Iyo MemTrax Bvunzo Inofananidzwa neMontreal Cognitive Yekuongorora Estimation yeMild Cognitive Impairment.

Rudzi rwechinyorwa: MemTrax tsvakurudzo chinyorwa

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

Kushamwaridzana:  Stanford University, Stanford, CA, USA - Dhipatimendi rePsychiatry uye Behavioral Sciences, Applied Research Center Food and Dairy, Van Hall Larenstein University of Applied Sciences, Leeuwarden, the Netherlands | Human and Animal Physiology, Wageningen University, Wageningen, the Netherlands | Hondo Inoenderana Nehurwere uye Kukuvara Yekudzidza Center, VA Palo Alto HCS, Palo Alto, CA, USA.

DOI: 10.3233/JAD-181003

Journal: Journal of Chirwere cheAlzheimer, vol. 67, no. 3, pp. 1045-1054, 2019

ngovepo

Kusagadzikana kwepfungwa ndicho chikonzero chikuru chekusashanda zvakanaka kune vakwegura. Rini nyoro yekuziva kukanganisa (MCI) inoitika kune vakwegura, inowanzova prodromal mamiriro kune dementia. Iyo Montreal Cognitive Assessment (MoCA) chishandiso chinowanzoshandiswa kuongorora MCI. Zvakadaro, bvunzo iyi inoda kutarisana nekutarisana uye inoumbwa neakasiyana-siyana emibvunzo iyo mhinduro dzinowedzerwa pamwe chete neanorata kupa zvibodzwa zvine revo chaiyo yanga ichipokana. Ichi chidzidzo chakagadzirirwa kuongorora kushanda kwekombuta memory bvunzo (MemTrax), inova inogadziriswa yebasa rinoramba richizivikanwa, maererano neMoCA. Matanho maviri emhedzisiro anogadzirwa kubva ku MemTrax bvunzo: MemTraxspeed uye MemTraxcorrect. Zvidzidzo zvakapihwa MoCA uye iyo MemTrax bvunzo. Zvichienderana nemhedzisiro yeMoCA, zvidzidzo zvakakamurwa mumapoka maviri ehutano hwekuziva: yakajairika cognition (n = 45) uye MCI (n = 37). Zvinoreva kuti MemTrax zvibodzwa zvaive zvakaderera zvakanyanya muMCI pane zvakajairika cognition boka. Yese MemTrax mhedzisiro inosiyana yaive yakabatana neMoCA. Nzira mbiri, computing avhareji MemTrax mamakisi uye mutsara kudzoreredza kwakashandiswa kufungidzira cutoff tsika dzeMemTrax bvunzo. kuona MCI. Idzi nzira dzakaratidza kuti kune mhedzisiro MemTrax_havukavu chibodzwa chiri pasi pehuwandu hwe0.87 - 91 s^-1 chiratidzo cheMCI, uye chemhedzisiro MemTrax_zvechokwadi chibodzwa chiri pasi pehuwandu hwe85 - 90% chiratidzo cheMCI.

NHANGANYAYA

Chiverengero chavagari vapasi chepasi rose, chinotungamirirwa neEurope, North America, uye Northern Asia, chiri kuchembera, kuchiparira kuwedzera nokukurumidza kwenhamba yevakweguru. Nekukura kwezera, kune kwakanyatso kudzika kufambira mberi, kuwedzera kwekuwedzera kwekukura kwekukanganisa kwekuziva, dementia, uye. Chirwere cheAlzheimer (AD), izvo zviri kukonzera kuwedzera kukuru kwehuwandu hwevanhu vane mamiriro aya. Kuonekwa kwekutanga uye kuzivikanwa kwekusagadzikana kwepfungwa kunogona kuvandudza kutarisirwa kwevarwere, kuderedza mari yekuchengetedza hutano, uye zvinogona kubatsira mukunonoka kutanga kwezviratidzo zvakakomba, nokudaro zvichibatsira kurerutsa mutoro unokurumidza kukura wedementia uye AD. Naizvozvo, maturusi ari nani anodiwa kuti atarise basa rekuziva kune vakwegura.

Kuita ongororo yekiriniki yekuziva uye maitiro evakuru, varapi nevatsvaguri vakagadzira mazana ekuongorora uye mapfupi maturusi ekuongorora, uye akati wandei bvunzo dzakauya mukushandiswa kwakafanana. Chimwe chezvishandiso zvinonyanya kushandiswa zvekuongororwa kwekiriniki kwehunyoro hwekuziva kukanganisa (MCI) muzvirongwa zvedzidzo ndeye. Kuongorora kweMontreal Kuziva (MoCA).

Iyo MoCA inoongorora mabasa manomwe ekuziva: mukuru, kutumidza zita, kutarisa, mutauro, kubvisa, ndangariro / kunonoka kurangarira, uye kutarisisa. Iwo madomasi ndangariro/kunonoka kurangarira uye kutariswa kweMoCA zvakamboonekwa sezvinhu zvinonyanya kunetsa kune yekutanga Alzheimer-mhando yekuziva kukanganisa, izvo zvakatungamira kune pfungwa yekuti memory encoding ndicho chinhu chakakosha chakarwiswa neAD neuropathological process. Naizvozvo, muchirongwa chekiriniki chekuongorora kukanganiswa kwekuziva kunoenderana neAD, chiyeuchidzo ndicho chinhu chepakati chekufunga kufunga, nepo kumwe kukanganisa, kusanganisira aphasia, apraxia, agnosia, uye kusashanda zvakanaka kwevakuru, kunyangwe kazhinji kukanganiswa neAD, kunogona kuve kwakabatana. kune kusashanda kweiyo neuroplastic memory processing masisitimu munzvimbo dzinotsigira neocortical.

