ndipo sizitha kuperekedwa mosavuta pafupipafupi. Njira yothetsera kuwunika kwachidziwitso idanenedwa kukhala makompyuta, koma zoyesayesa zambiri zotere zapereka zochulukirapo kuposa kuyesa kwapakompyuta kwa mayeso omwe amagwiritsidwa ntchito nthawi zambiri, ndipo sizinapangidwe kuti zithetseretu zovuta za kuwunika kwachidziwitso komwe kumafunikira kumvetsetsa koyambirira. maganizo ndi kupita kwake. Choncho, zida zatsopano zowunikira zidziwitso ziyenera kukhazikitsidwa pakompyuta ndikutengera magwero opanda malire a mayeso ofananiza, omwe sali malire ndi chilankhulo kapena chikhalidwe, omwe amapereka milingo yolondola, yolondola, komanso yodalirika yomwe ingasinthidwe pang'onopang'ono. Kuonjezera apo, mayesero oterowo ayenera kukhala osangalatsa komanso ochititsa chidwi, kotero kuti kuyesa mobwerezabwereza kudzaonedwa ngati zabwino osati zochitika zovuta. Kuyesa pa intaneti, makamaka, kumapereka mwayi wokwaniritsa chosowachi, pomwe akupereka kusonkhanitsa mwachangu ndi kusanthula deta, ndikupereka ndemanga zaposachedwa kwa anthu omwe atenga nawo mbali, azachipatala, ndi ofufuza.

Phunziroli lidapangidwa kuti liwunikire kugwiritsa ntchito njira yosinthira pa intaneti ya paradigm yodziwika bwino (CRT), poyesa kuzindikira kwachidziwitso pakati pa anthu okhala mdera lomwe sanadziwike kuti ali ndi dementia. Paradigm ya CRT imagwiritsidwa ntchito kwambiri pamaphunziro maphunziro a kukumbukira njira. Njira ya CRT idakhazikitsidwa koyamba ngati chida chowonetsera omvera chomwe chimapereka chidziwitso kwa anthu omwe anali ndi chidwi mavuto a kukumbukira. Pambuyo pake, mayesowa adakhazikitsidwa pa intaneti ndi kampani yaku France (HAPPYneuron, Inc.); ndi kampani yaku US, MemTrax, LLC (http://www.memtrax.com); pa Brain Health Registry yopangidwa ndi Dr. Michael Weiner, UCSF, ndi gulu lake kuti athandizire kulembera anthu maphunziro a kuwonongeka kwa chidziwitso; ndi kampani yaku China ya SJN Biomed, LTD). Mayesowa, kuyambira Juni 2018, adapeza zambiri kuchokera kwa ogwiritsa ntchito oposa 200,000, ndipo ali m'mayesero m'maiko angapo.

Pakafukufuku wapano, MemTrax (MTX), mayeso ozikidwa pa CRT, adayendetsedwa molumikizana ndi MoCA mwa okalamba odzidalira okha kumpoto kwa Netherlands. Cholinga cha kafukufukuyu chinali kudziwa mgwirizano womwe ulipo pakati pa machitidwe a CRT ndi MoCA. Funso linali ngati MTX ingakhale yothandiza pakuyerekeza ntchito zachidziwitso zoyesedwa ndi MoCA, zomwe zingasonyeze kuti zitha kugwiritsidwa ntchito kuchipatala.

ZIDA NDI NJIRA

Chiwerengero cha ophunzira

Pakati pa Okutobala 2015 ndi Meyi 2016, kafukufuku wam'mbali adachitika pakati pa okalamba okhala mdera lakumpoto kwa Netherlands. Mitu (≥75y) adalembetsedwa kudzera pakugawa timapepala komanso pamisonkhano yamagulu yokonzekera okalamba. Anthu omwe akuyembekezeka adachezeredwa kunyumba kuti awonere momwe angaphatikizire komanso osasankhidwa asanalembetsedwe mu kafukufukuyu. Anthu omwe anali ndi vuto laumisala (wodzinenera okha) kapena omwe anali ndi vuto lakuwona bwino kapena kumva zomwe zingakhudze kayendetsedwe ka mayeso a chidziwitso sanaloledwe kutenga nawo gawo mu kafukufukuyu. Kuonjezera apo, ophunzira ankafunika kulankhula ndi kumvetsa chinenero cha Chidatchi komanso osakhala osaphunzira. Kafukufuku wachitika molingana ndi chilengezo cha Helsinki cha 1975 ndipo onse omwe adatenga nawo gawo adasaina chikalata. chidziwitso chodziwika fomu atalandira tsatanetsatane wa kafukufukuyu.

