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Article(id=1203033500707418644, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203033494428541350, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2023.05.0587, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1646928000000, receivedDateStr=2022-03-11, revisedDate=null, revisedDateStr=null, acceptedDate=1649520000000, acceptedDateStr=2022-04-10, onlineDate=1764755137849, onlineDateStr=2025-12-03, pubDate=1685203200000, pubDateStr=2023-05-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1764755137849, onlineIssueDateStr=2025-12-03, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1764755137849, creator=13701087609, updateTime=1764755137849, updator=13701087609, issue=Issue{id=1203033494428541350, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='5', pageStart='489', pageEnd='626', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1764755136353, creator=13701087609, updateTime=1764756085669, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1203037476202967229, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203033494428541350, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1203037476202967230, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203033494428541350, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=587, endPage=595, ext={EN=ArticleExt(id=1203033501047157289, articleId=1203033500707418644, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=A tablet-based comprehensive evaluation of drawing complex graphics performance of patients with mild cognitive impairment, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To evaluate the usability of tablet-based digital complex figure test (dCFT) software on assessment of drawing strategies of patients with amnestic mild cognitive impairment (aMCI). Methods A total of 64 patients treated in a hospital from Nov. 2020 to Nov. 2021 were selected, including 26 cognitively normal people (control group) and 38 aMCI patients(aMCI group). All subjects underwent standardized neuropsychological assessments, including the mini-mental state examination(MMSE), the montreal cognitive assessment (MoCA), the Rey–Osterrieth Complex Figure (ROCF) test, and other cognitive domain scales. And then use the dCFT (including copying and recall) developed by our team to collect drawing parameters, such as stroke length, time, speed and number. The Pearson correlation coefficient was used to evaluate the correlation between the original and simplified ROCF test scores, and partial correlation used to analyze the correlation between the dCFT parameters and the comprehensive scores of each cognitive domain. Results (1) In the copying test, all dCFT parameters had no statistically significant between the two groups (P>0.05). In the immediate recall test, the total thinking time and element delay time in aMCI group were significantly longer than those in the control group [27.15(21.49, 33.94) vs. 21.85(18.26, 24.81), 1.99(1.36, 3.62) vs.1.32(1.03, 1.99), P<0.05]. In the delayed recall test, the transition time of short and long stroke sequence, total thinking time, total completion time, first thinking time and element delay time of the aMCI group were significantly higher than those of control group [1.89(1.12, 3.93) vs. 1.19(0.42, 2.41), 23.94(18.86, 36.87) vs. 19.93(16.59, 23.00), 40.30(34.83, 56.21) vs. 34.52(29.96, 42.15), 7.92(6.20, 9.83) vs. 5.92(5.16, 8.04), 1.63(1.25, 2.47) vs. 1.08(0.83, 1.55), P<0.05]. The first 5 stroke ratios (%), speed of the longest stroke (cm/s) and strokes per minute of aMCI group were significantly lower than those of control group [60(40, 80) vs. 80(60, 100), 4.65(3.53, 6.07) vs. 6.00(4.54, 7.13), 21(18, 25) vs. 26(21, 27), P<0.05]. Other dCFT parameters had no statistically significance between the two groups (P>0.05). (2) Correlation analysis showed that the transition time was negatively correlated with attention and executive function (r=–0.292, r=–0.275, P<0.05); the speed of the longest stroke was positively correlated with the executive function (r=0.302, P<0.05); the total thinking time was negatively correlated with memory, attention, executive function and visuospatial ability (r=–0.26, r=–0.408, r=–0.448, r=–0.264, P<0.05); the total completion time was negatively correlated with attention, executive function and visuospatial ability (r=–0.342, r=–0.429, r=–0.273, P<0.05); the first stroke latency was negatively correlated with memory and visuospatial ability (r=–0.365, r=–0.407, P<0.01); the average element latency was negatively correlated with memory and attention (r=–0.377, r=–0.33, P<0.01); the strokes per minute was positively correlated with memory, attention, executive function and visuospatial ability (r=0.326, r=0.311, r=0.376, r=0.263, P<0.05). Conclusions Visuospatial memory impairment of aMCI patients was presented in 3-minute recall test of the complex figure test, and their drawing strategy was acceptable. But after 20 minutes, the memory and the organization strategy of drawing were significantly affected. Visual perception is not significantly impaired in the process. The dCFT software is a convenient, objective assessment tool for aMCI.

, correspAuthors=Yang Li, authorNote=null, correspAuthorsNote=
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目的 评估基于平板电脑的数字化复杂图形测验（dCFT）软件检测遗忘型轻度认知障碍（aMCI）患者绘图表现的适用性。方法 选取2020年11月－2021年11月就诊于山西医科大学第一医院门诊的38例aMCI患者为观察组，26例认知功能正常者为对照组。两组均接受全面的神经心理测评，包括简易智力状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）、Rey复杂图形测验及各认知域量表等。同时期完成dCFT测评（dCFT软件基于平板电脑，可自动化采集多维度绘图参数），包括临摹、3 min即刻回忆及20 min延迟回忆测验。采用Pearson相关系数评估原始与简化版Rey复杂图形测验分值的相关性，采用偏相关分析dCFT参数与各认知域综合分值的相关性。结果 （1）dCFT临摹测验中，两组间参数比较差异无统计学意义（均P>0.05）；即刻回忆测验中，观察组思考总时间、元素延迟时间（s）均明显长于对照组[27.15（21.49，33.94）vs. 21.85（18.26，24.81），1.99（1.36，3.62）vs. 1.32（1.03，1.99），P<0.05]；延迟回忆测验中，观察组短长笔画序列过渡时间、思考总时间、完成总时间、第一笔思考时间及元素延迟时间（s）均长于对照组[1.89（1.12，3.93）vs. 1.19（0.42，2.41），23.94（18.86，36.87）vs. 19.93（16.59，23.00），40.30（34.83，56.21）vs. 34.52（29.96，42.15），7.92（6.20，9.83）vs. 5.92（5.16，8.04），1.63（1.25，2.47）vs. 1.08（0.83，1.55），P<0.05]，前5笔长笔画率（%）、最长笔画速度（cm/s）及每分钟笔画数（个）均低于对照组[60（40，80）vs. 80（60，100），4.65（3.53，6.07）vs. 6.00（4.54，7.13），21（18，25）vs. 26（21，27），P<0.05]；两组其他dCFT参数差异均无统计学意义（P>0.05）。（2）控制年龄、性别及受教育程度后，相关分析显示，短长笔画序列过渡时间与注意力及执行功能呈负相关（r=–0.292，r=–0.275，P<0.05），最长笔画速度与执行功能呈正相关（r=0.302，P<0.05），思考总时间与记忆力、注意力、执行功能、视空间能力均呈负相关（r=–0.26，r=–0.408，r=–0.448，r=–0.264，P<0.05），完成总时间与注意力、执行功能、视空间能力均呈负相关（r=–0.342，r=–0.429，r=–0.273，P<0.05），第一笔思考时间与记忆力、视空间能力均呈负相关（r=–0.365，r=–0.407，P<0.01），元素延迟时间与记忆力、注意力均呈负相关（r=–0.377，r=–0.33，P<0.01），每分钟笔画数与记忆力、注意力、执行功能、视空间能力均呈正相关（r=0.326，r=0.311，r=0.376，r=0.263，P<0.05）。结论 在复杂图形测验中，aMCI患者间隔3 min重新绘图时表现为视空间记忆受损，绘图策略尚可；间隔20 min重新绘图时记忆力及绘图策略均受到显著影响，但视觉感知在进程中受损不明显。dCFT可作为一种简便、客观的aMCI测评工具。