Kunyangwe iyo MoCA ichishandiswa zvakanyanya pakuongorora MCI, kutonga kweMoCA kunoitwa chiso nechiso, izvo zvinotora nguva uye zvinoda kusangana kwekiriniki uye nekudaro zvinoda mutengo wakakura kune wega wega. Mukati mekuongorora, nguva inodiwa kuita bvunzo inowedzera huchokwadi hwekuongorora, saka zviitiko zveramangwana zvinofanirwa kutora hukama uhwu kuti ugadzire bvunzo dzakanyanya.

Chinhu chakakosha munharaunda iyi chinodikanwa chekuongorora kwekuziva nekufamba kwenguva. Ongororo yekuchinja nekufamba kwenguva vari zvakakosha pakuona nekugadzirisa kufambira mberi kwehurema, kushanda kwekurapa, uye kuongororwa kwemishonga yekutsvakurudza tsvakurudzo. Zvizhinji zvezvishandiso zvakadaro zviripo hazvina kukodzera kana kuti zvakagadzirirwa mazinga epamusoro ekurongeka uye hazvigoni kupiwa nyore nyore nguva nenguva. Mhinduro yekuvandudza cognitive assessment yakataurwa kuve komputa, asi kwakawanda kuedza kwakadaro kwakapa zvishoma kupfuura komputa yezvinowanzo shandiswa neuropsychological bvunzo, uye haina kugadzirwa kuti igadzirise zvakananga nyaya dzakakosha dzekuongorora kwekuziva kunodiwa kuti unzwisise pakutanga. dementia uye kufambira mberi kwayo. Naizvozvo, maturusi matsva ekuongorora ekuziva anofanirwa kuve nekombuta uye zvichibva pane isingaperi sosi yemiedzo inofananidzwa, iyo isingaganhurirwe nemutauro kana tsika, inopa mwero wekururama, kurongeka, uye kuvimbika izvo zvinogona kuvandudzwa zvishoma nezvishoma. Pamusoro pezvo, bvunzo dzakadai dzinofanirwa kuve dzinonakidza uye dzinobata, kuitira kuti kudzokororwa kuyedzwa kunoonekwa seyakanaka kwete chiitiko chinonetsa. Kuongororwa kwepamhepo, kunyanya, kunopa mukana wekuzadzisa chinodiwa ichi, uku uchipa kuunganidzwa nekukurumidza uye kuongororwa kwedata, uye nekupa mhinduro nekukurumidza kune vanhu vari kutora chikamu, varapi, uye vaongorori.

Chidzidzo chemazuva ano chakagadzirirwa kuongorora kushandiswa kwe-on-line adaptation ye-continuous recognition task (CRT) paradigm, yekuongorora basa rekuziva muhuwandu hwevanhu vanogara munharaunda avo vakanga vasati vaonekwa sevane dementia. Iyo CRT paradigm inoshandiswa zvakanyanya mune zvedzidzo zvidzidzo zvendangariro michina. Nzira yeCRT yakatanga kushandiswa sechishandiso chekuratidzira chevateereri icho chakapa data pane vanhu vaifarira zvinetso zvemusoro. Zvadaro, bvunzo iyi yakaitwa pa-line nekambani yeFrance (HAPPYneuron, Inc.); nekambani yeUS-based, MemTrax, LLC (http://www.memtrax.com); naBrain utano Registry yakagadzirwa naDr. Michael Weiner, UCSF, uye boka rake kuti ritsigire kutorwa kwezvidzidzo zvekushaya njere; uye nekambani yekuChina SJN Biomed, LTD). Muedzo uyu, kubva muna Chikumi 2018, wakawana data kubva kuvashandisi vanopfuura mazana maviri ezviuru, uye uri mumiedzo munyika dzakati wandei.

Muchidzidzo chazvino, iyo MemTrax (MTX), bvunzo-yakavakirwa paCRT, yakaitwa pamwe chete neMoCA muvanhu vakwegura vanogara vakazvimiririra kuchamhembe kweNetherlands. Chinangwa chechidzidzo ichi chaive chekuona hukama pakati pekuita pakuitwa uku kweCRT neMoCA. Mubvunzo waive wekuti MTX ingave yakakosha here pakuenzanisa mabasa ekuziva akaongororwa neMoCA, izvo zvinogona kuratidza kugona kushanda kwekiriniki.

ZVINHU NEMITARIDZO

Kudzidza kuwanda

Pakati paGumiguru 2015 naMay 2016, chidzidzo chemuchinjika chakaitwa pakati pevakwegura vanogara munharaunda kuchamhembe kweNetherlands. Zvidzidzo (≥75y) zvakatorwa kuburikidza nekugoverwa kwemapepa uye panguva yemisangano yeboka yakarongerwa vanhu vakura. Vangangove zvidzidzo vakashanyirwa kumba kuti vatarise nzira yekubatanidzwa uye yekusabatanidzwa vasati vanyoreswa muchidzidzo ichi. Vanhu vairwara nechirwere che(self-reported) dementia kana vaive nekuona zvakanyanya kana kunzwa kwaizopesvedzera mafambisirwo ebvunzo dzekunzwisisa havana kubvumidzwa kutora chikamu muchidzidzo ichi. Mukuwedzera, zvidzidzo zvaida kukwanisa kutaura uye kunzwisisa mutauro wechiDutch uye kusagona kuverenga. Chidzidzo ichi chakaitwa maererano neHelsinki declaration ye1975 uye vese vatori vechikamu vakasaina gwaro. chibvumirano chakanaka fomu mushure mekugamuchira tsananguro yakadzama yechidzidzo.

