Uvavanyo lwe-MemTrax xa luthelekiswa noVavanyo loVavanyo lwengqondo lwaseMontreal

Uhlobo lwenqaku: MemTrax Research inqaku

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

Ukubambisana:  University of Stanford, Stanford, CA, USA - iSebe leNgqondo kunye neeNzululwazi zokuziphatha, iZiko loPhando oluSetyenzisiweyo lokutya kunye neDairy, i-Van Hall Larenstein University of Applied Sciences, eLeeuwarden, eNetherlands | IPhysiology yabantu kunye nezilwanyana, iYunivesithi yaseWageningen, eWageningen, eNetherlands | Iziko leSigulo esiNxulumene neMfazwe kunye neNzalo, i-VA Palo Alto HCS, iPalo Alto, CA, USA

I-DOI: 10.3233/JAD-181003

Ijenali: Ijenali ye Isifo sika-Alzheimer, iv. 67, hayi. I-3, iphe. 1045-1054, 2019

Abstract

Ukuphazamiseka kwengqondo ngoyena nobangela uphambili wokungasebenzi kakuhle kwabantu abadala. Nini ukuphazamiseka kwengqondo okuphakathi (MCI) yenzeka kubantu abadala, idla ngokuba yimeko yeprodromal ukuya kwidementia. I-Montreal Cognitive Assessment (MoCA) sisixhobo esisetyenziswa ngokuqhelekileyo ukuhluza i-MCI. Nangona kunjalo, olu vavanyo lufuna ulawulo lobuso ngobuso kwaye luqulunqwe yi-assortment yemibuzo eneempendulo zayo zongezwa kunye ne-rater ukubonelela ngamanqaku anentsingiselo echanekileyo iye yaphikisana. Olu phononongo lwenzelwe ukuvavanya ukusebenza kwekhompyuter uvavanyo lweememori (i-MemTrax), ekulungelelaniswa nomsebenzi oqhubekayo wokuqaphela, ngokubhekiselele kwi-MoCA. Imilinganiselo yeziphumo ezimbini zenziwa kwi Uvavanyo lweMemTrax: I-MemTraxspeed kunye ne-MemTrax echanekileyo. Izifundo zalawulwa yi-MoCA kunye ne Uvavanyo lweMemTrax. Ngokusekelwe kwiziphumo ze-MoCA, izifundo zahlulahlulwe ngamaqela amabini esimo sengqondo: ukuqonda okuqhelekileyo (n = 45) kunye ne-MCI (n = 37). Amanqaku eMemTrax athetha aphantsi kakhulu kwi-MCI kuneqela eliqhelekileyo lokuqonda. Zonke iziphumo eziguquguqukayo zeMemTrax zayanyaniswa ngokufanelekileyo ne-MoCA. Iindlela ezimbini, ukubala umyinge Inqaku le-MemTrax kunye nokuhlehliswa komgca kusetyenziswe ukuqikelela amaxabiso e-cutoff yovavanyo lweMemTrax ukubona i-MCI. Ezi ndlela zabonisa ukuba isiphumo MemTrax_isantya inqaku elingaphantsi koluhlu lwe-0.87 - 91 s^-1 luphawu lwe-MCI, kunye nesiphumo se-MemTrax_lungile inqaku elingaphantsi koluhlu lwe-85 - 90% luphawu lwe-MCI.

INTSHAYELELO

Abemi behlabathi lonke, abakhokelwa yiYurophu, uMntla Merika, noMntla Asia bayaluphala, nto leyo ebangela ukwanda ngokukhawuleza kwenani labantu abalupheleyo. Ngokukhula kweminyaka, kukho inkqubela phambili esele imiselwe, ukwanda okubonakalayo kophuhliso lokuphazamiseka kwengqondo, ukudemeka kwengqondo, kunye Isifo se-Alzheimer (AD), nto leyo ekhokelela ekwandeni okukhulu kwenani labantu abanezi meko. Ukufumanisa kwangoko kunye nokuchongwa kokuphazamiseka kwengqondo kunokuphucula ukhathalelo lwesigulane, ukunciphisa iindleko zokhathalelo lwempilo, kwaye kunokunceda ukulibazisa ukuqala kweempawu ezinzima, ngaloo ndlela kunokunceda ukunciphisa umthwalo okhula ngokukhawuleza we-dementia kunye ne-AD. Ngoko ke, izixhobo ezingcono zifunekayo ukujonga umsebenzi wokuqonda kubantu abadala.

Ukwenza uvavanyo lweklinikhi lwemisebenzi yokuqonda kunye nokuziphatha kwabantu abadala, oogqirha kunye nabaphandi baye baphuhlisa amakhulu ezixhobo zokuhlola kunye novavanyo olufutshane, kwaye iimvavanyo ezininzi ziye zasetyenziswa ngokufanayo. Esinye sezona zixhobo zisetyenziswa rhoqo kuvavanyo lweklinikhi lokukhubazeka okuncinci kwengqondo (MCI) kwiindawo zemfundo Montreal Cognitive Assessment (MoCA).

I-MoCA ivavanya imisebenzi yengqondo esixhenxe: isigqeba, ukubiza amagama, ukuhoywa, ulwimi, ukuthabatha, inkumbulo / ukulibaziseka ukukhumbula, kunye noqhelaniso. Imemori yemimandla / ukulibaziseka ukukhumbula kunye nokuqhelaniswa kwe-MoCA ngaphambili zichongiwe njengezona zinto zinovakalelo kwi-Alzheimer-type ye-cognitive impairments yokuqala, eyakhokelela kumbono wokuba i-encoding yememori yayiyeyona nto ibalulekileyo ehlaselwe yinkqubo ye-neuropathological AD. Ke ngoko, kwisixhobo seklinikhi sovavanyo lokuphazamiseka kwengqondo okuhambelana ne-AD, inkumbulo yeyona nto iphambili yokuqonda ukucinga, ngelixa ezinye iziphazamiso, kubandakanya i-aphasia, i-apraxia, i-agnosia, kunye nokungasebenzi kakuhle kwesigqeba, nangona ngokuqhelekileyo kuphazanyiswa yi-AD, kunokunxulumana. ukungasebenzi kweendlela zokulungisa imemori ye-neuroplastic kwimimandla exhasayo ye-neocortical.