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李阳，E-mail：
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张肖南，博士研究生，主要从事人工智能技术在阿尔茨海默病防治中的应用研究

, authorsList=张肖南, 吕亮亮, 李阳, 郁磊, 赵娅蓉, 闵国文, 王秋艳, 申佳妮, 陈金雨)}, authors=[Author(id=1203033504113193690, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1203033504205468390, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, authorId=1203033504113193690, language=EN, stringName=Xiao-Nan Zhang, firstName=Xiao-Nan, middleName=null, lastName=Zhang, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi 030001, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1203033504285160173, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, authorId=1203033504113193690, language=CN, stringName=张肖南, firstName=肖南, middleName=null, lastName=张, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1山西医科大学影像学院，山西太原 030001, bio={"content":"

张肖南，博士研究生，主要从事人工智能技术在阿尔茨海默病防治中的应用研究

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张肖南，博士研究生，主要从事人工智能技术在阿尔茨海默病防治中的应用研究

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Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease[J].Alzheimers Dement, 2011, 7(3): 280-292., articleTitle=Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease, refAbstract=null), Reference(id=1203033512866705543, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, doi=null, pmid=null, pmcid=null, year=1944, volume=30, issue=null, pageStart=206, pageEnd=356, url=null, language=null, rfNumber=[13], rfOrder=13, authorNames=Osterrieth PA, journalName=Arch Psychol, refType=null, unstructuredReference=Osterrieth PA. Test of copying a complex figure; contribution to the study of perception and memory[J]. 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Front Neurol, 2021, 12: 680474., articleTitle=Overview of the complex figure test and its clinical application in neuropsychiatric disorders,including copying and recall, refAbstract=null), Reference(id=1203033513030283404, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, doi=null, pmid=null, pmcid=null, year=2015, volume=37, issue=10, pageStart=1052, pageEnd=1061, url=null, language=null, rfNumber=[15], rfOrder=15, authorNames=Wilson NA, Batchelor J, journalName=J Clin Exp Neuropsychol, refType=null, unstructuredReference=Wilson NA, Batchelor J. Examining Rey Complex Figure Test organization in healthy adults[J]. J Clin Exp Neuropsychol,2015, 37(10): 1052-1061., articleTitle=Examining Rey Complex Figure Test organization in healthy adults, refAbstract=null), Reference(id=1203033513093197967, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, doi=null, pmid=null, pmcid=null, year=2021, volume=30, issue=9, pageStart=794, pageEnd=799, url=null, language=null, rfNumber=[16], rfOrder=16, authorNames=Zhang XN, Zhao YR, Lv LL, journalName=Chin J Behav Med Brain Sci, refType=null, unstructuredReference=Zhang XN, Zhao YR, Lv LL, et al. Performance characteristics and diagnostic efficacy of the digital clock drawing test in patients with amnestic mild cognitive impairment[J]. Chin J Behav Med Brain Sci, 2021, 30(9): 794-799., articleTitle=Performance characteristics and diagnostic efficacy of the digital clock drawing test in patients with amnestic mild cognitive impairment, refAbstract=null), Reference(id=1203033513181278357, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, doi=null, pmid=null, pmcid=null, year=2021, volume=30, issue=9, pageStart=794, pageEnd=799, url=null, language=null, rfNumber=[16], rfOrder=17, authorNames=张肖南, 赵娅蓉, 吕亮亮, journalName=中华行为医学与脑科学杂志, refType=null, unstructuredReference=[张肖南, 赵娅蓉, 吕亮亮, 等. 遗忘型轻度认知障碍患者数字化画钟测验的表现特征及诊断效能研究[J]. 中华行为医学与脑科学杂志, 2021, 30(9): 794-799.], articleTitle=遗忘型轻度认知障碍患者数字化画钟测验的表现特征及诊断效能研究, refAbstract=null), Reference(id=1203033513269358742, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, doi=null, pmid=null, pmcid=null, year=2019, volume=9, issue=1, pageStart=3543, pageEnd=null, url=null, language=null, rfNumber=[17], rfOrder=18, authorNames=Müller S, Herde L, Preische O, journalName=Sci Rep, refType=null, unstructuredReference=Müller S, Herde L, Preische O, et al. Diagnostic value of digital clock drawing test in comparison with CERAD neuropsychological battery total score for discrimination of patients in the early course of Alzheimer's disease from healthy individuals[J]. Sci Rep, 2019, 9(1): 3543., articleTitle=Diagnostic value of digital clock drawing test in comparison with CERAD neuropsychological battery total score for discrimination of patients in the early course of Alzheimer's disease from healthy individuals, refAbstract=null), Reference(id=1203033513349050523, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, doi=null, pmid=null, pmcid=null, year=2020, volume=75, issue=1, pageStart=73, pageEnd=83, url=null, language=null, rfNumber=[18], rfOrder=19, authorNames=Dion C, Arias F, Amini S, journalName=J Alzheimers Dis, refType=null, unstructuredReference=Dion C, Arias F, Amini S, et al. Cognitive correlates of digital clock drawing metrics in older adults with and without mild cognitive impairment[J]. J Alzheimers Dis, 2020, 75(1): 73-83., articleTitle=Cognitive correlates of digital clock drawing metrics in older adults with and without mild cognitive impairment, refAbstract=null), Reference(id=1203033513441325217, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, doi=null, pmid=null, pmcid=null, year=2020, volume=22, issue=10, pageStart=1058, pageEnd=1061, url=null, language=null, rfNumber=[19], rfOrder=20, authorNames=Wei W, Zhao HY, Liu Y, journalName=Chin J Geriatr Heart Brain Vessel Dis, refType=null, unstructuredReference=Wei W, Zhao HY, Liu Y, et al. Characteristics of digital clock drawing test in elderly cerebral small vessel disease patients[J].Chin J Geriatr Heart Brain Vessel Dis, 2020, 22(10): 1058-1061., articleTitle=Characteristics of digital clock drawing test in elderly cerebral small vessel disease patients, refAbstract=null), Reference(id=1203033513533599910, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, doi=null, pmid=null, pmcid=null, year=2020, volume=22, issue=10, pageStart=1058, pageEnd=1061, url=null, language=null, rfNumber=[19], rfOrder=21, authorNames=魏微, 赵弘轶, 刘宇, journalName=中华老年心脑血管病杂志, refType=null, unstructuredReference=[魏微, 赵弘轶, 刘宇, 等. 老年脑小血管病患者数字化画钟测试的表现特征[J]. 中华老年心脑血管病杂志, 2020, 22(10): 1058-1061.], articleTitle=老年脑小血管病患者数字化画钟测试的表现特征, refAbstract=null)], funds=[Fund(id=1203033510488535113, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, awardId=YDZX20191400002563, language=EN, fundingSource=Central Guide Local 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tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, companyId=1203033503999947471, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4山西大学疾病防控的数学技术与大数据分析山西省重点实验室，山西太原 030006)])], figs=[ArticleFig(id=1203033509049888768, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=EN, label=Fig. 1, caption=

Pearson correlation analysis of the total score of the original and simplified ROCF test