Nzira yekudzidza

Mushure mekunyoresa muchidzidzo ichi, gwaro remibvunzo yakaitwa, iro raisanganisira mibvunzo pamusoro pehuwandu hwevanhu, sezera nemakore edzidzo (kutangira kuchikoro chepuraimari), nhoroondo yezvokurapa, uye kunwa doro. Zvichitevera kupera kwegwaro remibvunzo, bvunzo dzeMoCA neMTX dzakaitwa zvisina tsarukano.

MemTrax - Research Medical Center

Seruremekedzo rweMemTrax, LLC (Redwood Guta, CA, USA), mavhezheni akazara emahara ebvunzo yeMTX akapihwa. Muyedzo iyi, nhevedzano yemifananidzo makumi mashanu inoratidzwa kusvika kumasekonzi matatu imwe neimwe. Pakaonekwa mufananidzo chaiwo wakadzokororwa (50/25), vadzidzi vakarairwa kuti vatore mufananidzo wakadzokororwa nekukurumidza nekudzvanya spacebar (iyo yairatidzwa nematepi ane ruvara rutsvuku). Musoro wacho pawakapindura mufananidzo, mufananidzo unotevera wakaratidzwa pakarepo. Mushure mekupedza bvunzo, chirongwa chinoratidza chikamu chemhinduro chaidzo (MTX_zvechokwadi) uye avhareji yenguva yekuita mumasekonzi yemifananidzo inodzokororwa, iyo inoratidza nguva inodiwa kudzvanya spacebar paunenge uchiona mufananidzo unodzokororwa. Kufananidza zviyero zvezviyero zviviri izvi, nguva yekuita yakashandurwa kuita yekumhanyisa kumhanya (MTX_havukavu) nekugovanisa 1 nenguva yekuita (kureva, 1/MTX_{reaction time}) Nhoroondo yebvunzo yemunhu wese MemTrax zvibodzwa uye kutendeseka kwavo kwakachengetwa otomatiki online muaccount account. Kutendeseka kweyese bvunzo dzakaitwa kwakatariswa, kuchida 5 kana shoma mhinduro dzenhema dzenhema, gumi kana kupfuura kuzivikanwa kwakaringana, uye avhareji yenguva yekuzivikanwa pakati pe 10 uye 0.4 masekondi, uye chete bvunzo dzechokwadi dzakabatanidzwa mukuongorora.

Pasati paitwa bvunzo chaiyo yeMTX, bvunzo yacho yakatsanangurwa zvakadzama uye bvunzo yekudzidzira yakapihwa kune zvidzidzo. Izvi zvaisanganisira kwete chete bvunzo pachayo, asiwo murayiridzo uye kuverenga-pasi mapeji kurega mubatanidzwa kuti ajairane marongerwo saiti uye zvokutanga zviito zvinodiwa, pamberi kutanga bvunzo. Kuti udzivise kudzokororwa kwemifananidzo panguva yekuedzwa chaiko, mifananidzo isina kuisirwa muMemTrax dhatabhesi yakashandiswa pakuita bvunzo.

Montreal cognitive ongororo turusi

Mvumo yakawanikwa kubva kuMoCA Institute & Clinique (Quebec, Canada) yekushandisa MoCA patsvagiridzo iyi. Iyo Dutch MoCA inowanikwa mune matatu mavhezheni, ayo akapihwa zvisina tsarukano kune zvidzidzo. Chibodzwa cheMoCA ihuwandu hwekuita pane yega yega yekuziva domain yakaongororwa uye ine chibodzwa chikuru chemakumi matatu mapoinzi. Sekurudziro yepamutemo, imwe poindi yakawedzerwa kana mutori wechikamu aine ≤30 makore edzidzo (kana <12 mapoinzi). Mirayiridzo yepamutemo yebvunzo yakashandiswa segwara panguva yekutonga kwebvunzo. Iwo maedzo akaitwa nevatatu vakadzidziswa vaongorori uye kutonga kweimwe bvunzo kwakatora gumi kusvika gumi nemashanu min.

MemTrax Data kuongororwa

Zvichienderana nemhedzisiro yeMoCA, iyo yakagadziridzwa padzidzo, zvidzidzo zvakakamurwa mumapoka maviri echimiro chekuziva: normal cognition (NC) versus mild cognitive impairment (MCI). Mucherechedzo weMoCA wemakumi maviri nenhatu wakashandiswa sekucheka kweMCI (zvibodzwa makumi maviri nemaviri zvichidzika zvakaonekwa seMCI), sezvakaratidzwa kuti chibodzwa ichi chakaratidza 'chakanakisa chekuongorora chechokwadi pane dzakasiyana siyana maparamita" zvichienzaniswa neyakakurudzirwa zvibodzwa zvekutanga. 23 kana kukosha kwe 22 kana 26. Pamusoro pekuongorora kwose, chiyero cheMoCA chakagadziriswa chakashandiswa sezvo chikamu ichi chinoshandiswa mumakiriniki.