Njira yophunzirira

Pambuyo polembetsa mu phunziroli, mafunso ambiri adaperekedwa, omwe adaphatikizapo mafunso okhudza chiwerengero cha anthu, monga zaka ndi zaka za maphunziro (kuyambira kusukulu ya pulayimale), mbiri yachipatala, ndi kumwa mowa. Pambuyo pomaliza kufunsa mafunso, mayeso a MoCA ndi MTX adayendetsedwa mwachisawawa.

MemTrax - Research Medical Center

Monga mwachilolezo cha MemTrax, LLC (Redwood City, CA, USA), mitundu yaulere ya mayeso a MTX idaperekedwa. Mu mayeso awa, mndandanda wazithunzi za 50 zikuwonetsedwa mpaka masekondi atatu chilichonse. Chithunzi chobwerezabwereza chikawonekera (25/50), ophunzirawo adalangizidwa kuti achitepo kanthu pa chithunzi chobwerezabwereza mwachangu momwe angathere ndikukanikiza spacebar (yomwe idawonetsedwa ndi tepi yofiira). Munthuyo atayankha chithunzi, chithunzi chotsatira chinawonetsedwa nthawi yomweyo. Mukamaliza mayeso, pulogalamuyi ikuwonetsa kuchuluka kwa mayankho olondola (MTX_zolondola) ndi avareji ya nthawi yakuchita mumasekondi pazithunzi zobwerezedwa, zomwe zimawonetsa nthawi yofunikira kuti musindikize spacebar pozindikira chithunzi chobwerezedwa. Kuti mufanane ndi kukula kwa miyeso iwiriyi, nthawi yochitapo kanthu idasinthidwa kukhala liwiro lakuchita (MTX_liwiro) pogawa 1 ndi nthawi yochitira (ie, 1/MTX_{nthawi yochitira}). Mbiri yoyeserera ya zigoli zonse za MemTrax ndi kutsimikizika kwake zidasungidwa pa intaneti mu akaunti yoyeserera. Kutsimikizika kwa mayeso onse omwe adachitidwa kudawunikidwa, kumafuna mayankho abodza a 5 kapena ochepa, 10 kapena kupitilirapo kolondola, komanso nthawi yodziwika pakati pa 0.4 ndi 2 masekondi, ndipo mayeso ovomerezeka okha adaphatikizidwa pakuwunika.

Mayeso enieni a MTX asanachitike, mayesowo adafotokozedwa mwatsatanetsatane ndipo mayeso oyeserera adaperekedwa kwa ophunzirawo. Izi sizinaphatikizepo kuyesa kokha, komanso malangizo ndi masamba owerengera kuti alole wophunzira kuti azolowere makonzedwe a malo ndi zochita zoyamba zomwe zimafunikira, asanayambe kuyesa. Pofuna kupewa kubwereza zithunzi panthawi yoyesera, zithunzi zomwe sizinaphatikizidwe mu database ya MemTrax zinagwiritsidwa ntchito poyesa kuyesa.

Montreal cognitive assessment chida

Chilolezo chinapezedwa ku MoCA Institute & Clinique (Quebec, Canada) kuti agwiritse ntchito MoCA pa kafukufukuyu. Dutch MoCA ikupezeka m'mitundu itatu, yomwe idaperekedwa mwachisawawa kwa maphunzirowo. Zolemba za MoCA ndi kuchuluka kwa magwiridwe antchito pagawo lililonse lazidziwitso lomwe limawunikidwa ndipo lili ndi mapointi 30 opambana. Malinga ndi malingaliro aboma, mfundo yowonjezera idawonjezedwa ngati wophunzirayo anali ndi zaka ≤12 zamaphunziro (ngati <30 mfundo). Malangizo a mayeso ovomerezeka adagwiritsidwa ntchito ngati chitsogozo panthawi yoyendetsa mayeso. Mayesowa adayendetsedwa ndi ofufuza atatu ophunzitsidwa bwino ndipo kuyang'anira mayeso amodzi kunatenga pafupifupi 10 mpaka 15 min.

Kusanthula kwa MemTrax Data

Kutengera ndi zotsatira za MoCA, zomwe zidakonzedwa pamaphunziro, maphunzirowo adagawidwa m'magulu awiri a chidziwitso cha chidziwitso: chidziwitso chodziwika bwino (NC) versus mild cognitive impairment (MCI). Zolemba za MoCA za 23 zidagwiritsidwa ntchito ngati njira yochepetsera ya MCI (ziwerengero za 22 ndi pansi zimaganiziridwa kuti ndi MCI), monga momwe zidawonetsedwera kuti ziwonetserozi zidawonetsa 'kulondola kwabwino kwambiri pazigawo zingapo' poyerekeza ndi zomwe zidaperekedwa poyamba. 26 kapena zikhalidwe za 24 kapena 25. Pazowunikira zonse, chiwerengero cha MoCA chokonzedwacho chinagwiritsidwa ntchito pamene chiwerengerochi chikugwiritsidwa ntchito muzochitika zachipatala.