, figureFileSmall=yUFfHOQgDgC4lbVXIoqH0Q==, figureFileBig=PYS2sXNAeQFZOQAPUYTHDw==, tableContent=null), ArticleFig(id=1203033509133774854, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=CN, label=图1, caption=原始与简化版Rey复杂图形测验总分值的Pearson相关性分析散点图, figureFileSmall=yUFfHOQgDgC4lbVXIoqH0Q==, figureFileBig=PYS2sXNAeQFZOQAPUYTHDw==, tableContent=null), ArticleFig(id=1203033509318324240, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=EN, label=Fig. 2, caption=Line analysis of dCFT, figureFileSmall=hjMholJDgZS9PNCTJ79KMA==, figureFileBig=sMQ9UtmajmceiviYX8CL9g==, tableContent=null), ArticleFig(id=1203033509398016021, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=CN, label=图2, caption=dCFT线条分析

dCFT. 基于平板电脑的复杂图形测验软件

, figureFileSmall=hjMholJDgZS9PNCTJ79KMA==, figureFileBig=sMQ9UtmajmceiviYX8CL9g==, tableContent=null), ArticleFig(id=1203033509502873625, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=EN, label=Fig. 3, caption=Quantity analysis of long and short strokes between the two groups in dCFT, figureFileSmall=NMYFxGxlCICfNZyxskxbNg==, figureFileBig=wiqZW2mMLPi68oFpfUkYlg==, tableContent=null), ArticleFig(id=1203033509586759709, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=CN, label=图3, caption=dCFT长、短笔画数量分析

dCFT. 数字化复杂图形测验；*P<0.05

, figureFileSmall=NMYFxGxlCICfNZyxskxbNg==, figureFileBig=wiqZW2mMLPi68oFpfUkYlg==, tableContent=null), ArticleFig(id=1203033509666451487, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=EN, label=Fig. 4, caption=Change curve of dCFT parameters in drawing process of the two groups, figureFileSmall=7GKL5Y9t49JLE8P2OalCxQ==, figureFileBig=GXMYh2H0x0EB4yop0IH5Cw==, tableContent=null), ArticleFig(id=1203033509737754658, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=CN, label=图4, caption=两组dCFT绘图过程参数变化曲线

dCFT. 数字化复杂图形测验；*P<0.05，**P<0.01

, figureFileSmall=7GKL5Y9t49JLE8P2OalCxQ==, figureFileBig=GXMYh2H0x0EB4yop0IH5Cw==, tableContent=null), ArticleFig(id=1203033509817446440, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=EN, label=Tab. 1, caption=

Comparison of demographic characteristics and neuropsychological test results between groups

, figureFileSmall=null, figureFileBig=null, tableContent=
项目对照组(n=26)观察组(n=38)t/zP
年龄(岁，$\bar{x}±s$)64.6±7.067.5±7.2–1.6000.115
男/女(例)11/1515/230.1550.693
受教育年限(年，$\bar{x}±s$)11.7±2.311.1±3.3–0.7500.456
MMSE[分，M(Q1,Q3)]28(27,29)27(25,28)–3.4670.001
MoCA[分，M(Q1,Q3)]25(23,26)21(19,23)–4.990<0.001
ADL[分，M(Q1,Q3)]21(20,22)21(20,23)–1.8840.060
AVLT 即刻回忆总数[个，M(Q1,Q3)]25.0(22.0,30.3)20.5(17.0,27.0)–3.0210.003
AVLT长延迟回忆[个，M(Q1,Q3)]10.0(8.8,11.0)5.0(2.3,8.0)–4.946<0.001
AVLT再认[个，M(Q1,Q3)]13(12,14)9(7,11)–4.800<0.001
Boston命名[分，M(Q1,Q3)]27(24,28)24(22,26)–3.4680.001
词语流畅性[个，M(Q1,Q3)]20.0(17.8,22.3)15.0(13.0,19.0)–3.976<0.001
数字广度顺[个，M(Q1,Q3)]8.0(6.8,9.0)8.0(6.8,8.0)–1.1210.262
数字广度逆[个，M(Q1,Q3)]5(4,6)4(3,5)–2.1510.031
连线A[s,M(Q1,Q3)]36.0(29.8,44.5)47.0(39.5,57.3)–3.0640.002
连线B[s,M(Q1,Q3)]60.0(46.3,79.3)83.0(62.8,104.3)–3.1110.002
Stroop-A[个，M(Q1,Q3)]80.5(69.0,88.0)67.5(60.8,81.0)–2.3040.021
Stroop-B[个，M(Q1,Q3)]63.0(55.0,70.0)52.0(42.0,62.3)–3.2690.001
Stroop-C[个，M(Q1,Q3)]31.0(27.8,34.3)27.0(20.0,31.0)–2.9780.003
线方向判断[分，M(Q1,Q3)]24.5(23.4,26.8)25.3(22.9,26.5)–0.1230.902
ROCF临摹[分，M(Q1,Q3)]33.0(31.0,34.3)32.0(29.4,33.3)–1.9280.054
ROCF 即刻回忆[分，M(Q1,Q3)]21.5(18.0,25.3)17.0(12.0,21.3)–2.9960.003
ROCF 延迟回忆[分，M(Q1,Q3)]20.8(17.5,24.3)17.3(11.9,19.5)–3.1390.002
简化版Rey临摹[分，M(Q1,Q3)]17.0(16.0,17.3)16.0(15.0,17.0)–2.0900.134
简化版Rey即刻回忆[分，M(Q1,Q3)]16.0(15.0,16.6)12.8(10.4,15.0)–3.973<0.001
简化版Rey延迟回忆[分，M(Q1,Q3)]16(14,17)13(10,15)–3.714<0.001
), ArticleFig(id=1203033509930692654, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=CN, label=表1, caption=

两组人口学特征及相关神经心理学测验结果比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目对照组(n=26)观察组(n=38)t/zP
年龄(岁，$\bar{x}±s$)64.6±7.067.5±7.2–1.6000.115
男/女(例)11/1515/230.1550.693
受教育年限(年，$\bar{x}±s$)11.7±2.311.1±3.3–0.7500.456
MMSE[分，M(Q1,Q3)]28(27,29)27(25,28)–3.4670.001
MoCA[分，M(Q1,Q3)]25(23,26)21(19,23)–4.990<0.001
ADL[分，M(Q1,Q3)]21(20,22)21(20,23)–1.8840.060
AVLT 即刻回忆总数[个，M(Q1,Q3)]25.0(22.0,30.3)20.5(17.0,27.0)–3.0210.003
AVLT长延迟回忆[个，M(Q1,Q3)]10.0(8.8,11.0)5.0(2.3,8.0)–4.946<0.001
AVLT再认[个，M(Q1,Q3)]13(12,14)9(7,11)–4.800<0.001
Boston命名[分，M(Q1,Q3)]27(24,28)24(22,26)–3.4680.001
词语流畅性[个，M(Q1,Q3)]20.0(17.8,22.3)15.0(13.0,19.0)–3.976<0.001
数字广度顺[个，M(Q1,Q3)]8.0(6.8,9.0)8.0(6.8,8.0)–1.1210.262
数字广度逆[个，M(Q1,Q3)]5(4,6)4(3,5)–2.1510.031
连线A[s,M(Q1,Q3)]36.0(29.8,44.5)47.0(39.5,57.3)–3.0640.002
连线B[s,M(Q1,Q3)]60.0(46.3,79.3)83.0(62.8,104.3)–3.1110.002
Stroop-A[个，M(Q1,Q3)]80.5(69.0,88.0)67.5(60.8,81.0)–2.3040.021
Stroop-B[个，M(Q1,Q3)]63.0(55.0,70.0)52.0(42.0,62.3)–3.2690.001
Stroop-C[个，M(Q1,Q3)]31.0(27.8,34.3)27.0(20.0,31.0)–2.9780.003
线方向判断[分，M(Q1,Q3)]24.5(23.4,26.8)25.3(22.9,26.5)–0.1230.902
ROCF临摹[分，M(Q1,Q3)]33.0(31.0,34.3)32.0(29.4,33.3)–1.9280.054
ROCF 即刻回忆[分，M(Q1,Q3)]21.5(18.0,25.3)17.0(12.0,21.3)–2.9960.003
ROCF 延迟回忆[分，M(Q1,Q3)]20.8(17.5,24.3)17.3(11.9,19.5)–3.1390.002
简化版Rey临摹[分，M(Q1,Q3)]17.0(16.0,17.3)16.0(15.0,17.0)–2.0900.134
简化版Rey即刻回忆[分，M(Q1,Q3)]16.0(15.0,16.6)12.8(10.4,15.0)–3.973<0.001
简化版Rey延迟回忆[分，M(Q1,Q3)]16(14,17)13(10,15)–3.714<0.001
), ArticleFig(id=1203033510039744564, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=EN, label=Tab. 2, caption=