Muedzo weMTX unopa mhinduro mbiri, dzinoti MTX_{reaction time}, iyo yakashandurwa kuita MTX_havukavu ne1/MTX_{reaction time}uye MTX_zvechokwadi.

Kuongorora kwenhamba kwakaitwa pachishandiswa R (vhezheni 1.0.143, Rstudio Team, 2016). Kujairika kwakatariswa kune ese akasiyana neiyo Shapiro-Wilk bvunzo. Misiyano yehuwandu hwechidzidzo chese, uye emapoka eNC neMCI, akashumwa seanoreva ± standard deviation (SD), median uye interquartile range (IQR) kana senhamba uye muzana. Yakazvimiririra sampu T-bvunzo uye Wilcoxon Sum Rank bvunzo dzekuenderera kuchinjika uye Chi-squared bvunzo dzemhando dzakasiyana dzakaitwa kuenzanisa maitiro eNC neMCI boka. Iyo isiri-parametric Kruskal-Wallis bvunzo yakashandiswa kuona kana iwo matatu mavhezheni eMoCA uye matatu maneja akakanganisa mhedzisiro yeMoCA. Pamusoro pezvo, yakazvimiririra T-bvunzo kana Wilcoxon Sum Rank bvunzo yakaitwa kuona kana kurongeka kwekutonga kweMoCA neMTX kwakapesvedzera mhinduro dzebvunzo (semuenzaniso, MoCA mamaki, MTX._zvechokwadiuye MTX_havukavu) Izvi zvakaitwa nekuona kana zvibodzwa zvakange zvakasiyana kune zvidzidzo zvakagamuchira kutanga MoCA uyezve MemTrax kana kuti vakagamuchira kutanga MTX uyezve MoCA.

Pearson kuenderana bvunzo dzakaverengerwa kuongorora hukama pakati peMTX neMoCA uye pakati peMemTrax ese bvunzo mhinduro, semuenzaniso, MTXspeed uye MTXcorrect. Yakamboitwa sampuli saizi yekuverenga yakaratidza kuti kune imwe-muswe Pearson correlation bvunzo (simba = 80% , α = 0.05), nekufungidzira kwehukuru hwepakati (r = 0.3), saizi shoma shoma ye n = 67 yaidiwa. Polyserial correlation bvunzo dzakaverengerwa kuti dziongorore hukama pakati peMTX bvunzo mhinduro uye yakaparadzana MoCA madomasi achishandisa psych package muR.

Mucherechedzo wakaenzana weMoCA wekupihwa zvibodzwa zveMemTrax wakaverengerwa nekombuta avhareji yeMemTrax mamakisi pane yega yega MoCA mamakisi uye mutsara regression wakaitwa kufungidzira equations ine chekuita nematanho aya. Mukuwedzera, kuti uone ma cutoff values ​​eMemTrax bvunzo yeMCI yakayerwa neMoCA, uye inowirirana senitivity uye chaiyo kukosha, Receiver Operator Characteristic (ROC) kuongororwa kwakaitwa uchishandisa pROC package muR. Non-parametric stratified bootstrapping (n = 2000) yakashandiswa kuenzanisa nzvimbo iri pasi pema curves (AUCs) uye nguva dzinoenderana dzekuvimba. Iyo yakakwana cutoff mamakisi yakaverengerwa neiyo Youden nzira, iyo inowedzera iwo echokwadi maposititi uku ichideredza manyepo enhema.

Pakuongorora kwese kwenhamba, mativi maviri p-value ye <0.05 yaionekwa sechikumbaridzo chekukosha kwenhamba, kunze kwekuongorora kuongorora hukama pakati peMTX neMoCA (kureva, kuongororwa kwekuenzanisa uye kudzoreredza kwemutsara) iyo imwe- sided p-value ye <0.05 yaionekwa seyakakosha.

MemTrax RESULTS

Zvidzidzo

Pakazara, zvidzidzo zve101 zvakabatanidzwa muchidzidzo ichi. Dhata revanhu gumi nevapfumbamwe harina kuverengerwa, sezvo bvunzo dzeMemTrax kubva kuzvidzidzo gumi nembiri hadzina kuchengetwa nechirongwa, zvidzidzo zvitanhatu zvaive nemhedzisiro yekuongororwa kweMemTrax, uye chidzidzo chimwe chete chaive nechibodzwa cheMoCA che19 mapoinzi, zvichiratidza kukanganisa kwakanyanya kwekuziva. chirevo chekusiya. Nokudaro, data kubva kune zvidzidzo zve12 zvakabatanidzwa mukuongorora. Hapana misiyano yakakosha mumhedzisiro yekuongororwa kweMoCA yakawanikwa pakati peshanduro dzakasiyana dzeMoCA uye pakati pevatariri. Pamusoro pezvo, iyo yekurongeka kwebvunzo manejimendi haina mhedzisiro yakakosha pane chero bvunzo mamakisi (MoCA, MTX_havukavu, MTX_zvechokwadi) Zvichienderana nemhedzisiro yebvunzo yeMoCA, zvidzidzo zvakaiswa muNC kana MCI boka (semuenzaniso, MoCA ≥ 23 kana MoCA <23, zvichiteerana). Mamiriro ezvidzidzo zvehuwandu hwehuwandu hwekudzidza, uye mapoka eNC neMCI anoratidzwa muTebhu 1. Hapana misiyano yakakura yakanga iripo pakati pemapoka, kunze kwepakati peMoCA scores (25 (IQR: 23 - 26) inopesana ne21 (IQR: 19 - 22) ) mapoinzi, Z = -7.7, p <0.001).