Mayeso a MTX amapereka zotsatira ziwiri, zomwe ndi MTX_{nthawi yochitira}, yomwe idasinthidwa kukhala MTX_liwiro pa 1/MTX_{nthawi yochitira}ndi MTX_zolondola.

Kusanthula kwachiwerengero kunachitika pogwiritsa ntchito R (mtundu 1.0.143, Rstudio Team, 2016). Chizoloŵezi chinayang'aniridwa pazosintha zonse ndi mayeso a Shapiro-Wilk. Zosintha za chiwerengero chonse chophunzira, komanso zamagulu a NC ndi MCI, zidanenedwa kuti ndizosiyana ± zopatuka (SD), median ndi interquartile range (IQR) kapena ngati nambala ndi kuchuluka. Mayeso odziyimira pawokha a T-mayeso ndi mayeso a Wilcoxon Sum Rank pazosintha mosalekeza komanso mayeso a Chi-squared pamitundu yosiyanasiyana adachitidwa kuti afananize mawonekedwe a gulu la NC ndi MCI. Mayeso a Kruskal-Wallis omwe sanali parametric adagwiritsidwa ntchito kuti adziwe ngati mitundu itatu ya MoCA ndi oyang'anira atatu adakhudza zotsatira za MoCA. Kuphatikiza apo, mayeso odziyimira pawokha a T kapena mayeso a Wilcoxon Sum Rank adachitidwa kuti adziwe ngati dongosolo la kayendetsedwe ka MoCA ndi MTX lidakhudza zotsatira za mayeso (mwachitsanzo, mphambu ya MoCA, MTX._zolondolandi MTX_liwiro). Izi zidachitidwa pozindikira ngati kuchuluka kwapakati kunali kosiyana kwa ophunzira omwe adalandira koyamba MoCA kenako MemTrax kapena omwe adalandira koyamba MTX kenako MoCA.

Pearson mgwirizano mayeso adawerengedwa kuti awone ubale pakati pa MTX ndi MoCA komanso pakati pa onse a MemTrax zotsatira zoyesa, mwachitsanzo, MTXspeed ndi MTXcorrect. Kuwerengera kwa kukula kwachitsanzo komwe kudachitika kale kunawonetsa kuti pamayeso amtundu umodzi wa Pearson (mphamvu = 80% , α = 0.05), ndi lingaliro la kukula kwapakati (r = 0.3), kukula kochepa kwa n = 67 kunali kofunikira. Mayeso a polyserial correlation adawerengedwa kuti awone ubale pakati pa zotsatira za mayeso a MTX ndi madera osiyana a MoCA pogwiritsa ntchito phukusi la psych mu R.

Zofanana za MoCA zopatsidwa za MemTrax zidawerengedwa powerengera kuchuluka kwa MemTrax pamlingo uliwonse wotheka wa MoCA ndi kubwezeredwa kwa mzere kunachitika kuti muyerekeze ma equation okhudzana ndi miyesoyi. Kuonjezera apo, kuti mudziwe chiwerengero cha cutoff cha mayeso a MemTrax a MCI omwe amayezedwa ndi MoCA, ndi kukhudzidwa kofanana ndi makhalidwe enieni, kufufuza kwa Receiver Operator Characteristic (ROC) kunachitika pogwiritsa ntchito phukusi la pROC mu R. Non-parametric stratified bootstrapping (n = 2000) idagwiritsidwa ntchito kuyerekeza malo omwe ali pansi pa ma curve (AUCs) ndi nthawi yodalirika yofananira. Kupambana koyenera kudawerengedwa ndi njira ya Youden, yomwe imakulitsa zabwino zenizeni ndikuchepetsa zabwino zabodza.

Pakuwunika konse kwa ziwerengero, p-value ya mbali ziwiri ya <0.05 idawonedwa ngati poyambira kufunikira kwa ziwerengero, kupatula kusanthula kuwunika mgwirizano pakati pa MTX ndi MoCA (ie, kusanthula kwamalumikizidwe ndi kuwongolera kosavuta) komwe kumodzi- mbali ya p-mtengo wa <0.05 idawonedwa ngati yofunika.