Comparison of dCFT parameters between the two groups in copying, 3-min recall, and 20-min delayed recall [M(Q1, Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
参数对照组(n=26)观察组(n=38)ZP
短长笔画序列过渡时间(s)
 临摹2.62(1.02,5.20)3.24(1.75,5.47)–0.8680.385
 即刻回忆1.50(0.95,3.13)2.05(1.23,3.75)–1.3190.187
 延迟回忆1.19(0.42,2.41)1.89(1.12,3.93)–2.0240.043
前5个长笔画经过时间(s)
 临摹8.69(6.39,12.37)10.49(8.07,13.72)–1.2850.199
 即刻回忆7.49(5.07,10.22)8.63(6.73,9.51)–0.4920.623
 延迟回忆7.10(5.56,9.09)8.39(5.77,9.95)–1.0250.305
前5笔长笔画率(%)
 临摹80(60,85)60(40,80)–1.5470.122
 即刻回忆60(60,85)60(40,80)–1.2810.20
 延迟回忆80(60,100)60(40,80)–2.6200.009
最长笔画速度(cm/s)
 临摹4.56(2.94,7.03)3.85(3.10,5.28)–1.0660.286
 即刻回忆5.19(4.05,6.55)4.78(3.84,6.02)–0.3690.712
 延迟回忆6.00(4.54,7.13)4.65(3.53,6.07)–2.0640.039
平均速度(cm/s)
 临摹4.17(3.04,4.62)3.66(3.12,4.40)–1.1070.268
 即刻回忆4.11(3.50,5.35)3.89(3.25,4.99)–0.8200.412
 延迟回忆4.67(3.56,5.81)3.95(3.37,4.59)–1.6410.101
思考总时间(s)
 临摹26.83(23.15,34.67)33.14(24.69,39.65)–1.7220.085
 即刻回忆21.85(18.26,24.81)27.15(21.49,33.94)–2.5430.011
 延迟回忆19.93(16.59,23.00)23.94(18.86,36.87)–2.7480.006
完成总时间(s)
 临摹48.22(37.47,57.72)56.88(42.87,63.08)–1.6130.107
 即刻回忆39.61(32.37,46.18)44.87(36.30,55.79)–1.8450.065
 延迟回忆34.52(29.96,42.15)40.30(34.83,56.21)–2.5700.01
第一笔思考时间(s)
 临摹8.15(5.85,10.3)9.35(6.35,10.95)–1.0800.280
 即刻回忆6.16(5.35,7.83)7.17(5.62,9.29)–1.4630.144
 延迟回忆5.92(5.16,8.04)7.92(6.20,9.83)–2.3650.018
元素延迟时间(s)
 临摹1.73(1.42,2.13)2.13(1.55,2.73)–1.7500.080
 即刻回忆1.32(1.03,1.99)1.99(1.36,3.62)–2.6790.007
 延迟回忆1.08(0.83,1.55)1.63(1.25,2.47)–3.0760.002
面积(cm2)
 临摹64.18(56.45,75.76)71.27(49.63,79,43)–0.7650.444
 即刻回忆59.03(47.77,71.89)49.49(39.31,72.20)–1.1890.234
 延迟回忆61.98(49.06,74.04)52.86(41.44,69.73)–1.2710.204
每分钟笔画数(个)
 临摹19(15,23)17(15,21)–0.9940.320
 即刻回忆22(20,29)21(16,25)–1.3630.173
 延迟回忆26(21,27)21(18,25)–2.7760.006
), ArticleFig(id=1203033510157185080, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=CN, label=表2, caption=

两组dCFT临摹、即刻回忆和延迟回忆参数比较[M(Q1，Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
参数对照组(n=26)观察组(n=38)ZP
短长笔画序列过渡时间(s)
 临摹2.62(1.02,5.20)3.24(1.75,5.47)–0.8680.385
 即刻回忆1.50(0.95,3.13)2.05(1.23,3.75)–1.3190.187
 延迟回忆1.19(0.42,2.41)1.89(1.12,3.93)–2.0240.043
前5个长笔画经过时间(s)
 临摹8.69(6.39,12.37)10.49(8.07,13.72)–1.2850.199
 即刻回忆7.49(5.07,10.22)8.63(6.73,9.51)–0.4920.623
 延迟回忆7.10(5.56,9.09)8.39(5.77,9.95)–1.0250.305
前5笔长笔画率(%)
 临摹80(60,85)60(40,80)–1.5470.122
 即刻回忆60(60,85)60(40,80)–1.2810.20
 延迟回忆80(60,100)60(40,80)–2.6200.009
最长笔画速度(cm/s)
 临摹4.56(2.94,7.03)3.85(3.10,5.28)–1.0660.286
 即刻回忆5.19(4.05,6.55)4.78(3.84,6.02)–0.3690.712
 延迟回忆6.00(4.54,7.13)4.65(3.53,6.07)–2.0640.039
平均速度(cm/s)
 临摹4.17(3.04,4.62)3.66(3.12,4.40)–1.1070.268
 即刻回忆4.11(3.50,5.35)3.89(3.25,4.99)–0.8200.412
 延迟回忆4.67(3.56,5.81)3.95(3.37,4.59)–1.6410.101
思考总时间(s)
 临摹26.83(23.15,34.67)33.14(24.69,39.65)–1.7220.085
 即刻回忆21.85(18.26,24.81)27.15(21.49,33.94)–2.5430.011
 延迟回忆19.93(16.59,23.00)23.94(18.86,36.87)–2.7480.006
完成总时间(s)
 临摹48.22(37.47,57.72)56.88(42.87,63.08)–1.6130.107
 即刻回忆39.61(32.37,46.18)44.87(36.30,55.79)–1.8450.065
 延迟回忆34.52(29.96,42.15)40.30(34.83,56.21)–2.5700.01
第一笔思考时间(s)
 临摹8.15(5.85,10.3)9.35(6.35,10.95)–1.0800.280
 即刻回忆6.16(5.35,7.83)7.17(5.62,9.29)–1.4630.144
 延迟回忆5.92(5.16,8.04)7.92(6.20,9.83)–2.3650.018
元素延迟时间(s)
 临摹1.73(1.42,2.13)2.13(1.55,2.73)–1.7500.080
 即刻回忆1.32(1.03,1.99)1.99(1.36,3.62)–2.6790.007
 延迟回忆1.08(0.83,1.55)1.63(1.25,2.47)–3.0760.002
面积(cm2)
 临摹64.18(56.45,75.76)71.27(49.63,79,43)–0.7650.444
 即刻回忆59.03(47.77,71.89)49.49(39.31,72.20)–1.1890.234
 延迟回忆61.98(49.06,74.04)52.86(41.44,69.73)–1.2710.204
每分钟笔画数(个)
 临摹19(15,23)17(15,21)–0.9940.320
 即刻回忆22(20,29)21(16,25)–1.3630.173
 延迟回忆26(21,27)21(18,25)–2.7760.006
), ArticleFig(id=1203033510257848379, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=EN, label=Tab. 3, caption=

