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ACR:小儿心智自动评估标准可用于评估儿童期发病的SLE患者的认知障碍

2013-4-11 作者:ACR   来源:dxy 我要评论0
Tags: SLE  认知障碍  

来自美国辛辛那提儿童医院医疗中心和辛辛那提大学威廉·罗风湿免疫科的HERMINE I. BRUNNER等人进行了一项研究,该研究的目的是评价小儿心智自动评估标准(Ped-ANAM)对儿童期发病的系统性红斑狼疮(cSLE)进行评估的有效性和可重复性。研究结果在线发布在2013年3月的《关节炎护理及研究》(Arthritis Care & Research)杂志上。作者发现,Ped-ANAM表现中等以上的可重复性、同期效度和结构效度,适合用于评估cSLE患儿的认知障碍变化。然而,仍需更多的研究来证实Ped-ANAM对认知障碍检测的精确性,及其对随时间变化的临床相关的认知改变进行检测的有效性。
该研究招募了40位cSLE患者和40位匹配的对照者,随访研究18个月。18个月随访时重复进行基线标准神经心理测试。对整体认知表现和特殊认知表现(注意力、记忆力、处理速度、视觉建构能力)进行评价,并按照认知功能正常,轻度/中度认知受损,或中度/重度认知受损进行分类。Ped-ANAM评价为10分度 ,基线时测试两次,随访时每6个月测试一次。Ped-ANAM表现是基于精度(AC)、平均正确反应时间(MNc)、完成量、检测反应一致性的正确反应(CVc)所需有效时间系数。
研究结果发现,MNc独特的表现出中等至大量的可重复性(组内相关系数是0.47-0.48)。平均筛选Ped-ANAM积分(MNc,AC, CVc)在认知表现不同的儿童中具有显著差异,能检测出中度或严重的认知障碍,其灵敏度为100%;特异性是86%。Ped-ANAM与cSLE患者总体认知功能的改变具有显著相关性(基线 vs 18个月:斯皮尔曼相关系数>0.4,P < 0.05;n=24)。
研究发现,Ped-ANAM表现出中等以上的可重复性、同期效度和结构效度,适合用于评价cSLE患儿的认知功能的变化。然而,仍需要更多的研究来证实Ped-ANAM对认知障碍检测的显著精确性,及其对随时间变化的临床相关的认知改变的检测的有效性。
认知障碍相关的拓展阅读:


Validation of the Pediatric Automated Neuropsychological Assessment Metrics in childhood-onset systemic lupus erythematosus.
OBJECTIVE
To evaluate the reproducibility and validity of the Pediatric Automated Neuropsychological Assessment Metrics (Ped-ANAM) when used in childhood-onset systemic lupus erythematosus (cSLE).
METHODS
Forty children with cSLE and 40 matched controls were followed for up to 18 months. Formal neuropsychological testing at baseline was repeated after 18 months of followup; overall cognitive performance and domain-specific cognition (attention, working memory, processing speed, and visuoconstructional ability) were measured and categorized as normal cognition, mild/moderate, or moderate/severe impairment. The 10 Ped-ANAM subtests were completed every 6 months and twice at baseline. Ped-ANAM performance was based on accuracy (AC), mean time to correct response (MNc), throughput, and coefficient of variation of the time required for a correct response (CVc) as a measure of response consistency.
RESULTS
Particularly, MNc scores demonstrated moderate to substantial reproducibility (intraclass correlation coefficients 0.47-0.80). Means of select Ped-ANAM scores (MNc, AC, CVc) differed significantly between children with different levels of cognitive performance and allowed for the detection of moderate or severe cognitive impairment with 100% sensitivity and 86% specificity. Six Ped-ANAM subtests significantly correlated with the change in overall cognitive function in cSLE (baseline versus 18 months; Spearman's correlation coefficient >0.4, P < 0.05; n = 24).
CONCLUSION
The Ped-ANAM has moderate to substantial reproducibility, criterion and construct validity, and may be responsive to change in cSLE. Additional research is required to confirm the outstanding accuracy of the Ped-ANAM in identifying cognitive impairment, as well as its usefulness in detecting clinically relevant changes in cognition over time.



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