Tafura 1

Nzvimbo dzemuitiro

	Huwandu hwevanhu vakadzidza (n = 82)	NC (n = 45)	MCI (n = 37)	p
Zera (y)	83.5 ± 5.2	82.6 ± 4.9	84.7 ± 5.4	0.074
Mukadzi, Kwete. (%)	55 (67)	27 (60)	28 (76)	0.133
Dzidzo (y)	10.0 (8.0 - 13.0)	11.0 (8.0 - 14.0)	10.0 (8.0 - 12.0)	0.216
Kunwa doro (# magirazi/vhiki)	0 (0 - 4)	0 (0 - 3)	0 (0 - 5)	0.900
MoCA mamakisi (# mapoinzi)	23 (21 - 25)	25 (23 - 26)	21 (19 - 22)	tsime

Values ​​inoratidzwa sezvinoreva ± sd, yepakati (IQR) kana senhamba ine muzana.

Mamiriro ekuziva akayerwa neMemTrax

Mamiriro ekuziva akayerwa nebvunzo yeMTX. Mufananidzo 1 unoratidza mhedzisiro ye Kuziva bvunzo mhedzisiro yeNC uye MCI zvidzidzo. Izvo zvinoreva MTX zvibodzwa (semuenzaniso, MTX_havukavu uye mx_zvechokwadi) akanga akasiyana zvakanyanya pakati pemapoka maviri aya. NC zvidzidzo (0.916 ± 0.152 s^-1) yaive neyakakura kukurumidza kuita yekumhanya ichienzaniswa neMCI zvidzidzo (0.816 ± 0.146 s^-1); t(80) = 3.01, p = 0.003) (Mufananidzo 1A). Pamusoro pezvo, zvidzidzo zveNC zvaive nezvibodzwa zviri nani paMTX_zvechokwadi zvakasiyana pane zvidzidzo zveMCI (91.2 ± 5.0% maringe ne87.0 ± 7.7% zvichiteerana; t_w (59) = 2.89, p = 0.005) (Mufananidzo 1B).

Fig.1

Mabhokisi eMTX bvunzo mhinduro dzeNC uye MCI mapoka. A) MTX_havukavu bvunzo mhinduro uye B) MTX_zvechokwadi test result. Zvese zviri zviviri zvinosiyana zveMTX bvunzo zvakaderera zvakanyanya muboka reMCI zvichienzaniswa neNC. Iwo grey ruvara runoratidza NC zvidzidzo, nepo rima grey ruvara runoratidza MCI zvidzidzo.

Kuwirirana pakati peMemTrax neMOCA

Kushamwaridzana pakati peMTX test scores uye MoCA inoratidzwa muFig. 2. Zvose zviri zviviri zveMTX zvakabatanidzwa zvakanaka neMoCA. MTX_havukavu uye MoCA yakaratidza kuwirirana kwakakosha kwe r = 0.39 (p = 0.000), uye kuwirirana pakati peMTX_zvechokwadi uye MoCA yaive r = 0.31 (p = 0.005). Pakanga pasina kushamwaridzana pakati peMTX_havukavu uye mx_zvechokwadi.

Fig.2

Kushamwaridzana pakati peA) MTX_havukavu uye MoCA; B) MTX_zvechokwadi uye MoCA; C) MTX_zvechokwadi uye mx_havukavu. Zvidzidzo zveNC neMCI zvinoratidzwa nemadotsi nemakona matatu zvichiteerana. Mukona yezasi yekurudyi yegirafu imwe neimwe iyo rho uye inoenderana p kukosha inoratidzwa yekubatana pakati pezviviri zvakasiyana.

Kushamwaridzana pakati peA) MTXspeed uye MoCA; B) MTXcorrect uye MoCA; C) MTXcorrect uye MTXspeed. Zvidzidzo zveNC neMCI zvinoratidzwa nemadotsi nemakona matatu zvichiteerana. Mukona yezasi yekurudyi yegirafu imwe neimwe rho uye p value inoenderana inoratidzwa yewirirano pakati pezvinhu zviviri izvi.[/caption]

Polyserial correlations akaverengerwa pakati peMemTrax bvunzo zvibodzwa uye MoCA madomasi kuona kubatanidzwa kwedomendi yega yega neMemTrax metrics. Iyo polyserial correlations inoratidzwa muTable 2. Multiple domains eMoCA ainyatsoenderana neMTX._{speed .}  Iyo domain "abstraction" yakaratidza kuwirirana kwepamusoro, kunyangwe iri pakati nepakati, neMTX_havukavu (r = 0.35, p = 0.002). Iwo madomasi "zita" uye "mutauro" airatidza kusasimba kusvika pakati nepakati kushamwaridzana kwakakosha neMTX_havukavu (r = 0.29, p = 0.026 uye r = 0.27, p = 0.012, maererano). MTX_zvechokwadi yakanga isinganyanyi kubatanidzwa kumatunhu eMoCA, kunze kwekunge isina kusimba neiyo domain "visuospatial" (r = 0.25, p = 0.021).