Nangona i-MoCA isetyenziswa ngokubanzi ukuhlola i-MCI, ulawulo lwe-MoCA lwenziwa ubuso ngobuso, nto leyo edla ixesha kwaye ifuna ukudibana kwekliniki kwaye ngenxa yoko ifuna iindleko ezinkulu kulawulo ngalunye. Ngethuba lovavanyo, ixesha elifunekayo lokuqhuba uvavanyo liyakwandisa ukuchaneka kovavanyo, ngoko ke uphuhliso lwexesha elizayo kufuneka luthathele ingqalelo obu budlelwane ukuze kuphuhliswe iimvavanyo ezisebenza ngokufanelekileyo.

Umba obalulekileyo kulo mba yimfuneko yovavanyo lokuqonda ekuhambeni kwexesha. Uvavanyo lotshintsho ngokuhamba kwexesha kubalulekile ukubhaqa kunye nokugqiba ukuqhubela phambili kokukhubazeka, ukusebenza kakuhle kwonyango, kunye novavanyo longenelelo lophando lonyango. Uninzi lwezixhobo ezinjalo ezikhoyo azifanelekanga kwaye ziyilelwe amanqanaba aphezulu okuchaneka kwaye azikwazi ukulawulwa lula rhoqo. Isisombululo sokuphucula uvavanyo lokuqonda kuye kwacetyiswa ukuba yikhompyuter, kodwa uninzi lwezo nzame ziye zabonelela kancinci kunekhompyuter yovavanyo oluqhelekileyo lwe-neuropsychological, kwaye aziphuhliswanga ukujongana ngqo nemiba ebalulekileyo yovavanyo lokuqonda olufunekayo ukuqonda kwangoko. ngqondweni kunye nokuqhubela phambili kwayo. Ke ngoko, izixhobo ezitsha zovavanyo lwengqiqo kufuneka zifakwe kwikhompyutha kwaye zisekelwe kumthombo ongenamkhawulo weemvavanyo ezithelekisekayo, ezingathintelwanga lulwimi okanye inkcubeko, ezibonelela ngamanqanaba okuchaneka, ukuchaneka, kunye nokuthembeka okunokuphuculwa ngokuqhubekayo. Ukongeza, uvavanyo olunjalo kufuneka lube mnandi kwaye lubandakanyeke, ukwenzela ukuba uvavanyo oluphindaphindiweyo luya kuthathwa njengento enhle kunokuba namava anzima. Uvavanyo lwe-intanethi, ngokukodwa, lunika amandla okuhlangabezana nale mfuno, ngelixa libonelela ngokuqokelelwa ngokukhawuleza kunye nohlalutyo lwedatha, kunye nokubonelela ngengxelo ekhawulezileyo kubantu abathatha inxaxheba, oogqirha kunye nabaphandi.

Uphononongo lwangoku lwenzelwe ukuvavanya ukusetyenziswa kokulungelelaniswa kwe-intanethi ye-paradigm ye-continuous recognition task (CRT), yokuvavanya umsebenzi wokuqonda kwinani labantu abahlala ekuhlaleni abangazange bachongwe ukuba banesifo sengqondo esiyingozi. I-paradigm yeCRT isetyenziswa ngokubanzi kwizifundo izifundo zenkumbulo iindlela. Indlela ye-CRT yaqala yaphunyezwa njengesixhobo sokubonisa abaphulaphuli esibonelela ngedatha kubantu abanomdla iingxaki zememori. Emva koko, olu vavanyo luphunyezwe kwi-intanethi yinkampani yaseFransi (HAPPYneuron, Inc.); yinkampani esekwe e-US, iMemTrax, LLC (http://www.memtrax.com); ngoBuchule impilo Ubhaliso oluphuhliswe nguDkt. Michael Weiner, UCSF, kunye neqela lakhe ukuxhasa ukuqeshwa kwezifundo zokuphazamiseka kwengqondo; kunye nenkampani yaseTshayina i-SJN Biomed, LTD). Olu vavanyo, ukusukela ngoJuni ka-2018, lufumene idatha kubasebenzisi abangaphezu kwama-200,000, kwaye lukwizilingo kumazwe aliqela.

Kuphononongo lwangoku, i-MemTrax (MTX), uvavanyo olusekelwe kwi-CRT, lulawulwa ngokubambisana ne-MoCA kubantu abadala abazimeleyo abahlala emantla eNetherlands. Injongo yolu phononongo yayikukumisela ubudlelwane phakathi kwentsebenzo kolu kuphunyezwa kweCRT kunye ne-MoCA. Umbuzo wawungowokuba ingaba i-MTX ingaba luncedo na ekuqikeleleni imisebenzi yokuqonda evavanywe yi-MoCA, enokubonisa ukusetyenziswa kweklinikhi okunokwenzeka.

IMPAHLA NENKQUBO

Inani labafundi

Phakathi kuka-Oktobha 2015 kunye noMeyi 2016, uphando olunqamlekileyo lwenziwa phakathi kwabantu abadala abahlala kwindawo esenyakatho yeNetherlands. Izifundo (≥75y) zafunyanwa ngokusasazwa kweeflaya nangexesha leentlanganiso zamaqela ezilungiselelwe abantu abadala. Izifundo ezinokuthi zityelelwe ekhaya ukuze zikhusele ukufakwa kunye neendlela zokukhutshwa ngaphambi kokuba zibhaliswe kolu phononongo. Izifundo ezinesifo sengqondo esiyingozi (ezazixelwe ngokwazo) okanye abangaboni kakuhle kakhulu okanye abangevayo okuya kuba nefuthe ekulawuleni iimvavanyo zengqondo abazange bavunyelwe ukuba bathathe inxaxheba kolu phononongo. Ukongezelela, izifundo kwakufuneka zikwazi ukuthetha nokuqonda ulwimi lwesiDatshi kwaye zingafundanga. Uphononongo lwenziwe ngokwesibhengezo saseHelsinki sika-1975 kwaye bonke abathathi-nxaxheba basayine imvume yokwazi ifomu emva kokufumana inkcazo eneenkcukacha zophononongo.