Zotsatira za MemTrax

Ophunzira

Pazonse, maphunziro a 101 adaphatikizidwa mu phunziroli. Deta ya anthu 19 idachotsedwa pakuwunikiridwa, popeza zotsatira za mayeso a MemTrax kuchokera ku maphunziro a 12 sizinasungidwe ndi pulogalamuyi, maphunziro a 6 anali ndi zotsatira za mayeso a MemTrax osavomerezeka, ndipo phunziro limodzi linali ndi mphambu ya MoCA ya 8 mfundo, zomwe zikuwonetsa kuwonongeka kwakukulu kwachidziwitso, komwe kunali mulingo wopatula. Choncho, deta yochokera ku maphunziro a 82 inaphatikizidwa mu kusanthula. Palibe kusiyana kwakukulu pazotsatira za mayeso a MoCA komwe kunapezeka pakati pa mitundu yosiyanasiyana ya MoCA ndi pakati pa oyang'anira. Kuphatikiza apo, dongosolo la kayendetsedwe ka mayeso silinakhudze kwambiri mayeso aliwonse (MoCA, MTX_liwiro, MTX_zolondola). Kutengera zotsatira za mayeso a MoCA, maphunziro adayikidwa mu gulu la NC kapena MCI (mwachitsanzo, MoCA ≥ 23 kapena MoCA <23, motsatana). Makhalidwe a phunziro la chiwerengero cha anthu omwe amaphunzira, ndi magulu a NC ndi MCI akufotokozedwa mu Table 1. Palibe kusiyana kwakukulu komwe kunalipo pakati pa magulu, kupatulapo mawerengero apakati a MoCA (25 (IQR: 23 - 26) motsutsana ndi 21 (IQR: 19 - 22) ) mfundo, Z = -7.7, p <0.001).

Gulu 1

Makhalidwe

	Chiwerengero chonse cha ophunzira (n = 82)	NC (n = 45)	MCI (n = 37)	p
Zaka (y)	83.5 ± 5.2	82.6 ± 4.9	84.7 ± 5.4	0.074
Mayi, Ayi. (%)	55 (67)	27 (60)	28 (76)	0.133
Maphunziro (y)	10.0 (8.0 - 13.0)	11.0 (8.0 - 14.0)	10.0 (8.0 - 12.0)	0.216
Kumwa mowa (magalasi # / sabata)	0 (0 - 4)	0 (0 - 3)	0 (0 - 5)	0.900
Zigoli za MoCA (# points)	23 (21 - 25)	25 (23 - 26)	21 (19 - 22)	bwino

Makhalidwe amawonetsedwa ngati ± sd, median (IQR) kapena ngati nambala yokhala ndi peresenti.

Chidziwitso choyezedwa ndi MemTrax

Chidziwitso cha chidziwitso chinayesedwa ndi mayeso a MTX. Chithunzi 1 chikuwonetsa zotsatira za mayeso achidziwitso zotsatira za maphunziro a NC ndi MCI. Zotsatira zake za MTX (mwachitsanzo, MTX_liwiro ndi MTX_zolondola) anali osiyana kwambiri pakati pa magulu awiriwa. Mitu ya NC (0.916 ± 0.152 s^-1) anali ndi liwiro lalikulu kwambiri poyerekeza ndi maphunziro a MCI (0.816 ± 0.146 s^-1); t(80) = 3.01, p = 0.003) (mkuyu 1A). Kuphatikiza apo, maphunziro a NC anali ndi mphambu zabwinoko pa MTX_zolondola zosinthika kuposa maphunziro a MCI (91.2 ± 5.0% motsutsana ndi 87.0 ± 7.7% motsatana; t_w (59) = 2.89, p = 0.005) (Mkuyu 1B).

Firiji.1

Mabokosi a zotsatira za mayeso a MTX a magulu a NC ndi MCI. A) MTX_liwiro zotsatira za mayeso ndi B) MTX_zolondola zotsatira za mayeso. Zotsatira zonse za mayeso a MTX ndizotsika kwambiri mu gulu la MCI poyerekeza ndi NC. Mtundu wotuwa wonyezimira umawonetsa maphunziro a NC, pomwe imvi yakuda imawonetsa maphunziro a MCI.

Kugwirizana pakati pa MemTrax ndi MOCA

Mayanjano pakati pa mayeso a mayeso a MTX ndi MoCA akuwonetsedwa mu Chithunzi 2. Zosintha zonse za MTX zinali zogwirizana ndi MoCA. MTX_liwiro ndipo MoCA idawonetsa kulumikizana kwakukulu kwa r = 0.39 (p = 0.000), ndi kulumikizana pakati pa MTX_zolondola ndipo MoCA inali r = 0.31 (p = 0.005). Panalibe mgwirizano pakati pa MTX_liwiro ndi MTX_zolondola.