Partial correlation analysis of dCFT parameters and cognitive domain of subjects (n=64)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目统计量短长笔画序列过渡时间前5笔长笔画率最长笔画速度思考总时间完成总时间第一笔思考时间元素延迟时间每分钟笔画数
记忆力Z分值r–0.1330.110–0.018–0.260–0.181–0.365–0.3770.326
P0.3070.3970.8910.0430.1630.0040.0030.010
语言Z分值r–0.1480.2420.070–0.220–0.120–0.199–0.1700.126
P0.2540.0600.5900.0890.3580.1150.1910.335
注意力Z分值r–0.2920.0950.081–0.408–0.342–0.183–0.3300.311
P0.0190.4690.5320.0010.0070.1590.0090.015
执行力Z分值r–0.2750.2170.302–0.448–0.429–0.230–0.2170.376
P0.03210.0930.015<0.0010.0010.0740.0930.003
视空间Z分值r–0.2260.1700.133–0.264–0.273–0.407–0.1660.263
P0.0800.1890.3070.0400.0330.0010.2020.040
), ArticleFig(id=1203033510354317375, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203033500707418644, language=CN, label=表3, caption=

受试者dCFT参数与认知域的偏相关分析结果(n=64)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目统计量短长笔画序列过渡时间前5笔长笔画率最长笔画速度思考总时间完成总时间第一笔思考时间元素延迟时间每分钟笔画数
记忆力Z分值r–0.1330.110–0.018–0.260–0.181–0.365–0.3770.326
P0.3070.3970.8910.0430.1630.0040.0030.010
语言Z分值r–0.1480.2420.070–0.220–0.120–0.199–0.1700.126
P0.2540.0600.5900.0890.3580.1150.1910.335
注意力Z分值r–0.2920.0950.081–0.408–0.342–0.183–0.3300.311
P0.0190.4690.5320.0010.0070.1590.0090.015
执行力Z分值r–0.2750.2170.302–0.448–0.429–0.230–0.2170.376
P0.03210.0930.015<0.0010.0010.0740.0930.003
视空间Z分值r–0.2260.1700.133–0.264–0.273–0.407–0.1660.263
P0.0800.1890.3070.0400.0330.0010.2020.040
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张肖南 1 , 吕亮亮 2 , 李阳 3, * , 郁磊 4 , 赵娅蓉 3 , 闵国文 3 , 王秋艳 3 , 申佳妮 2 , 陈金雨 2
解放军医学杂志 | 临床研究 2023,48(5): 587-595
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解放军医学杂志 | 临床研究 2023, 48(5): 587-595
基于平板电脑对轻度认知障碍患者绘制复杂图形表现的综合评定
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张肖南1, 吕亮亮2, 李阳3, * , 郁磊4, 赵娅蓉3, 闵国文3, 王秋艳3, 申佳妮2, 陈金雨2
作者信息
  • 1山西医科大学影像学院，山西太原 030001
  • 2山西医科大学第一临床医学院，山西太原 030001
  • 3山西医科大学第一医院神经内科，山西太原 030001
  • 4山西大学疾病防控的数学技术与大数据分析山西省重点实验室，山西太原 030006

    • 张肖南，博士研究生，主要从事人工智能技术在阿尔茨海默病防治中的应用研究

通讯作者:

李阳，E-mail：
A tablet-based comprehensive evaluation of drawing complex graphics performance of patients with mild cognitive impairment
Xiao-Nan Zhang1, Liang-Liang Lv2, Yang Li3, * , Lei Yu4, Ya-Rong Zhao3, Guo-Wen Min3, Qiu-Yan Wang3, Jia-Ni Shen2, Jin-Yu Chen2
Affiliations
  • 1Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi 030001, China
  • 2the First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi 030001, China
  • 3Department of Neurology, the First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
  • 4Shanxi Provincial Key Laboratory of Mathematical Technology and Big Data Analysis for Disease Control and Prevention, Shanxi University, Taiyuan, Shanxi 030006, China
出版时间: 2023-05-28 doi: 10.11855/j.issn.0577-7402.2023.05.0587
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摘要
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目的 评估基于平板电脑的数字化复杂图形测验（dCFT）软件检测遗忘型轻度认知障碍（aMCI）患者绘图表现的适用性。方法 选取2020年11月－2021年11月就诊于山西医科大学第一医院门诊的38例aMCI患者为观察组，26例认知功能正常者为对照组。两组均接受全面的神经心理测评，包括简易智力状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）、Rey复杂图形测验及各认知域量表等。同时期完成dCFT测评（dCFT软件基于平板电脑，可自动化采集多维度绘图参数），包括临摹、3 min即刻回忆及20 min延迟回忆测验。采用Pearson相关系数评估原始与简化版Rey复杂图形测验分值的相关性，采用偏相关分析dCFT参数与各认知域综合分值的相关性。结果 （1）dCFT临摹测验中，两组间参数比较差异无统计学意义（均P>0.05）；即刻回忆测验中，观察组思考总时间、元素延迟时间（s）均明显长于对照组[27.15（21.49，33.94）vs. 21.85（18.26，24.81），1.99（1.36，3.62）vs. 1.32（1.03，1.99），P<0.05]；延迟回忆测验中，观察组短长笔画序列过渡时间、思考总时间、完成总时间、第一笔思考时间及元素延迟时间（s）均长于对照组[1.89（1.12，3.93）vs. 1.19（0.42，2.41），23.94（18.86，36.87）vs. 19.93（16.59，23.00），40.30（34.83，56.21）vs. 34.52（29.96，42.15），7.92（6.20，9.83）vs. 5.92（5.16，8.04），1.63（1.25，2.47）vs. 1.08（0.83，1.55），P<0.05]，前5笔长笔画率（%）、最长笔画速度（cm/s）及每分钟笔画数（个）均低于对照组[60（40，80）vs. 80（60，100），4.65（3.53，6.07）vs. 6.00（4.54，7.13），21（18，25）vs. 26（21，27），P<0.05]；两组其他dCFT参数差异均无统计学意义（P>0.05）。（2）控制年龄、性别及受教育程度后，相关分析显示，短长笔画序列过渡时间与注意力及执行功能呈负相关（r=–0.292，r=–0.275，P<0.05），最长笔画速度与执行功能呈正相关（r=0.302，P<0.05），思考总时间与记忆力、注意力、执行功能、视空间能力均呈负相关（r=–0.26，r=–0.408，r=–0.448，r=–0.264，P<0.05），完成总时间与注意力、执行功能、视空间能力均呈负相关（r=–0.342，r=–0.429，r=–0.273，P<0.05），第一笔思考时间与记忆力、视空间能力均呈负相关（r=–0.365，r=–0.407，P<0.01），元素延迟时间与记忆力、注意力均呈负相关（r=–0.377，r=–0.33，P<0.01），每分钟笔画数与记忆力、注意力、执行功能、视空间能力均呈正相关（r=0.326，r=0.311，r=0.376，r=0.263，P<0.05）。结论 在复杂图形测验中，aMCI患者间隔3 min重新绘图时表现为视空间记忆受损，绘图策略尚可；间隔20 min重新绘图时记忆力及绘图策略均受到显著影响，但视觉感知在进程中受损不明显。dCFT可作为一种简便、客观的aMCI测评工具。