Inkqubo yokufunda

Emva kokubhaliswa kwisifundo, i-questionnaire jikelele ilawulwa, ebandakanya imibuzo malunga neemeko zabantu, ezifana neminyaka kunye neminyaka yemfundo (ukuqala esikolweni esiprayimari), imbali yonyango, kunye nokusetyenziswa kotywala. Emva kokugqitywa koluhlu lwemibuzo, iimvavanyo ze-MoCA kunye ne-MTX zaye zaqhutywa ngokulandelelana.

I-MemTrax - IZiko lezoNyango loPhando

Njengoncedo lweMemTrax, LLC (Redwood City, CA, USA), iinguqulelo ezipheleleyo zasimahla zovavanyo lweMTX zanikezelwa. Kolu vavanyo, uthotho lwemifanekiso engama-50 luboniswa ukuya kuthi ga kwimizuzwana emithathu nganye. Xa umfanekiso ophindaphindiweyo ochanekileyo ubonakala (25/50), izifundo zayalelwa ukuba zisabele kumfanekiso ophindaphindiweyo ngokukhawuleza ngokucinezela i-spacebar (eyayiboniswa yi-tape enemibala ebomvu). Xa umbandela uphendula umfanekiso, umfanekiso olandelayo waboniswa ngoko nangoko. Emva kokugqiba uvavanyo, inkqubo ibonisa ipesenti yeempendulo ezichanekileyo (MTX_lungile) kunye ne-avareji yexesha lokuphendula kwimizuzwana yemifanekiso ephindaphindiweyo, ebonisa ixesha elifunekayo ukucofa i-spacebar xa ubona umfanekiso ophindaphindiweyo. Ukutshatisa imilinganiselo yale milinganiselo mibini, ixesha lokusabela liguqulelwe kwisantya sokusabela (MTX_isantya) ngokwahlula i-1 ngexesha lokuphendula (okt, 1/MTX_{ixesha lokuphendula}). Imbali yovavanyo lwawo onke amanqaku e-MemTrax kunye nokuqinisekiswa kwawo kwagcinwa ngokuzenzekelayo kwi-intanethi kwi-akhawunti yovavanyo. Ukuqinisekiswa kwazo zonke iimvavanyo ezenziweyo zihlolwe, zifuna i-5 okanye iimpendulo ezimbalwa zobuxoki, i-10 okanye ngaphezulu kokuqaphela okuchanekileyo, kunye nexesha eliqhelekileyo lokuqaphela phakathi kwe-0.4 kunye ne-2 imizuzwana, kwaye iimvavanyo ezisebenzayo kuphela zifakwe kuhlalutyo.

Ngaphambi kokuba uvavanyo lwe-MTX lwenyani lwenziwe, uvavanyo lwachazwa ngokweenkcukacha kwaye uvavanyo lokuziqhelanisa lunikezelwe kwizifundo. Oku akubandakanyi kuphela uvavanyo ngokwalo, kodwa kunye nomyalelo kunye namaphepha okubala-phantsi ukuvumela umthathi-nxaxheba ukuba aqhelane nokwakheka kwendawo kunye nezenzo zokuqala ezifunekayo, ngaphambi kokuqala kovavanyo. Ukuze ugweme ukuphindaphinda kwemifanekiso ngexesha lovavanyo lwangempela, imifanekiso engabandakanywanga kwi-database ye-MemTrax yayisetyenziselwa uvavanyo lokuziqhelanisa.

Uvavanyo lokuqonda lwaseMontreal isixhobo

Imvume ifunyenwe kwi-MoCA Institute & Clinique (Quebec, Canada) ukusebenzisa i-MoCA kolu phando. I-MoCA yesiDatshi ifumaneka kwiinguqulelo ezintathu, eziye zalawulwa ngokungacwangciswanga kwizifundo. Amanqaku e-MoCA sisimbuku sokwenziwa komsebenzi kwi-domain nganye eyahlukileyo ehloliweyo kwaye inamanqaku aphezulu angama-30. Ngokwengcebiso esemthethweni, inqaku elongezelelweyo longezwa ukuba umthathi-nxaxheba ube ≤12 iminyaka yokufunda (ukuba <30 amanqaku). Imiyalelo yovavanyo esemthethweni yasetyenziswa njengesikhokelo ngexesha lokubhalwa kweemvavanyo. Iimvavanyo zilawulwa ngabaphandi abathathu abaqeqeshiweyo kunye nokulawulwa kovavanyo olunye kuthathe malunga ne-10 ukuya kwi-15 min.

Uhlalutyo lwedatha yeMemTrax

Ngokusekelwe kwiziphumo ze-MoCA, eyalungiselelwa imfundo, izifundo zahlulwa ngokwamaqela amabini esimo sengqondo: i-normal cognition (NC) versus mild cognitive impairment (MCI). Amanqaku e-MoCA angama-23 asetyenziswe njenge-cutoff ye-MCI (amanqaku angama-22 nangaphantsi athathwa njenge-MCI), njengoko kubonisiwe ukuba eli nqaku libonise ngokupheleleyo 'elona nqanaba lichanekileyo lokuxilonga kuluhlu lweparameters' xa kuthelekiswa namanqaku acetyiswayo ekuqaleni. I-26 okanye ixabiso le-24 okanye i-25. Kulo lonke uhlalutyo, amanqaku e-MoCA alungisiweyo asetyenziswe njengoko eli nqaku lisetyenziswa kwizicwangciso zeklinikhi.

Uvavanyo lwe-MTX lunika iziphumo ezibini, ezizezi, iMTX_{ixesha lokuphendula}, eyaguqulelwa kwi-MTX_isantya ngo-1/MTX_{ixesha lokuphendula}, kunye ne-MTX_lungile.