Firiji.2

Mgwirizano pakati pa A) MTX_liwiro ndi MoCA; B) MTX_zolondola ndi MoCA; C) MTX_zolondola ndi MTX_liwiro. Mitu ya NC ndi MCI imawonetsedwa ndi madontho ndi makona atatu motsatana. Pakona yakumanja ya graph iliyonse rho ndi mtengo wofananira wa p akuwonetsedwa pakulumikizana pakati pa mitundu iwiriyi.

Mgwirizano pakati pa A) MTXspeed ndi MoCA; B) MTXcorrect ndi MoCA; C) MTXZolondola ndi MTXspeed. Mitu ya NC ndi MCI imawonetsedwa ndi madontho ndi makona atatu motsatana. Pa ngodya ya kumanja ya graph iliyonse pali rho ndi p mtengo wofananira ndi kugwirizana pakati pa mitundu iwiriyi.[/caption]

Malumikizidwe a Polyserial adawerengedwa pakati pa mayeso a MemTrax ndi madera a MoCA kuti adziwe kugwirizana kwa domeni iliyonse ndi ma metric a MemTrax. Malumikizidwe a polyserial akuwonetsedwa mu Table 2. Madera angapo a MoCA anali ogwirizana kwambiri ndi MTX._{liwiro .}  Dera la "abstraction" likuwonetsa kulumikizana kwakukulu, ngakhale kuli kocheperako, ndi MTX_liwiro (r = 0.35, p = 0.002). Madera "kutchula mayina" ndi "chinenero" adawonetsa kusagwirizana kwakukulu ndi MTX_liwiro (r = 0.29, p = 0.026 ndi r = 0.27, p = 0.012, motsatira). MTX_zolondola sizinali zogwirizana kwambiri ndi madera a MoCA, kupatulapo kusagwirizana kofooka ndi dera la "visuospatial" (r = 0.25, p = 0.021).

Gulu 2

Kulumikizana kwa Polyserial kwa zotsatira za mayeso a MTX ndi madera a MoCA

	MTXliwiro	MTXzolondola
	r	p	r	p
Zithunzi za Visuospatial	0.22	0.046	0.25	0.021
Kutchula	0.29	0.026	0.24	0.063
chisamaliro	0.24	0.046	0.09	0.477
Language	0.27	0.012	0.160	0.165
Kuchotsa	0.35	0.002	0.211	0.079
Kumbukirani	0.15	0.159	0.143	0.163
Mafotokozedwe	0.21	0.156	0.005	0.972

Zindikirani: Kugwirizana kwakukulu kumasonyezedwa mwakuda.

Zolemba za MemTrax ndi mitengo yocheperako ya MCI

Kuti mudziwe ziwerengero zofananira za MemTrax ndi MoCA, zigoli za MemTrax za mphambu iliyonse ya MoCA zidawerengedwa ndipo kutsika kwa mzere kunawerengedwera kulosera za ubale ndi ma equation ofanana. Zotsatira za kusinthika kwa mzere zikuwonetsa kuti MTX_liwiro adafotokoza 55% ya kusiyana kwa MoCA (R² = 0.55, p = 0.001). Mtengo wa MTX_zolondola adafotokoza 21% ya kusiyana kwa MoCA (R² = 0.21, p = 0.048). Kutengera ma equation a maubwenzi amenewa, zigoli zofananira za MoCA zidawerengeredwa popatsidwa zigoli za MTX, zomwe zawonetsedwa mu Gulu 3. Kutengera ma equation awa, milingo yofananira yodulira (monga, mphambu ya MoCA ya 23 points) ya MTX._liwiro ndi MTX_zolondola ndi 0.87s^-1 ndi 90%. Kuphatikiza apo, kusinthasintha kwa mizere yambiri pamitundu yonse ya MemTrax kunachitika, koma kusinthika kwa MTX_zolondola sizinathandize kwambiri pa chitsanzocho ndipo zotsatira zake sizikuwonetsedwa.

Gulu 3

Zolinga zofananira za MoCA pazopatsidwa za MemTrax

MoCA (points)	Zofanana ndi MTXliwiro (s-1)a	CI yolosera ndi MTXliwiro (mfundo)	Zofanana ndi MTXzolondola (%)b	CI yolosera ndi MTXzolondola (mfundo)
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

^aEquation yogwiritsidwa ntchito: 1.1 + 25.2 *MTX_liwiro; ^b Equation yogwiritsidwa ntchito: -9.7 + 0.36 *MTX_zolondola.