轻度认知障碍  /  复杂图形测验  /  神经心理测验  /  数字化测评  /  阿尔茨海默病

Objective To evaluate the usability of tablet-based digital complex figure test (dCFT) software on assessment of drawing strategies of patients with amnestic mild cognitive impairment (aMCI). Methods A total of 64 patients treated in a hospital from Nov. 2020 to Nov. 2021 were selected, including 26 cognitively normal people (control group) and 38 aMCI patients(aMCI group). All subjects underwent standardized neuropsychological assessments, including the mini-mental state examination(MMSE), the montreal cognitive assessment (MoCA), the Rey–Osterrieth Complex Figure (ROCF) test, and other cognitive domain scales. And then use the dCFT (including copying and recall) developed by our team to collect drawing parameters, such as stroke length, time, speed and number. The Pearson correlation coefficient was used to evaluate the correlation between the original and simplified ROCF test scores, and partial correlation used to analyze the correlation between the dCFT parameters and the comprehensive scores of each cognitive domain. Results (1) In the copying test, all dCFT parameters had no statistically significant between the two groups (P>0.05). In the immediate recall test, the total thinking time and element delay time in aMCI group were significantly longer than those in the control group [27.15(21.49, 33.94) vs. 21.85(18.26, 24.81), 1.99(1.36, 3.62) vs.1.32(1.03, 1.99), P<0.05]. In the delayed recall test, the transition time of short and long stroke sequence, total thinking time, total completion time, first thinking time and element delay time of the aMCI group were significantly higher than those of control group [1.89(1.12, 3.93) vs. 1.19(0.42, 2.41), 23.94(18.86, 36.87) vs. 19.93(16.59, 23.00), 40.30(34.83, 56.21) vs. 34.52(29.96, 42.15), 7.92(6.20, 9.83) vs. 5.92(5.16, 8.04), 1.63(1.25, 2.47) vs. 1.08(0.83, 1.55), P<0.05]. The first 5 stroke ratios (%), speed of the longest stroke (cm/s) and strokes per minute of aMCI group were significantly lower than those of control group [60(40, 80) vs. 80(60, 100), 4.65(3.53, 6.07) vs. 6.00(4.54, 7.13), 21(18, 25) vs. 26(21, 27), P<0.05]. Other dCFT parameters had no statistically significance between the two groups (P>0.05). (2) Correlation analysis showed that the transition time was negatively correlated with attention and executive function (r=–0.292, r=–0.275, P<0.05); the speed of the longest stroke was positively correlated with the executive function (r=0.302, P<0.05); the total thinking time was negatively correlated with memory, attention, executive function and visuospatial ability (r=–0.26, r=–0.408, r=–0.448, r=–0.264, P<0.05); the total completion time was negatively correlated with attention, executive function and visuospatial ability (r=–0.342, r=–0.429, r=–0.273, P<0.05); the first stroke latency was negatively correlated with memory and visuospatial ability (r=–0.365, r=–0.407, P<0.01); the average element latency was negatively correlated with memory and attention (r=–0.377, r=–0.33, P<0.01); the strokes per minute was positively correlated with memory, attention, executive function and visuospatial ability (r=0.326, r=0.311, r=0.376, r=0.263, P<0.05). Conclusions Visuospatial memory impairment of aMCI patients was presented in 3-minute recall test of the complex figure test, and their drawing strategy was acceptable. But after 20 minutes, the memory and the organization strategy of drawing were significantly affected. Visual perception is not significantly impaired in the process. The dCFT software is a convenient, objective assessment tool for aMCI.