Tafura 2

Polyserial correlations yeMTX bvunzo zvabuda neMoCA domains

	MTXhavukavu	MTXzvechokwadi
	r	p	r	p
Visuospatial	0.22	0.046	0.25	0.021
Kutumidza	0.29	0.026	0.24	0.063
Attention	0.24	0.046	0.09	0.477
mutauro	0.27	0.012	0.160	0.165
Abstraction	0.35	0.002	0.211	0.079
Yeuka	0.15	0.159	0.143	0.163
Orientation	0.21	0.156	0.005	0.972

Ongorora: Hukama hwakakosha hunoratidzwa nemavara matema.

MemTrax zvibodzwa uye inofungidzirwa cutoff kukosha kweMCI

Kuti uone zvibodzwa zvinoenderana zveMemTrax neMoCA, zvibodzwa zveMemTrax zvechikamu chega chega cheMoCA zvakayerwa uye kudzokororwa kwemutsara kwakaverengerwa kufanotaura hukama uye maequation anoenderana. Mhedzisiro yekudzokororwa kwemutsara yakaratidza kuti MTX_havukavu yakatsanangura 55% yemusiyano muMoCA (R² = 0.55, p = 0.001). Iyo yakasiyana MTX_zvechokwadi yakatsanangura 21% yemusiyano muMoCA (R² = 0.21, p = 0.048). Zvichienderana nekuenzanisa kwehukama uhwu, zvibodzwa zvakaenzana zveMoCA zvakaverengerwa kupihwa zvibodzwa zveMTX, izvo zvinoratidzwa muTebhurari 3. Zvichienderana neaya equation, iwo anoenderana cutoff values ​​(semuenzaniso, MoCA mamakisi makumi maviri nematatu) yeMTX._havukavu uye mx_zvechokwadi dziri 0.87s^-1 uye 90%. Uye zvakare, kudzokororwa kwemutsara kwakawanda pane ese MemTrax akasiyana akaitwa, asi iyo inoshanduka MTX_zvechokwadi haina kunyanya kubatsira kumuenzaniso uye naizvozvo zvigumisiro hazvina kuratidzwa.

Tafura 3

Yakakurudzirwa yakaenzana MoCA mamakisi akapihwa MemTrax zvibodzwa

MoCA (mapoinzi)	Yakaenzana MTXhavukavu (s-1)a	CI yekufanotaura neMTXhavukavu (mapoinzi)	Yakaenzana MTXzvechokwadi (%)b	CI yekufanotaura neMTXzvechokwadi (mapoinzi)
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 yakashandiswa: 1.1 + 25.2 *MTX_havukavu; ^b Equation yakashandiswa: -9.7 + 0.36 *MTX_zvechokwadi.

Pamusoro pezvo, MTX cutoff values ​​uye inoenderana senitivity uye chaiyo yakatemwa kuburikidza neROC ongororo. Iwo ROC macurves eMemTrax akasiyana anoratidzwa muFig. 3. Iyo AUCs yeMTX._havukavu uye mx_zvechokwadi vari, maererano, 66.7 (CI: 54.9 - 78.4) uye 66.4% (CI: 54.1 - 78.7). Iwo maAUC eMemTrax akasiyana anoshandiswa kuongorora MCI yakagadzwa neMoCA anga asina kusiyana zvakanyanya. Tafura 4 inoratidza kunzwisiswa uye kujeka kweakasiyana cutoff mapoinzi eMemTrax akasiyana. Iwo akanakisa cutoff mamakisi, ayo akawedzera echokwadi mapositi uku achideredza manyepo enhema, eMTX._havukavu uye mx_zvechokwadi yaiva 0.91s^-1 (kunzwa = 48.9% zvakananga = 78.4%) uye 85% (kunzwa = 43.2%; zvakananga = 93.3%), maererano.

Fig.3

ROC curves yeMTX bvunzo mhedzisiro yekuongorora MCI yakayerwa neMoCA. Mutsetse une doti unoratidza MTX_havukavu uye mutsara wakasimba MTX_zvechokwadi. Mutsara wegrey unomiririra mutsara we0.5.

Tafura 4

MTX_havukavu uye mx_zvechokwadi cutoff points uye inoenderana chaiyo uye sensitivity

	Cutoff point	Tp (#)	tn (#)	Fp (#)	Fn (#)	Zvakananga (%)	Sensitivity (%)
MTXhavukavu	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
MTXzvechokwadi	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, chokwadi chakanaka; tn, chokwadi chisina kunaka; fp, nhema dzakanaka; fn, nhema dzisina kunaka.