Kuphatikiza apo, ma MTX cutoff values ​​ndi kukhudzika kofananira ndi kutsimikizika zidatsimikiziridwa kudzera pakuwunika kwa ROC. Mipiringidzo ya ROC yamitundu yosiyanasiyana ya MemTrax ikuwonetsedwa mu Chithunzi 3. Ma AUC a MTX_liwiro ndi MTX_zolondola ali, motero, 66.7 (CI: 54.9 - 78.4) ndi 66.4% (CI: 54.1 - 78.7). Ma AUC amitundu ya MemTrax omwe amagwiritsidwa ntchito poyesa MCI yokhazikitsidwa ndi MoCA sanali osiyana kwambiri. Table 4 ikuwonetsa kukhudzika ndi kutsimikizika kwa magawo osiyanasiyana amitundu yosiyanasiyana ya MemTrax. Zotsatira zabwino kwambiri, zomwe zidakulitsa zabwino zenizeni ndikuchepetsa zabwino zabodza, za MTX._liwiro ndi MTX_zolondola anali 0.91s^-1 (zomvera = 48.9% zenizeni = 78.4%) ndi 85% (zokhudzidwa = 43.2%; zenizeni = 93.3%), motero.

Firiji.3

ROC curves ya zotsatira za mayeso a MTX kuti awone MCI yovoteledwa ndi MoCA. Mzere wamadontho ukuwonetsa MTX_liwiro ndi mzere wolimba wa MTX_zolondola. Mzere wotuwa umayimira mzere wolozera wa 0.5.

Gulu 4

MTX_liwiro ndi MTX_zolondola ma cutoff point ndi kutsimikizika kofananira ndi chidwi

	Cutoff point	Tp (#)	tn (#)	Fp (#)	Fn (#)	Zachidziwitso (%)	Kukhudzika (%)
MTXliwiro	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
MTXzolondola	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, zenizeni zenizeni; tn, zenizeni zenizeni; fp, zabodza; fn, zabodza negative.

KUKANGANANI

Phunziroli linakhazikitsidwa kuti lifufuze chida cha MemTrax pa intaneti, mayeso ozikidwa pa CRT, pogwiritsa ntchito MoCA monga kufotokozera. MoCA idasankhidwa chifukwa mayesowa amagwiritsidwa ntchito kwambiri powonera MCI. Komabe, zodulira bwino za MoCA sizinakhazikitsidwe bwino [28]. Kuyerekeza kwa miyeso yamunthu payekha ya MemTrax ndi MoCA kukuwonetsa kuti kuyesa kosavuta, kwakanthawi kochepa, pa intaneti kumatha kutenga gawo lalikulu la kusiyana kwa magwiridwe antchito komanso kuwonongeka kwa chidziwitso. Pakusanthula uku, zotsatira zamphamvu kwambiri zidawoneka pakuyezetsa liwiro. Njira yolondola idawonetsa ubale wocheperako. Chofunikira chinali chakuti palibe kulumikizana komwe kunawonedwa pakati pa liwiro la MTX ndi miyeso yolondola, kuwonetsa kuti zosinthazi zimayesa magawo osiyanasiyana azomwe zili pansi. ubongo processing ntchito. Choncho, palibe chisonyezero cha malonda olondola mofulumira omwe anapezeka pamitu yonse. Kuonjezera apo, njira ziwiri zosiyana zinagwiritsidwa ntchito kuyerekezera miyeso ya cutoff ya MemTrax memory test kuti azindikire MCI. Njirazi zikuwonetsa kuti pa liwiro lazotsatira ndi kulondola, mphambu pansi pa milingo ya 0.87 - 91 s.^-1 ndipo 85 - 90% ndi chisonyezo chakuti anthu omwe apeza pansi pa mzerewu amakhala ndi mwayi wokhala ndi MCI. "Kusanthula kuyenera kwa mtengo" kungasonyeze nthawi yomwe munthu ayenera kulangizidwa kuti afunsane ndi dokotala za kuyezetsa kokwanira kuti awonetsere MCI [8-35].