Uhlalutyo lwamanani lwenziwe kusetyenziswa i-R (inguqulo 1.0.143, iQela le-Rstudio, i-2016). Isiqhelo sajongwa kuzo zonke izinto eziguquguqukayo ngovavanyo lwe-Shapiro-Wilk. Izinto eziguquguqukayo zabantu abafundayo bephela, kunye namaqela e-NC kunye ne-MCI, zichazwe njengentsingiselo ± ukutenxa okusemgangathweni (SD), i-median kunye ne-interquartile range (IQR) okanye njengenani kunye nepesenti. Iimvavanyo ze-T ezizimeleyo zesampula kunye ne-Wilcoxon Sum Rank iimvavanyo zeenguqu eziqhubekayo kunye neemvavanyo ze-Chi-squared ze-categorical variables zenziwa ukuthelekisa iimpawu ze-NC kunye neqela le-MCI. Uvavanyo lwe-non-parametric Kruskal-Wallis lusetyenziselwe ukufumanisa ukuba iinguqulelo ezintathu ze-MoCA kunye nabalawuli abathathu bazichaphazele iziphumo ze-MoCA. Ukongeza, uvavanyo lwe-T oluzimeleyo okanye uvavanyo lwe-Wilcoxon Sum Rank lwenziwa ukufumanisa ukuba umyalelo wolawulo lwe-MoCA kunye ne-MTX ube nefuthe kwiziphumo zovavanyo (umz., amanqaku e-MoCA, i-MTX_lungile, kunye ne-MTX_isantya). Oku kwenziwa ngokumisela ukuba amanqaku aphakathi ahluke kwizifundo ezifumene kuqala i-MoCA kunye ne-MemTrax okanye ngubani owafumana kuqala i-MTX kunye ne-MoCA.

Ulungelelwaniso lwePearson iimvavanyo zabalwa ukuvavanya ubudlelwane phakathi kwe-MTX kunye ne-MoCA naphakathi kwe-MemTrax zombini iziphumo zovavanyo, umzekelo, i-MTXspeed kunye ne-MTX echanekileyo. Ubungakanani besampulu esele yenziwe ngaphambili ibonise ukuba uvavanyo lolungelelwaniso lwePearson olunomsila omnye (amandla = 80% , α = 0.05), kunye nokucinga kobungakanani besiphumo esiphakathi (r = 0.3), isampula encinci ye-n = 67 yayifuneka. Iimvavanyo ze-Polyserial correlation zibalwe ukuvavanya ubudlelwane phakathi kweziphumo zovavanyo lwe-MTX kunye nemimandla eyahlukeneyo ye-MoCA kusetyenziswa iphakheji yengqondo kwi-R.

Amanqaku e-MoCA alinganayo kumanqaku anikiweyo e-MemTrax abalwe ngokubala i-avareji yenqaku le-MemTrax kwinqaku ngalinye elinokubakho le-MoCA kunye nokuhlehliswa komgca kwenziwe ukuqikelela ii-equations ezinxulumene nale milinganiselo. Ukongezelela, ukumisela amaxabiso e-cutoff yovavanyo lwe-MemTrax ye-MCI elinganiswe yi-MoCA, kunye novelwano oluhambelanayo kunye nemilinganiselo ethile, uhlalutyo lwe-Receiver Operator Characteristic (ROC) lwenziwa kusetyenziswa iphakheji ye-pROC kwi-R. Non-parametric stratified bootstrapping (n = 2000) yayisetyenziselwa ukuthelekisa indawo ephantsi kwee-curves (AUCs) kunye nezihlandlo zokuzithemba ezihambelanayo. Elona nqanaba liphezulu lokunqunyulwa libalwe kunye nendlela ye-Youden, eyandisa ii-positives eziyinyani ngelixa unciphisa ubuxoki.

Kulo lonke uhlalutyo lweenkcukacha-manani, i-p-value enamacala amabini <0.05 ithathwa njengengqalelo yokubaluleka kweenkcukacha-manani, ngaphandle kohlalutyo lokuvavanya ubudlelwane phakathi kwe-MTX kunye ne-MoCA (okt, uhlalutyo lolungelelwaniso kunye nokuhlehla komgca olulula) apho enye- Ixabiso le-p elisecaleni lika-<0.05 lithathwe njengelibalulekileyo.

I-MemTrax IZIPHUMO

I zifundo

Zizonke, izifundo ezili-101 zibandakanyiwe kolu phononongo. Idatha yabantu be-19 yayingabandakanywanga kuhlalutyo, njengoko iziphumo zovavanyo lwe-MemTrax ezivela kwizifundo ze-12 azizange zigcinwe yiprogram, izifundo ze-6 zineziphumo zovavanyo ze-MemTrax ezingekho mthethweni, kunye nesifundo esinye sasinamanqaku e-MoCA amanqaku e-8, ebonisa ukuphazamiseka okukhulu kwengqondo, okwathi inqobo yokukhetha. Ngoko ke, idatha evela kwizifundo ze-82 ifakwe kuhlalutyo. Akukho mahluko ubalulekileyo kwiziphumo zovavanyo lwe-MoCA ofunyenweyo phakathi kweenguqulelo ezahlukeneyo ze-MoCA naphakathi kwabalawuli. Ukongeza, umyalelo wolawulo lovavanyo awuzange ube nempembelelo ebalulekileyo kuwo nawaphi na amanqaku ovavanyo (MoCA, MTX_isantya, MTX_lungile). Ngokusekelwe kwiziphumo zovavanyo lwe-MoCA, izifundo zifakwe kwiqela le-NC okanye le-MCI (umzekelo, i-MoCA ≥ 23 okanye i-MoCA <23, ngokulandelanayo). Iimpawu zesifundo kuluntu lonke lokufunda, kunye ne-NC kunye namaqela e-MCI achazwe kwiThebhile 1. Akukho ntlukwano ebalulekileyo ekhoyo phakathi kwamaqela, ngaphandle kwamanqaku e-MoCA aphakathi (25 (IQR: 23 - 26) ngokubhekiselele kwi-21 (IQR: 19 - 22) ) amanqaku, Z = -7.7, p <0.001).