KUKURUKURA

Ichi chidzidzo chakagadzwa kuti chiongorore pa-line MemTrax chishandiso, CRT-yakavakirwa bvunzo, uchishandisa iyo MoCA sereferensi. Iyo MoCA yakasarudzwa nekuti bvunzo iyi parizvino inoshandiswa zvakanyanya kuratidza MCI. Nekudaro, iwo akanyanya kuchekwa-mapoinzi eMoCA haana kunyatso kusimbiswa [28]. Kuenzaniswa kwematanho ega ega eMemTrax neMoCA kunoratidza kuti bvunzo yakapfava, pfupi, yepa-line inogona kutora chikamu chakakosha chekusiyana kwekushanda kwekuziva uye kukanganiswa kwenjere. Mukuongorora uku, simba rakasimba rakaonekwa nokuda kweyero yekukurumidza. Chiyero chekururama chakaratidza hukama husina kusimba. Chinhu chakakosha chakawanikwa ndechekuti hapana kuwirirana kwakaonekwa pakati peMTX kumhanya uye kurongeka matanho, zvichiratidza kuti izvi zvinosiyana zvinoyera zvikamu zvakasiyana zvepasi. uropi hwekugadzirisa basa. Nokudaro, hapana chinoratidza kukurumidza-kururamisa kutengeserana kwakawanikwa pane zvidzidzo. Pamusoro pezvo, nzira mbiri dzakasiyana dzakashandiswa kufungidzira ma cutoff values ​​eMemTrax memory test kuona MCI. Nzira idzi dzakaratidza kuti kumhanyiro nekurongeka kwemhedzisiro, zvibodzwa zviri pasi pematanho e0.87 - 91 s.^-1 uye 85 - 90% chiratidzo chekuti vanhu vanowana pazasi peimwe yeaya mazinga vanogona kuve neMCI. Kuongororwa kwe "mutengo-kukodzera" kwaizoratidza pane imwe nguva munhu anofanirwa kurairwa kubvunza chiremba nezvekuita ongororo dzakadzama kuti aonere MCI [8-35].

Muchidzidzo chemazuva ano, zvakaonekwa kuti nzvimbo "zita", "mutauro", uye "abstraction" yakayerwa neMoCA yakanga ine hukama hwepamusoro neimwe yemigumisiro yeMemTrax, kunyange zvazvo hukama hwakanga husina simba kusvika pakati. Izvi zvakasiyana nezvaitarisirwa, sezvo zvidzidzo zvekare zvakaratidza mukuongorora Mini-Mental State bvunzo uchishandisa Item Response Theory, kuti madomasi "ndangariro/kunonoka kuyeuka" uye "kutarisisa" ndiwo ainyanya kunzwa kune yekutanga AD [12]. Panguva iyi nhanho yekutanga yekuziva kusashanda zvakanaka, zvinoita sekunge MoCA zviratidzo zvekukanganisa kusinganzwisisike mukutumidza zita, mutauro, uye kubvisa zvinonyanya kunzwisiswa neMCI pane zviyero zvekurangarira uye kutungamira, zvinoenderana nezvakawanikwa zvekare muItem Response Theory kuongororwa kweMoCA [36]. Uyezve, the MemTrax chiyero chekuzivikanwa chinomhanya chinoratidzika kuratidza uku kukanganisika kwekutanga kusati kwazivikanwa ndangariro sekuyerwa neMTX (iyo ine yakakosha sirin'i maitiro). nyeredzi iyi ye mhedzisiro inoratidza kuti zvakaomarara zveiyo pathology inokonzera MCI inoratidza huropi hwekutanga shanduko dzave dzakaoma kufungidzira nemaitiro akareruka eurocognitive uye anganyatso kuratidza kufambira mberi kweiyo iri pasi neuropathology [37].

Mapoinzi akasimba muchidzidzo chazvino ndeekuti saizi yemuenzaniso (n = 82) yaive yakanyanya kukwana kuona kuwirirana pakati peMoCA neMTX muhuwandu hwekare. Mukuwedzera, muedzo wekudzidzira wakaiswa kune zvidzidzo zvose, kuitira kuti vanhu vakwegura vakanga vasina kujaira kombiyuta vakawana mukana wekugadzirisa kumamiriro ekuedzwa uye midziyo. Zvichienzaniswa neMoCA, zvidzidzo zvakaratidza kuti MemTrax yainakidza kuita, nepo MoCA yainzwa senge bvunzo. Zera rezvidzidzo uye rusununguko rwenharaunda yavo yakaganhurira kutarisa kwekuongorora kune iri boka rakasarudzwa revanhu vane basa repamusoro, asi boka iri riri pakati pezvakanyanya kuoma pakuzivikanwa kwekukanganiswa.

Zvecherechedzo, kunyangwe ichionekwa seyakajairwa yekuongorora bvunzo, iyo MoCA ingori bvunzo yekuratidza kuvepo kweMCI, kwete yekuongorora chishandiso kana chiyero chakakwana chekuziva kusashanda zvakanaka. Saka, saizvozvo, kuenzanisa kweMoCA neMTX kune hukama, uye pamwe ingangove yakabata yakazvimirira musiyano mukuzivikanwa kweMCI. Saizvozvowo, nyaya inokosha mumabhuku yave iri kuedza kutsanangura kubatsira kweMoCA [38], kusimbiswa kwayo [39], kugadzwa kwezvinyorwa zvetsika [40], kuenzanisa nedzimwe ongororo pfupi dzekuongorora [41-45] , uye kushandiswa kwayo sechinhu chekuongorora cheMCI [46] (yakaongororwa naCarson et al., 2017 [28]), pamwe chete nekushanda kweshanduro yemagetsi [47]. Ongororo dzakadaro dzinosanganisira kuongororwa kwekunzwa uye kujeka, kazhinji kushandisa ROC kuongororwa nechiyero che "nzvimbo iri pasi pe curve", uye kurudziro ye cutoff ye "diagnosis". Nekudaro, mukushaikwa kweimwe nzira yekuona zvachose kuti munhu akarara papi paienderera mberi nekuremara, pamwe nekusiyana kukuru kwezviri pasi. kushanda kweuropi zvichibatsira mukukanganiswa ikoko, ese maturusi akadai anogona chete kupa fungidziro inogoneka. Kupa kuwirirana pakati pezviyero zvakasiyana zvinongoratidza kuti mamiriro ari pasi ari kutariswa nemazvo, asi mamiriro chaiwo ebhayoloji haagone kunyatsotsanangurwa nenzira iyi. Kunyange zvazvo kuongororwa kwepamusoro-soro kunogona kubatsira munharaunda yekiriniki, kugadzwa kwekushandisa kwakadaro kunoda kuwedzera kutariswa kwezvinhu zvina: kuwanda kwemamiriro muhuwandu; mutengo wekuedzwa, mutengo wemhedzisiro yenhema-yakanaka, uye kubatsirwa kwezvinhu kwechokwadi chekuongorora kwakanaka [8, 35].