Pakafukufuku wapano, zidapezeka kuti madera "kutchula mayina", "chilankhulo", "chinenedwe" choyezedwa ndi MoCA chinali ndi kulumikizana kwapamwamba kwambiri ndi chimodzi mwazotsatira za MemTrax, ngakhale kuti zolumikizanazo zinali zofooka pang'ono. Izi ndizosiyana ndi zomwe zimayembekezeredwa, popeza maphunziro am'mbuyomu adawonetsa pakuwunika Mayeso a Mini-Mental State pogwiritsa ntchito Item Response Theory, kuti madera "kukumbukira / kuchedwa kukumbukira" ndi "mayendedwe" anali okhudzidwa kwambiri ndi AD [12] yoyambirira. Pa izi pachiyambi za kusagwira bwino ntchito kwachidziwitso, zikuwoneka kuti zizindikiro za MoCA za kuwonongeka kosawoneka bwino pakutchula mayina, chilankhulo, komanso kutulutsa zimakhudzidwa kwambiri ndi MCI kuposa momwe amakumbukira komanso momwe amaganizira, mogwirizana ndi zomwe zapezedwa m'mbuyomu mu Item Response Theory kusanthula kwa MoCA [36]. Komanso, a Muyezo wa MemTrax wa liwiro lozindikirika ukuwoneka kuti ukuwonetsa kuwonongeka koyambiriraku musanazindikire kukumbukira monga momwe amayesedwera ndi MTX (yomwe ili ndi denga lalikulu). kuwundana uku Zotsatira zikuwonetsa kuti zovuta za matenda omwe amayambitsa MCI amawonetsa ubongo woyambirira zosintha zomwe zakhala zovuta kuzilingalira ndi njira zosavuta za neurocognitive ndipo zitha kuwonetsa kupitilira kwazomwe zimayambitsa matenda a neuropathology [37].

Mfundo zamphamvu mu kafukufuku wapano ndizoti kukula kwachitsanzo (n = 82) kunali kokwanira kuzindikira kugwirizana pakati pa MoCA ndi MTX pa anthu akale akale. Kuphatikiza apo, mayeso oyeserera amaperekedwa kwa maphunziro onse, kotero kuti okalamba omwe sanazolowerane ndi makompyuta anali ndi mwayi wosinthira ku malo oyesera ndi zida. Poyerekeza ndi MoCA, maphunziro adawonetsa kuti MemTrax inali yosangalatsa kuchita, pomwe MoCA idamva ngati mayeso. Zaka za maphunzirowa ndi kudziimira pawokha m'dera lawo zimangoyang'ana kuwunika kwa gulu losankhidwa ili la anthu omwe amagwira ntchito kwambiri, koma gulu ili ndi limodzi mwazovuta kwambiri pakuzindikiritsa kuwonongeka.

Chodziwikiratu, ngakhale amayesedwa ngati mayeso oyeserera, MoCA ndi mayeso chabe osonyeza kupezeka kwa MCI, osati chida chodziwira matenda kapena kuyeza kwathunthu kwa kusagwira bwino ntchito kwachidziwitso. Chifukwa chake, kufananiza kwa MoCA ndi MTX kuli kofanana, ndipo mwina mwina kudatenga kusiyana kodziyimira pawokha pakuzindikiritsa kwa MCI. Chifukwa chake, nkhani yofunika kwambiri m'mabuku yakhala kuyesetsa kufotokoza kufunika kwa MoCA [38], kutsimikizika kwake [39], kukhazikitsidwa kwa ziwerengero zokhazikika [40], kuyerekeza ndi kuwunika kwina kwachidule kwachidziwitso [41-45] , ndi zofunikira zake ngati chida chowunikira cha MCI [46] (yowunikiridwa ndi Carson et al., 2017 [28]), komanso kugwiritsa ntchito mtundu wamagetsi [47]. Kusanthula kotereku kumaphatikizapo kuwunika kukhudzika ndi kutsimikizika, nthawi zambiri kugwiritsa ntchito kusanthula kwa ROC ndi kuyeza kwa "malo opindika", komanso malingaliro odulira "kuzindikira". Komabe, popanda njira iliyonse yodziwira komwe munthu wagona pakupitilirabe kufooka pang'ono, komanso kusiyanasiyana kwakukulu komwe kulipo. ntchito za ubongo Kuthandizira kuwonongeka kumeneko, zida zonse zotere zitha kungopereka chiyerekezo chotheka. Kupereka mgwirizano pakati pa miyeso yosiyana kumangosonyeza kuti zomwe zili pansizi zikuyankhidwa molondola, koma zenizeni zenizeni zamoyo sizingafotokozedwe bwino ndi njirayi. Ngakhale kusanthula kwapamwamba kungakhale kothandiza pazachipatala, kukhazikitsidwa kwa chithandizo choterocho kumafuna kulingalira mowonjezereka pazifukwa zinayi: kufalikira kwa matendawa mwa anthu; mtengo woyezetsa, mtengo wa zotsatira zabodza, ndi phindu lazinthu zodziwikiratu zowona [8, 35].