Itheyibhile 1

Iimpawu zezihloko

	Itotali yabemi bofundo (n = 82)	I-NC (n = 45)	I-MCI (n = 37)	p
Ubudala (y)	83.5 ± 5.2	82.6 ± 4.9	84.7 ± 5.4	0.074
Owasetyhini, Hayi. (%)	55 (67)	27 (60)	28 (76)	0.133
Imfundo (y)	10.0 (8.0 - 13.0)	11.0 (8.0 - 14.0)	10.0 (8.0 - 12.0)	0.216
Ukusela utywala (# iiglasi/iveki)	0 (0 - 4)	0 (0 - 3)	0 (0 - 5)	0.900
Amanqaku e-MoCA (# amanqaku)	23 (21 - 25)	25 (23 - 26)	21 (19 - 22)	kuhle

Amaxabiso achazwa njengentsingiselo ± sd, i-median (IQR) okanye njengenani ngepesenti.

Ubume bengqondo bulinganiswa yiMemTrax

Ubume bengqondo bulinganiswa ngovavanyo lwe-MTX. Umzobo 1 ubonisa iziphumo ze uvavanyo lwengqondo iziphumo zezifundo ze-NC kunye ne-MCI. Amanqaku aqhelekileyo e-MTX (umz., MTX_isantya kunye ne-MTX_lungile) zahluke kakhulu phakathi kwamaqela amabini. Izifundo ze-NC (0.916 ± 0.152 s^-1) ibenesantya esibalulekileyo sokusabela ngokukhawuleza xa kuthelekiswa nezifundo ze-MCI (0.816 ± 0.146 s^-1); t (80) = 3.01, p = 0.003) (Umfanekiso 1A). Ukongeza, izifundo ze-NC zazinamanqaku angcono kwi-MTX_lungile ukuguquguquka kunezifundo ze-MCI (91.2 ± 5.0% ngokuchasene ne-87.0 ± 7.7% ngokulandelelanayo;_w (59) = 2.89, p = 0.005) (Umfanekiso 1B).

Umzobo.1

Iibhokisi zeziphumo zovavanyo lwe-MTX ze-NC kunye namaqela e-MCI. A) MTX_isantya iziphumo zovavanyo kunye B) MTX_lungile iziphumo zovavanyo. Zombini iziphumo eziguquguqukayo zovavanyo lwe-MTX ziphantsi kakhulu kwiqela le-MCI xa kuthelekiswa ne-NC. Umbala ongwevu okhanyayo ubonisa izifundo ze-NC, ngelixa umbala omnyama ubonisa izifundo ze-MCI.

Unxulumano phakathi kweMemTrax kunye ne-MOCA

Imibutho phakathi kwamanqaku ovavanyo lwe-MTX kunye ne-MoCA iboniswe kwi-Fig. MTX_isantya kunye ne-MoCA ibonise ukulungelelaniswa okubalulekileyo kwe-r = 0.39 (p = 0.000), kunye nokulungelelaniswa phakathi kwe-MTX_lungile kunye ne-MoCA yaba r = 0.31 (p = 0.005). Kwakungekho nxulumano phakathi kweMTX_isantya kunye ne-MTX_lungile.

Umzobo.2

Unxulumano phakathi A) MTX_isantya kunye ne-MoCA; B) MTX_lungile kunye ne-MoCA; C) MTX_lungile kunye ne-MTX_isantya. Izifundo ze-NC kunye ne-MCI ziboniswa ngamachaphaza kunye nonxantathu ngokulandelelanayo. Kwikona esezantsi ekunene kwigrafu nganye i-rho kunye nexabiso le-p elihambelanayo liboniswa unxulumano phakathi kwezinto ezimbini eziguquguqukayo.

Unxulumano phakathi kwe-A) ne-MTXspeed ne-MoCA; B) I-MTX echanekileyo kunye ne-MoCA; C) I-MTX echanekileyo kunye ne-MTXspeed. Izifundo ze-NC kunye ne-MCI ziboniswa ngamachaphaza kunye nonxantathu ngokulandelelanayo. Kwikona esezantsi ekunene kwigrafu nganye i-rho kunye nexabiso le-p elihambelanayo liboniswa unxulumano phakathi kwezinto ezimbini eziguquguqukayo.[/caption]

Ulungelelwaniso lwe-Polyserial lubalwe phakathi kwamanqaku ovavanyo lwe-MemTrax kunye nemimandla ye-MoCA ukumisela ukudibanisa kwe-domain nganye kunye ne-MemTrax metrics. Ulungelelwaniso lwe-polyserial luboniswe kwiThebhile 2. Iindawo ezininzi ze-MoCA zaye zadityaniswa kakhulu ne-MTX._{isantya .}  I-domain "abstraction" ibonise ukulungelelaniswa okuphezulu, nangona imodareyitha, kunye ne-MTX_isantya (r = 0.35, p = 0.002). Imimandla "yegama" kunye "nolwimi" ibonise ubuthathaka ukuya kwimodareyitha yobudlelwane obubalulekileyo kunye ne-MTX_isantya (r = 0.29, p = 0.026 kunye r = 0.27, p = 0.012, ngokulandelanayo). MTX_lungile ayizange idibaniswe kakhulu nemimandla ye-MoCA, ngaphandle kokulungelelaniswa okubuthathaka kunye ne-domain "visuospatial" (r = 0.25, p = 0.021).