Chikuru chikamu chedambudziko mukuongorora AD nekukanganiswa kwayo kwekuziva kwakabatana ndeyekuti hapana chaicho "matanho" [48], asi pane kuenderera kwechinguvana kwekufambira mberi [8, 17, 49]. Musiyano we "zvakajairika" kubva kuMCI wakaoma zvakanyanya pane kusiyanisa chero yeaya mamiriro kubva kune akapfava. dementia yakabatana neAD [50, 51]. Uchishandisa pfungwa ye "Modern Test Theory", nyaya inova yekuona kuti ndepapi painoenderera munhu angangove mukati meimwe nguva yekuvimba-yenguva, achipihwa imwe bvunzo mamakisi. Kuita zvisungo zvakadaro, ongororo dzakadzama dzinodiwa pane dzinopihwa nemiedzo mipfupi yekuziva, asi seyakapihwa neMTX. Kuwedzera kurongeka uye kubviswa kwevacherechedzi nekuyedza komputa igwara rinovimbisa. Zvakare, bvunzo yekombuta, yakadai seMemTrax, inopa mukana wehuwandu husingaverengeki hwemiedzo inofananidzwa, zvichideredza zvakanyanya kusiyana kwefungidziro yekukanganisa. Kupfuurirazve, musimboti, kuyedzwa kwekombuta kunogona kuyedza akawanda enzvimbo dzine chekuita nendangariro dzakakanganiswa neAD. Ichi chidzidzo hachina kuenzanisa MTX nemimwe miedzo yakawanda yekombuta yakagadzirwa (ona sumo), asi hapana imwe iripo kusvika parizvino inoshandisa nzira ine simba inopiwa neCRT. Kumwe kuvandudzwa kwekuyedzwa kwekombuta inzvimbo yakakosha yekuwedzera kutariswa nerutsigiro. Pakupedzisira, kudzidzisa migumisiro inogona kuverengerwa muongororo.

Panguva ino, bvunzo dzepamhepo pamhepo haisi nzira yakasimbiswa skrini yedementia, kuongorora kukanganisa kwekuziva, kana kuita chero kuongororwa kwekliniki. Nekudaro, simba uye kugona kweiyi nzira, kunyanya kushandiswa kweCRT, kuongorora episodic (yenguva pfupi) ndangariro, yakakura uye ingangove yakakosha mumashandisirwo emangwana ekuongorora kwekuziva, kusanganisira. dementia kuongorora uye kuongorora, post-operative confusion monitoring, kugadzwa kwesimba repfungwa rekuita sarudzo, kuona post-concussion deficits, uye fungidziro yezvingangoita kukanganisa kwekutyaira kuchengetedza. Muchidzidzo ichi, zvinoratidzwa kuti MemTrax inogona kutora chikamu chakakosha chekusiyana kwekukanganisa kwekuziva. Pamusoro pezvo, cutoff values ​​inounzwa kune iyo MTX misiyano yakaenzana neMoCA cutoff mamakisi eMCI. Nekutsvagisa kweramangwana, zvinokurudzirwa kuferefeta muhombe, inotsanangurwa zvakajeka huwandu hwevanhu kuti vamise MemTrax sechombo chekuongorora cheMCI. Huwandu hwakadai hunofanirwa kusanganisira sampuli dzekiriniki apo nyaya dzekuongorora dzinogona kutsanangurwa senge sezvinobvira uye zvidzidzo zvinogona kuteverwa nekufamba kwenguva neMTX uye mamwe maedzo ekuziva. Ongororo dzakadaro dzinogona kuona mutsauko mumakwara ekuderera kwekuziva, zvine chekuita nekuchembera kwakajairika uye akasiyana pathological mamiriro. Sezvo bvunzo dzekombuta uye registries zvinokura, ruzivo rwakawanda nezvemazinga e hutano huchave huripo uye pasina mubvunzo huchatungamira mukuvandudzika kukuru kwehutano hwehutano uye tinovimba nzira dzekudzivirira dzakadai seAD.

ZVINONYANYA

Tinoda kutenda Anne van der Heijden, Hanneke Rasing, Esther Sinnema, naMelinda Lodders nebasa ravo muchidzidzo chino. Pamusoro pezvo, tinoda kutenda iyo MemTrax, LLC nekupa emahara akazara mavhezheni eMemTrax bvunzo. Iri basa chikamu chechirongwa chekutsvagisa, icho chinopihwa mari neProvince yeFryslân (01120657), Netherlands neAlfasigma Nederland BV (mupiro wakananga kupa nhamba 01120657). Yakaburitswa: 12 Kukadzi 2019

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Keywords: Chirwere cheAlzheimer, kuenderera mberi kwekuita basa, dementia, vakweguru, ndangariro, hunyoro hwekuziva kukanganisa, kuongorora