mild cognitive impairment  /  complex figure test  /  neuropsychological test  /  digital evaluation  /  Alzheimer's disease
张肖南, 吕亮亮, 李阳, 郁磊, 赵娅蓉, 闵国文, 王秋艳, 申佳妮, 陈金雨. 基于平板电脑对轻度认知障碍患者绘制复杂图形表现的综合评定. 解放军医学杂志, 2023 , 48 (5) : 587 -595 . DOI: 10.11855/j.issn.0577-7402.2023.05.0587
Xiao-Nan Zhang, Liang-Liang Lv, Yang Li, Lei Yu, Ya-Rong Zhao, Guo-Wen Min, Qiu-Yan Wang, Jia-Ni Shen, Jin-Yu Chen. A tablet-based comprehensive evaluation of drawing complex graphics performance of patients with mild cognitive impairment[J]. Medical Journal of Chinese People’s Liberation Army, 2023 , 48 (5) : 587 -595 . DOI: 10.11855/j.issn.0577-7402.2023.05.0587
正文
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2019年我国约有5000万痴呆患者，预计到2050年可能达到1.52亿，将给照料者、医疗行业和整个社会带来沉重的精神与经济负担[1]。阿尔茨海默病(Alzheimer's disease，AD)是老年痴呆最常见的病因，占50%～60%。轻度认知障碍(mild cognitive impairment，MCI)是AD的临床前驱期，每年有10%～15%转化为痴呆，对其进行早期识别及干预具有重要意义[2-3]。AD患者早期以记忆及视空间能力受损为主要特征，因此视空间能力测试在鉴别AD与非AD方面优于其他测评工具[4]。复杂图形测验(complex figure test，CFT)是一类常用于记忆和视空间能力测评的工具，Rey复杂图形(Rey-Osterrieth complex figure，ROCF)是CFT的经典版本。近年来，国外多项研究将CFT行数字化改良，并运用人工智能(如计算机扫描技术、高斯滤波技术、深度学习算法等)开发自动评分软件，其评分值与人工评分值的相关性可达88%，一致性可高达94%[5-8]；或使用数字化设备(如数字笔、平板电脑等)捕获绘图过程，通过提取空间、顺序、运动学维度参数分析患者绘图的行为模式，不仅可提高测评的客观性、一致性，还可精确反映受试者绘图的处理速度、运动控制能力及组织策略等[9-11]。近期，本课题组开发了具有自主知识产权的数字化复杂图形测验(digital CFT，dCFT)软件，可通过对笔画数量、长度、速度及时间等参数的分析，测评遗忘型MCI(amnestic MCI，aMCI)患者在临摹、3 min即刻回忆及20 min延迟回忆中的绘图策略，以评估其记忆及视空间能力的受损程度。
1 资料与方法
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1.1 研究对象
选取2020年11月－2021年11月就诊于山西医科大学第一医院门诊的AD源性aMCI患者38例为观察组，其中男15例，女23例，年龄(67.5±7.2)岁，受教育程度(11.1±3.3)年。aMCI的诊断参考2011年美国国立老化研究所(NIA)和阿尔茨海默病协会(ADA)合作制定的临床MCI诊断标准[12]。(1)纳入标准：①患者主诉记忆力下降≥6个月；②简易智力状态检查量表(mini-mental state examination，MMSE)分值≥24分；③存在一个或多个认知功能区域受损的客观证据，表现为相应神经心理测验分值≤健康老人的“均数－1.5个标准差”；④复杂的工具性日常能力可有轻微受损，但保持独立的日常生活能力；⑤临床痴呆评定量表(clinical dementia rating，CDR)分值0.5分，尚未达到痴呆的诊断标准。(2)排除标准：①入组时诊断为痴呆；②有明确的脑卒中病史；③具有酒精中毒、药物成瘾、脑外伤、癫痫、脑炎、正常颅压脑积水等可引起认知障碍及运动障碍的神经系统疾病史；④患有相关焦虑抑郁症或精神病；⑤文化程度低于小学或严重视力、听力障碍而不能完成神经心理测评；⑥拒绝参与研究。
另选取同一时期就诊于该医院门诊的认知功能正常老年人26例为对照组，其中男11例，女15例，年龄(64.6±7.0)岁，受教育程度(11.7±2.3)年。纳入标准：(1)患者主诉无记忆力下降或无相关的客观测评证据；(2)MMSE分值≥26分，CDR分值0分，日常生活能力量表(activity of daily living，ADL)分值正常。本研究通过山西医科大学第一医院伦理委员会批准[(2019)伦审字(K036)]，所有受试者均签署书面知情同意书。
1.2 方法
神经心理测评工作由山西医科大学第一医院神经内科认知测评师及医师共同进行，评估人员均经过专业化培训，一致性较好。认知功能评估工具主要包括标准化神经心理测评、简化版Rey复杂图形和dCFT软件。
1.2.1 标准化神经心理测评
(1)总体认知水平评估：MMSE、蒙特利尔认知评估量表(montreal cognitive assessment，MoCA)及CDR；(2)记忆力评估：听觉词语学习测验(auditory verbal learning test，AVLT)、Rey复杂图形测验的3 min回忆及20 min延迟回忆；(3)语言功能评估：Boston命名测验(boston naming test，BNT)、词语流畅性测验(verbal fluency test，VFT)；(4)注意力评估：数字广度测验(digit span test，DST)；(5)视空间能力评估：Rey复杂图形测验的临摹、线方向判断测验(judgement of line orientation，JLO)；(6)执行功能评估：连线测验(trial making test，TMT)、Stroop色词测验(Stroop's color word test，SCWT)；(7)日常生活能力评估：ADL量表。
1.2.2 简化版Rey复杂图形
该图形由Poreh等[9]于2018年开发，是一个基于原始Rey复杂图形的理论组织策略模型，其临摹、回忆及策略的测评分值在健康老年人群(60岁以上)中呈正态分布，已有研究显示其比原始Rey复杂图形更适用于老年人群的视空间能力和记忆力损害评估。该图形包含9个评分单位(4个基本结构和5个局部元素)。4个基本结构：大长方形、水平中线、垂直中线、对角线；5个局部元素：左上角的长方形、右上象限的三角形、左下象限的圆、右侧半圆、长方形下的线段。
1.2.3 dCFT软件
dCFT软件由山西医科大学第一医院李阳教授团队和山西传控电子科技有限公司共同研发，知识产权归山西医科大学第一医院所有。配套的硬件采用10.8寸平板电脑(配专用手写笔)，以像素为单位，建立X-Y坐标轴(0,0)-(2560,1600)，采样频率为60 Hz。显示界面分为两部分，上部分设定为图形显示区域，下部分设定为绘图区域。由于绘图界面无撤销按钮，测试前需告知受试者只能绘图一次，无法修改。
(1)dCFT测试过程：测验开始时，平板显示界面上半部分出现一个图形，请受试者用笔在显示界面的下半部分尽可能仔细、准确地绘制上述图形，提示受试者出现绘图错误时不能更改，可忽略后继续绘图，没有完成时间的限制；间隔3 min及20 min后分别请患者根据回忆在绘图区域重新绘制上述图形，每次绘图不超过10 min。(2)dCFT参数采集：采集绘图过程中笔画数量、长度、速度及间隔时间，还原绘图轨迹，并经自动分析获取dCFT参数，包括短长笔画序列过渡时间(所有短长笔画序列中绘制长笔画前的思考时间之和)、前5个长笔画的绘图总时间、前5个笔画中的长笔画占比、最长笔画的平均速度、平均速度(笔画总长度/绘图总时间)、思考总时间(笔在空中停留总时间)、完成总时间、第一笔思考时间、元素延迟时间(绘制局部元素第一笔与前一笔画的平均间隔时间)、图形面积、每分钟笔画数、笔画总数、长笔画数、短笔画数。(3)伪彩色图像：使用一系列颜色将笔画进行编码，如前4个笔画编码红色，接下来4个笔画编码黄色，依次类推。(4)评分方法：采用Osterrich[13]的评分方法对原始及简化版Rey复杂图形测验评分。以临摹、即刻(3 min)回忆和延迟(20 min)回忆分值(平均值)之和为Rey复杂图形测验的总分值。临摹分值低提示视觉感知、视觉运动整合能力受损，即刻及延迟回忆分值低提示视空间回忆能力受损。
1.3 统计学处理
采用SPSS 26.0软件进行统计分析。计量资料符合正态分布时以$\bar{x}±s$表示，采用独立样本t检验，呈偏态分布则以M(Q1，Q3)表示，采用Mann-Whitney U检验。计数资料采用χ2检验。运用Pearson相关系数评估原始与简化版Rey复杂图形测验分值的相关性，以验证简化版Rey复杂图形的有效性。dCFT软件中的长短笔画临界值采用K均值聚类分析(K-means cluster)确定。在调整年龄、性别及受教育程度后，采用偏相关分析检验dCFT参数与各认知域综合分值之间的相关性。P<0.05为差异有统计学意义。
2 结果
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2.1 两组人口学特征及相关神经心理学测验结果比较
两组的年龄、性别及受教育程度比较差异均无统计学意义(P>0.05)。观察组MMSE、MoCA分值明显低于对照组(P<0.01)。两组ADL、数字广度顺、线方向判断分值比较差异均无统计学意义(P>0.05)，两组其余各认知域测验分值比较均有明显差异(P<0.05或P<0.001，表1)。