Itheyibhile 2

Ulungelelwaniso lwePolyserial lweziphumo zovavanyo lwe-MTX kunye nemimandla ye-MoCA

	MTXisantya	MTXlungile
	r	p	r	p
Visuospatial	0.22	0.046	0.25	0.021
Ukubiza igama	0.29	0.026	0.24	0.063
ingqalelo	0.24	0.046	0.09	0.477
ulwimi	0.27	0.012	0.160	0.165
Ukuthintela	0.35	0.002	0.211	0.079
Khumbula	0.15	0.159	0.143	0.163
NgezoBomi	0.21	0.156	0.005	0.972

Qaphela: Unxulumano olubalulekileyo lubonakaliswe ngqindilili.

Amanqaku e-MemTrax kunye namaxabiso aqikelelweyo okunqunyulwa kwe-MCI

Ukumisela amanqaku ahambelanayo e-MemTrax kunye ne-MoCA, amanqaku e-MemTrax enqaku ngalinye le-MoCA aqikelelwe kwaye ukuhlehliswa komgca kubalwe ukuqikelela ubudlelwane kunye nee-equations ezihambelanayo. Iziphumo zokuhlehla komgca zibonise ukuba i-MTX_isantya icacise i-55% yomahluko kwi-MoCA (R² = 0.55, p = 0.001). Utshintsho lwe-MTX_lungile icacise i-21% yomahluko kwi-MoCA (R² = 0.21, p = 0.048). Ngokusekwe kwi-equations kobu budlelwane, amanqaku e-MoCA alinganayo abalwe kumanqaku e-MTX anikiweyo, aboniswe kwiThebhile 3. Ngokusekelwe kwezi zibalo, amaxabiso ahambelanayo okunqunyulwa (umzekelo, amanqaku e-MoCA amanqaku angama-23) kwi-MTX._isantya kunye ne-MTX_lungile yi 0.87s^-1 kunye ne-90%. Ukongeza, uhlengahlengiso oluninzi kwiindlela zombini zeMemTrax zenziwa, kodwa i-MTX eguquguqukayo_lungile akazange abe negalelo elikhulu kumzekelo kwaye ke iziphumo aziboniswanga.

Itheyibhile 3

Ingcebiso elinganayo yamanqaku e-MoCA anikwe amanqaku e-MemTrax

I-MoCA (amanqaku)	I-MTX elinganayoisantya (s-1)a	I-CI yokubikezela kunye ne-MTXisantya (amanqaku)	I-MTX elinganayolungile (%)b	I-CI yokubikezela kunye ne-MTXlungile (amanqaku)
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

^aInxaki esetyenzisiweyo: 1.1 + 25.2 *MTX_isantya; ^b Inxaki esetyenzisiweyo: -9.7 + 0.36 *MTX_lungile.

Ukongezelela, amaxabiso e-MTX cutoff kunye novelwano oluhambelanayo kunye neenkcukacha ezithile zichongwe ngokuhlalutya kwe-ROC. Iigophe ze-ROC ze-MemTrax eziguquguqukayo zinikezelwe kwi-Fig. 3. I-AUCs ye-MTX_isantya kunye ne-MTX_lungile ngaba, ngokulandelanayo, i-66.7 (CI: 54.9 - 78.4) kunye ne-66.4% (CI: 54.1 - 78.7). Ii-AUC zeMemTrax eziguquguqukayo ezisetyenziselwa ukuvavanya i-MCI esekwe yi-MoCA yayingahlukanga kakhulu. Itheyibhile 4 ibonisa ubuntununtunu kunye neenkcukacha zamanqaku ahlukeneyo e-cutoff ye-MemTrax variables. Awona manqaku e-cutoff awona aphezulu, athe anyusa ii-positives eziyinyani ngelixa unciphisa iziphumo zobuxoki, kwi-MTX._isantya kunye ne-MTX_lungile yayiyi-0.91 s^-1 (ubuntununtunu = 48.9% ukuchaneka = 78.4%) kunye ne-85% (ubuntununtunu = 43.2%; ngokukodwa = 93.3%), ngokulandelanayo.

Umzobo.3

Iijika ze-ROC zeziphumo zovavanyo lwe-MTX zokuvavanya i-MCI elinganiswe yi-MoCA. Umgca wamachaphaza ubonisa i-MTX_isantya kunye nomgca oqinileyo we-MTX_lungile. Umgca ongwevu ubonisa umgca wereferensi we-0.5.

Itheyibhile 4

MTX_isantya kunye ne-MTX_lungile amanqaku asikiweyo kunye neenkcukacha ezihambelanayo kunye novakalelo

	Indawo yokuqhawula	Tp (#)	tn (#)	Fp (#)	Fn (#)	Ucalulo (%)	Uvakalelo (%)
MTXisantya	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
MTXlungile	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, inyani yokwenene; tn, inyani yokwenyani; fp, i-positive positive; fn, negative negative.

UKUQALA

Olu pho nonongo lwamiselwa ukuphanda isixhobo se-MemTrax kwi-intanethi, uvavanyo olusekelwe kwi-CRT, kusetyenziswa i-MoCA njengesalathiso. I-MoCA yakhethwa ngenxa yokuba olu vavanyo lusetyenziswa ngokubanzi ukukhangela i-MCI. Nangona kunjalo, ezona ndawo zilungileyo zokusikwa kwe-MoCA azikasekwa ngokucacileyo [28]. Ukuthelekiswa kwamanyathelo omntu ngamnye we-MemTrax kunye ne-MoCA kubonisa ukuba uvavanyo olulula, olufutshane, lwe-intanethi lunokuthi lubambe umlinganiselo omkhulu wokungafani ekusebenzeni kwengqondo kunye nokuphazamiseka kwengqondo. Kolu hlalutyo, isiphumo esinamandla sabonwa kumlinganiselo wesantya. Umlinganiselo wokuchaneka ubonise ubudlelwane obungaqinanga kangako. Ukufunyaniswa okubalulekileyo kukuba akukho kulungelelaniswa okubonwayo phakathi kwesantya se-MTX kunye nemilinganiselo yokuchaneka, ebonisa ukuba ezi ziguquko zilinganisa amacandelo ahlukeneyo angaphantsi. umsebenzi wokucubungula ingqondo. Ngaloo ndlela, akukho nto ibonisa ukuba i-speed-accuracy trade-off yafunyanwa kuzo zonke izifundo. Ukongeza, iindlela ezimbini ezahlukeneyo zisetyenziselwe ukuqikelela amaxabiso e-cutoff yovavanyo lwememori ye-MemTrax ukufumana i-MCI. Ezi ndlela zibonise ukuba kwisantya seziphumo kunye nokuchaneka, amanqaku angaphantsi koluhlu ngokulandelelana kwe-0.87 - 91 s.^-1 kunye nama-85 – 90% abonisa ukuba abantu abafumana amanqaku angaphantsi kolunye kolo luhlu kunokwenzeka ukuba babe ne-MCI. "Uhlalutyo lokufaneleka kweendleko" luya kubonisa ukuba kuliphi ixesha umntu kufuneka acetyiswe ukuba adibane nogqirha malunga nokwenza iimvavanyo ezibanzi ngakumbi kwi-MCI [8-35].