Chofunika gawo lavuto pakuwunika AD ndi kuwonongeka kwachidziwitso komwe kumagwirizanako ndikuti palibe zenizeni "magawo" [48], koma kupitilira kwakanthawi [8, 17, 49]. Kusiyanitsa kwa "zabwinobwino" kuchokera ku MCI ndikovuta kwambiri kuposa kusiyanitsa izi ndi zofatsa. dementia yogwirizana ndi AD [50, 51]. Pogwiritsa ntchito lingaliro la "Chiphunzitso Chamakono Chakuyesa", vuto limakhala lodziwikiratu komwe nthawi zonse munthu atha kukhala mkati mwanthawi yodalirika, atapatsidwa mphambu inayake. Kuti mudziwe izi, kuwunika kolondola kumafunika kuposa kuyesedwa kwachidule kwachidziwitso, koma komwe kumaperekedwa ndi MTX. Kuchulukirachulukira ndikuchotsa kukondera kwa owonera ndi kuyezetsa pakompyuta ndi njira yodalirika. Komanso, kuyesa kwa makompyuta, monga MemTrax, kumapereka mwayi wa chiwerengero chopanda malire cha mayesero ofanana, kuchepetsa kwambiri kusiyana kwa chiwerengero cha kuwonongeka. Komanso, kwenikweni, kuyesa pakompyuta kumatha kuyesa madera ambiri okhudzana ndi kukumbukira omwe akhudzidwa ndi AD. Phunziroli silinafanizire MTX ndi mayeso ena ambiri apakompyuta omwe adapangidwa (onani mawu oyamba), koma palibe omwe alipo mpaka pano omwe amagwiritsa ntchito njira yamphamvu yoperekedwa ndi CRT. Kupititsa patsogolo kuyesa kwa makompyuta ndi gawo lofunikira kuti mupitirize kuyang'anitsitsa ndikuthandizira. Pomaliza, zotsatira za maphunziro zitha kuphatikizidwa muzowunikira.

Pakadali pano, kuyesa kwapaintaneti pakompyuta si njira yokhazikitsidwa chophimba cha dementia, kuunika kuwonongeka kwa chidziwitso, kapena kupanga matenda aliwonse. Komabe, mphamvu ndi kuthekera kwa njirayi, makamaka kugwiritsa ntchito CRT, kuyesa kukumbukira kwakanthawi kochepa (kanthawi kochepa), ndikwambiri ndipo kuyenera kukhala kofunikira pakugwiritsa ntchito mtsogolo pakuwunika kwachidziwitso, kuphatikiza. kuwunika kwa dementia ndi kuwunika, kuyang'anira chisokonezo pambuyo pa opaleshoni, kukhazikitsidwa kwa mphamvu zamaganizo popanga zisankho, kuzindikira zoperewera zapambuyo pachisokonezo, ndi kulingalira za kuwonongeka komwe kungakhalepo chifukwa cha chitetezo cha galimoto. Mu kafukufukuyu, zikuwonetsedwa kuti MemTrax imatha kutenga gawo lalikulu la kusiyana kwa kusokonezeka kwa chidziwitso. Kuphatikiza apo, ma cutoff amaperekedwa pazosintha za MTX zomwe ndi zofanana ndi gawo la MoCA cutoff la MCI. Pakafukufuku wamtsogolo, akuti tifufuze m'magulu akulu, omveka bwino kuti akhazikitse MemTrax ngati chida chowunikira cha MCI. Chiwerengero choterechi chiyenera kuphatikizapo zitsanzo zachipatala kumene zovuta zowunikira zingathe kufotokozedwa ndendende momwe zingathere ndipo maphunziro amatha kutsatiridwa pakapita nthawi ndi MTX ndi mayesero ena achidziwitso. Kusanthula kotereku kumatha kudziwa kusiyanasiyana kwa njira zakuchepa kwachidziwitso, zokhudzana ndi ukalamba wabwinobwino komanso zovuta zosiyanasiyana zamatenda. Pamene kuyezetsa makompyuta ndi zolembera zikukula, zidziwitso zambiri za milingo ya thanzi lidzakhalapo ndipo mosakayikira lidzabweretsa kusintha kwakukulu kwa chisamaliro chaumoyo ndipo mwachiyembekezo njira zopewera mikhalidwe monga AD.

ZIZINDIKIRO

Tikufuna kuthokoza Anne van der Heijden, Hanneke Rasing, Esther Sinnema, ndi Melinda Lodders chifukwa cha ntchito yawo m’phunziroli. Kuphatikiza apo, tikufuna kuthokoza MemTrax, LLC popereka mitundu yonse yaulere ya mayeso a MemTrax. Ntchitoyi ndi gawo la pulogalamu yofufuza, yomwe imathandizidwa ndi Province of Fryslân (01120657), Netherlands ndi Alfasigma Nederland BV (zopereka mwachindunji ku nambala ya 01120657). Kusinthidwa: 12 February 2019

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Mfundo zazikuluzikulu: Matenda a Alzheimer's, ntchito yopitiliza kugwira ntchito, dementia, okalamba, kukumbukira, kufooka kwachidziwitso, kuwunika