2.2 原始与简化版Rey复杂图形测验分值比较
观察组原始及简化版Rey复杂图形的即刻回忆、延迟回忆分值均明显低于对照组(P<0.01)，两组临摹分值比较差异无统计学意义(P>0.05，表1)。Pearson相关分析结果显示，原始与简化版Rey复杂图形测验总分值呈显著正相关(r=0.598，P<0.001，图1)。
2.3 两组dCFT参数(临摹、即刻回忆和延迟回忆)比较
将临摹、即刻回忆和延迟回忆测验纳入线条分析，结果显示长短笔画的临界值为55.72 mm(图2)。两组笔画总数及长短笔画数比较差异均无统计学意义(P>0.05)；两组长笔画数占比比较，临摹时观察组明显低于对照组(P=0.018)，而即刻回忆和延迟回忆中两组差异均无统计学意义(P>0.05，图3)。
两组临摹测验的相关dCFT参数比较差异均无统计学意义(P>0.05)；即刻回忆测验中，观察组思考总时间和元素延迟时间均明显长于对照组(P<0.05)；延迟回忆测验中，观察组短长笔画序列过渡时间、思考总时间、完成总时间、第一笔思考时间和元素延迟时间均明显长于对照组(P<0.05)，前5笔长笔画率、最长笔画速度及每分钟笔画数明显低于对照组(P<0.05)；两组其他dCFT参数比较差异均无统计学意义(P>0.05，表2)。
纵向分析结果显示，随着间隔时间延长，两组短长笔画序列过渡时间、前5个长笔画经过时间、思考总时间、完成总时间、第一笔思考时间和元素延迟时间均逐渐缩短，但观察组下降速度慢于对照组，而且第一笔思考时间在间隔20 min时明显升高；两组最长笔画速度和每分钟笔画数均逐渐升高，间隔3 min时趋势相同，间隔20 min时观察组几乎无变化或略有降低。两组前5笔长笔画率比较，观察组明显低于对照组(P<0.05，图4)。
2.4 受试者dCFT参数与认知域的偏相关分析
将各认知域测验分值转化为标准Z分值，通过计算平均值得到各认知域综合Z分值。控制年龄、性别及受教育程度后，相关分析显示，短长笔画序列过渡时间与注意力及执行功能均呈负相关(P<0.05)，最长笔画速度与执行功能呈正相关(P<0.05)，思考总时间与记忆力、注意力、执行功能及视空间能力均呈负相关(P<0.05)，完成总时间与注意力、执行功能及视空间能力均呈负相关(P<0.05)，第一笔思考时间与记忆力及视空间能力均呈负相关(P<0.01)，元素延迟时间与记忆力及注意力均呈负相关(P<0.01)，每分钟笔画数与记忆力、注意力、执行功能及视空间能力均呈正相关(P<0.05，表3)。
3 讨论
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CFT可通过受试者对复杂图形的临摹和回忆表现评定其多个认知维度的功能受损程度，包括视觉感知能力、非语言记忆、注意力和集中力、精细运动协调能力、规划组织能力等，是一种常用的神经心理测验工具。CFT的传统评分方法侧重于对图形准确性及位置精度进行单一量化评分，虽然几种过程性评分方法(如Bennett-Levy、BQSS、DSS)可量化绘图顺序，增加对执行功能和组织策略的评定，但由于存在耗时长、测评者需经过规范化培训等缺点，在临床上使用受限[14]。Rey复杂图形是CFT的经典版本，在相关研究中应用广泛。Rey复杂图形由18个元素组成，包括4个基本结构和14个局部元素，其用于MCI和轻中度AD的检测准确性良好。简化版Rey复杂图形由原始Rey复杂图形简化和改进而来。
本研究对简化版Rey复杂图形进行了有效性验证，结果显示其总分值与原始Rey复杂图形测验总分值呈显著正相关，提示其在评估老年人视空间结构能力及视觉记忆方面与原始Rey复杂图形具有可比性。Poreh等[9]曾对本研究使用的简化版Rey复杂图形进行验证，结果显示与RBANS复杂图形临摹及延迟回忆分值显著相关，且临摹、回忆及策略分值在老年人群中呈正态分布。Kim等[10]在开发dCFT软件时设计了一个简化版Rey复杂图形，其临摹分值与原始图的相关性达0.889，在绘图过程中AD患者配合度和积极性较高，且数字化参数提取更准确、稳定，提示简化版Rey复杂图形对低文化、老年人群及图形的数字化改良适用前景较好。
本研究结果显示，原始及简化版Rey复杂图形测验中aMCI患者的即刻回忆、延迟回忆分值均明显低于对照组，而两组的临摹分值差异不明显。进一步行dCFT分析，结果显示在即刻回忆测验中，aMCI患者思考总时间及元素延迟时间长于对照组；在延迟回忆测验中，aMCI患者短长笔画序列过渡时间、思考总时间、完成总时间、第一笔思考时间及元素延迟时间均长于对照组，前5笔长笔画率、最长笔画速度及每分钟笔画数均低于对照组，提示aMCI患者绘图表现不佳可能与绘图过程的组织策略有关。简化版Rey复杂图形由基本结构及局部元素组成，当画图时，笔画长度可能与结构策略有关，长笔画提示受试者更关注全局特征，短笔画提示更关注局部特征。既往Wilson和Batchelor[15]报道，50%以上正常受试者先绘制基本结构，再添加局部元素，碎片化、混乱方式则提示受试者前额叶皮质受损，因而不能正确整合全局信息。本研究中，两组的总笔画及长短笔画数差异不明显，但aMCI患者长笔画数占比低于对照组。Kim等[10]曾报道，AD患者在临摹CFT时表现出更加碎片化的方式，思考时间更长，绘制速度减慢且准确性更低，易于靠近目标图形，而且晚发型AD在图形空间利用上表现出向左偏离的迹象。本研究aMCI患者在完成CFT过程中，在绘图开始或添加局部元素时多表现为犹豫不决，甚至遗漏部分结构，因此第一笔思考时间、元素延迟时间延长可提示其视空间工作记忆及注意力受损。绘制图形框架至少需要5个笔画(长方形、水平垂直中线及对角线)，其中最长的笔画更有可能用于构建图形框架，因此最长笔画速度降低提示执行功能受损。短长笔画序列过渡时间延长或前5笔长笔画率降低提示aMCI患者更早地绘制局部特征，是执行功能及注意力受损的表现。既往针对数字画钟测验的研究显示，aMCI患者思考时间及完成总时间显著长于对照组，每分钟笔画数低于对照组，且与工作记忆、处理速度、注意力及视空间能力等多个认知域相关[16-18]；魏微等[19]也发现老年脑小血管病患者的思考时间显著长于对照组，且与注意力、信息处理速度及执行功能相关。上述结果与本研究结果基本一致，表明思考时间体现的是一种类似于运动计划与策略的、无法被明确观察到的认知功能活动，笔画增多可反映整体认知功能的下降。由此可见，aMCI患者即刻回忆表现不佳与视空间工作记忆受损有关，而绘图策略尚可；间隔20 min时记忆力及绘图的组织策略则受到显著影响，但视空间能力受损不明显。
本研究的纵向分析结果显示，随着间隔时间延长，两组变化趋势大致相同，绘图及思考时间均逐渐下降，绘图速度及每分钟笔画数逐渐升高。间隔3 min时，aMCI患者因视空间记忆受损，而绘图策略尚可，元素延迟时间及思考时间下降稍缓慢；间隔20 min时，aMCI患者记忆力持续下降，组织策略受损突出，表现为第一笔思考时间明显延长，且绘图速度及每分钟笔画数未见增加。对照组间隔20 min后仍表现良好，可能与较好的组织策略有关。此外，dCFT软件的另一个优势是，绘图结束后可以通过对笔画颜色编码来跟踪绘图顺序，这样无须中断绘图过程，不影响对患者整体记忆的处理。
上述结果表明，本研究团队自主研发的dCFT可自动化分析受试者的绘图行为，定量阐述绘图策略，同时增加对图形结构设计的理解，而对临摹、即刻回忆及延迟回忆相关的dCFT参数进行纵向分析，对于探讨绘图行为的潜在神经心理学机制具有重要价值。本研究亦存在局限性，如研究样本量较小，可能造成检验效能不足、选择偏倚，限制了结果的可靠性及有效性。因此，后续将扩大样本量，同时纳入更多类型患者，进一步观察不同痴呆类型患者的dCFT表现特征，检验其临床适用性。
总之，经过对相关量表的数字化改良，dCFT具有崭新的测评维度，通过对笔画数量、长度、速度及耗时进行分析，可更精细地分析aMCI患者的绘图行为模式。本研究结果提示，绘图过程中的运动学参数有望成为AD患者视空间结构能力障碍的数字生物标志物，未来通过检验其临床适用性及纳入大样本量受试对象，可能建立一种简便、客观、规范的数字化评分系统，用于aMCI相关的临床实践。
基金
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  • 中央引导地方科技发展专项资金项目(YDZX20191400002563)
  • 山西省医学重点攻关专项(2020XM22)
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2023年第48卷第5期
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doi: 10.11855/j.issn.0577-7402.2023.05.0587
  • 接收时间：2022-03-11
  • 首发时间：2025-12-03
  • 出版时间：2023-05-28
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  • 收稿日期：2022-03-11
  • 录用日期：2022-04-10
基金
Central Guide Local Science and Technology Development Special Fund(YDZX20191400002563)
中央引导地方科技发展专项资金项目(YDZX20191400002563)
Shanxi Provincial Medical Key Project(2020XM22)
山西省医学重点攻关专项(2020XM22)
作者信息
    1山西医科大学影像学院，山西太原 030001
    2山西医科大学第一临床医学院，山西太原 030001
    3山西医科大学第一医院神经内科，山西太原 030001
    4山西大学疾病防控的数学技术与大数据分析山西省重点实验室，山西太原 030006

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