Kuphononongo lwangoku, kwafunyaniswa ukuba imimandla ethi "naming", "ulwimi", kunye "ne-abstraction" elinganiswe yi-MoCA yayinonxibelelwano oluphezulu kunye nesinye seziphumo zeMemTrax, nangona ulungelelwaniso lwalubuthathaka ukumodareyitha. Oku kuchasene noko bekulindelekile, ekubeni izifundo zangaphambili zibonise ekuhloleni i Mini-Mental State Exam usebenzisa i-Item Response Theory, ukuba iindawo "inkumbulo / ukulibazisa ukukhumbula" kunye "noqhelaniso" yayizezona zinovakalelo kwi-AD yokuqala [12]. Kule nto kanye inqanaba lokuqala yokungasebenzi kakuhle kwengqondo, kubonakala ngathi izalathi ze-MoCA zothintelo olufihlakeleyo ekubizeni amagama, ulwimi, kunye nokutsalwa zinovakalelo ngakumbi kwi-MCI kunemilinganiselo yememori kunye nokuqhelaniswa, ngokuhambelana neziphumo zangaphambili kuhlalutyo lwe-Item Response Theory ye-MoCA [36]. Ngapha koko, i Umlinganiselo we-MemTrax wesantya sokuqondwa ubonakala ubonisa oku konakala kwangaphambili phambi kokuqondwa kwenkumbulo njengoko kulinganiswe yi-MTX (enesiphumo esibalulekileyo sosilingi). Eli kroza le Iziphumo zibonisa ukuba imiba entsonkothileyo ye-pathology ebangela i-MCI ibonakalisa ubuchopho bokuqala utshintsho obekunzima ukuluqonda ngeendlela ezilula ze-neurocognitive kwaye ngokwenene lunokubonisa ukuqhubela phambili kwe-neuropathology ephantsi [37].

Amanqaku anamandla kuphononongo lwangoku kukuba ubungakanani besampulu (n = 82) bebungaphezulu kokwaneleyo ukufumanisa ulungelelwaniso phakathi kwe-MoCA kunye ne-MTX kule ndawo idala kakhulu. Ukongezelela, uvavanyo lokuziqhelanisa lwenziwa kuzo zonke izifundo, ukuze abantu abadala abangaqhelanga ukusebenzisa ikhompyutha babe nethuba lokuziqhelanisa nemekobume yovavanyo nezixhobo zokusebenza. Xa kuthelekiswa ne-MoCA, izifundo zibonise ukuba i-MemTrax ibimnandi kakhulu ukuyenza, ngelixa i-MoCA ivakala ngathi luviwo. Ubudala bezifundo kunye nokuzimela koluntu lwabo luthintele ugxininiso lohlalutyo kweli qela likhethiweyo labantu abasebenza kakhulu, kodwa eli qela liphakathi kwezona zinzima kakhulu ekuchongeni ukukhubazeka.

Inqaku, nangona ithathwa njengovavanyo oluqhelekileyo lovavanyo, i-MoCA luvavanyo kuphela lokubonisa ubukho obunokwenzeka be-MCI, hayi isixhobo sokuxilonga okanye umlinganiselo opheleleyo wokungasebenzi kakuhle kwengqondo. Ke, ngokufanelekileyo, ukuthelekiswa kwe-MoCA kunye ne-MTX kuyazalana, kwaye mhlawumbi kungenzeka ukuba ibambe umahluko ozimeleyo kuchongo lwe-MCI. Ngako oko, umba obalulekileyo kuncwadi ibe ngumzamo wokuchaza ukuba luncedo kwe-MoCA [38], ukuqinisekiswa kwayo [39], ukusekwa kwamanqaku aqhelekileyo [40], ukuthelekiswa nolunye uvavanyo olufutshane lwengqondo [41-45] , kunye nokusetyenziswa kwayo njengesixhobo sokuhlola i-MCI [46] (ihlaziywe nguCarson et al., 2017 [28]), kunye nokusetyenziswa kwenguqulo ye-elektroniki [47]. Uhlalutyo olunjalo lubandakanya ukuhlolwa kovakalelo kunye neenkcukacha ezithile, ngokuqhelekileyo kusetyenziswa uhlalutyo lwe-ROC kunye nokulinganisa "ummandla ophantsi kwegophe", kunye nokucetyiswa kwe-cutoff "yokuxilongwa". Nangona kunjalo, ngokungabikho kwayo nayiphi na indlela yokumisela ngokupheleleyo apho umntu alele khona kuqhubekeko lothintelo olungephi, kunye nokwahluka okumangalisayo kwinto ekhoyo. imisebenzi yengqondo igalelo kokonakala, zonke ezo zixhobo zinokubonelela kuphela ngoqikelelo olunokwenzeka. Ukubonelela ngolungelelwaniso phakathi kwamanyathelo ahlukeneyo kubonisa kuphela ukuba imeko esisiseko ilungiswa ngokuchanekileyo, kodwa imeko yebhayoloji yokwenyani ayinakuchazwa ngokuchanekileyo ngale ndlela. Nangona uhlalutyo lwenqanaba eliphezulu lunokuba luncedo kwimeko yeklinikhi, ukusekwa koncedo olunjalo kufuna ingqwalasela eyongezelelweyo yezinto ezine: ukuxhaphaka kwemeko kubemi; iindleko zovavanyo, iindleko zeziphumo ezingezizo zobuxoki, kunye nenzuzo yezinto ezibonakalayo zokuxilongwa kwenyani [8, 35].

Eyona nto iphambili inxalenye yengxaki ekuvavanyeni i-AD kunye nokuphazamiseka kwayo kwengqondo okunxulumeneyo kukuba akukho nyani "izigaba" [48], kodwa kunoko ukuqhubeka kwexesha lokuqhubela phambili [8, 17, 49]. Umahluko "wesiqhelo" kwi-MCI eneneni unzima kakhulu kunokwahlula enye yezi meko kwi-mild. isifo sengqondo esixhalabisayo kunye AD [50, 51]. Ngokusebenzisa ingqikelelo “yeTheory yoVavanyo yanamhlanje”, umba uba kukumisela ukuba phi na ngokuqhubekayo umntu kunokwenzeka ukuba abe ngaphakathi kuluhlu lwexesha lokuzithemba, enikwa amanqaku athile ovavanyo. Ukwenza umiselo olunjalo, uvavanyo oluchanekileyo oluthe kratya luyafuneka kunokuba lubonelelwe luninzi lovavanyo olufutshane lwengqondo, kodwa olubonelelwa yi-MTX. Ukuchaneka okwandisiweyo kunye nokususwa komkhi-mkhanyo wokuthambekela ngovavanyo lwekhompyuter lukhokelo oluthembisayo. Kwakhona, uvavanyo lwekhompyutha, olufana ne-MemTrax, lubonelela ngokunokwenzeka kwenani elingenamkhawulo leemvavanyo ezinokuthelekiswa, ukunciphisa kakhulu ukuhluka koqikelelo lomonakalo. Ngapha koko, ngokomgaqo, uvavanyo lwekhompyuter lunokuvavanya uninzi lwemimandla enxulumene nenkumbulo echatshazelwa yi-AD. Olu phononongo aluzange luqhathanise i-MTX kunye nolunye uvavanyo oluninzi lwekhompyuter oluye lwenziwa (jonga intshayelelo), kodwa akukho nanye ekhoyo ngoku sebenzisa indlela enamandla enikezelwa yiCRT. Uphuhliso olongezelelweyo lovavanyo lwekhompyutha luyinkalo ebalulekileyo yokuqwalaselwa ngakumbi kunye nenkxaso. Ekugqibeleni, iziphumo zoqeqesho inokudityaniswa kuhlalutyo.

Ngeli xesha, uvavanyo lwekhompyutha kwi-intanethi ayisiyondlela emiselweyo isikrini se-dementia, ukuvavanya ukuphazamiseka kwengqondo, okanye wenze naluphi na uxilongo lweklinikhi. Nangona kunjalo, amandla kunye namandla ale ndlela, ngakumbi ukusetyenziswa kweCRT, ukuvavanya imemori ye-episodic (yexesha elifutshane), inkulu kwaye iya kuba yinto ebalulekileyo kwizicelo zexesha elizayo zovavanyo lokuqonda, kubandakanywa. ukuhlolwa kwesifo sengqondo esiyingozi kunye novavanyo, ukubeka iliso kwisiphithiphithi emva kotyando, ukusekwa kwamandla engqondo ukwenza izigqibo, ukufumanisa iintsilelo zasemva kokudibana, kunye noqikelelo lomonakalo onokwenzeka wokhuseleko lokuqhuba. Kolu phononongo, kuboniswa ukuba i-MemTrax inokubamba ubungakanani obubalulekileyo bokuhluka kokuphazamiseka kwengqondo. Ukongeza, amaxabiso e-cutoff anikezelwa kwiinguqu ze-MTX ezilingana ne-MoCA cutoff score ye-MCI. Kuphando lwexesha elizayo, kucetyiswa ukuba kuphandwe kumanani amakhulu, achazwe ngokucacileyo ngakumbi ukuseka i-MemTrax njengesixhobo sokuhlola se-MCI. Abantu abanjalo kufuneka babandakanye iisampulu zeklinikhi apho imiba yokuxilonga inokuchazwa ngokuchanekileyo njengoko kunokwenzeka kwaye izifundo zinokulandelwa ngokuhamba kwexesha kunye ne-MTX kunye nezinye iimvavanyo zokuqonda. Uhlalutyo olunjalo lunokugqiba ukuhluka kwiindlela zokuhla kweengqondo, ezinxulumene nokuguga okuqhelekileyo kunye neemeko ezahlukeneyo ze-pathological. Njengoko uvavanyo lwekhompyutha kunye neerejistri ziphuhla, ulwazi oluninzi malunga namanqanaba impilo iya kufumaneka kwaye ngokungathandabuzekiyo ikhokelele ekuphuculeni okukhulu kukhathalelo lwempilo kwaye ngethemba iindlela zokuthintela iimeko ezinje ngeAD.

AMAKHODI

Sithanda ukubulela uAnne van der Heijden, uHanneke Rasing, uEsther Sinnema, noMelinda Lodders ngomsebenzi wabo kwesi sifundo. Ukongeza, singathanda ukubulela iMemTrax, LLC ngokubonelela ngeenguqulelo ezipheleleyo zasimahla zovavanyo lweMemTrax. Lo msebenzi uyinxalenye yenkqubo yophando, exhaswa ngemali yiPhondo laseFryslân (01120657), eNetherlands kunye ne-Alfasigma Nederland BV (igalelo ngqo kwinombolo yesibonelelo 01120657). Ipapashwe: 12 February 2019

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Amagama angundoqo: Isifo sika-Alzheimer, umsebenzi oqhubekayo wokusebenza, ukudodobala kwengqondo, abantu abadala, inkumbulo, ukuphazamiseka kwengqondo okuthambileyo, ukuhlolwa