头部转向征兆有助于辨识阿兹海默氏症


  【24drs.com】一种称为「头部转向征兆(Head Turning Sign,HTS)」的简单快速的检测方法,或许有助于评估是否出现阿兹海默氏症(Alzheimer's disease,AD)。
  
  一篇新研究显示,会将他们的头转向他们的照护者以寻求协助、或作为帮助他们回答简单问题之线索的患者,比较可能是患有AD失智症,而不是轻度认知障碍(MCI)或额颞叶失智(FTD)。
  
  第一作者、葡萄牙Coimbra大学医院神经内科Miguel Tabuas Pereira表示,对于AD,转头虽然不是特异性警讯,但应将转头视为一个警告信号,特别是在咨询过程中一再出现时。
  
  他们也发现,出现这个征兆与AD生物标记有关,包括脑脊液(CSF)中的tau与磷酸化tau。
  
  Pereira医师在2016年欧洲神经科学院(EAN)研讨会中发表研究结果。
  
  虽然HTS在20多年前就被提出,且曾经被认为在AD患者常见,Pereira医师表示,对于这个测试诊断工具,相关的报告令人惊讶的少。
  
  这次的研究包括了78名健忘症MCI (aMCI)、AD或FTD患者,都有神经精神评估和CSF生物标记,包括:amyloid β、 tau与磷酸化tau,他们还必须有一个可信的护理人员陪伴他们评估。
  
  研究者排除了严重失智或失语性失智的患者,以及无法合作进行测试者。
  
  研究对象完成了简易心智量表(MMSE)、Montreal认知评估、以及老年忧郁量表;研究者也评估了研究对象对他们的认知障碍的看法。
  
  研究者将HTS定义为:在回应医师连续发问的5个问题时,患者主动将头部转向坐在患者后方45度角、1公尺远的照护者。这些问题包括:「你最近一次用餐是哪里时候?」以及「今天的日期?」 HTS的给分为0到5分,分数取决于研究对象转头求助的次数。
  
  36名AD患者中有30人(83.3%)出现HTS,27名aMCI患者中有12人(44.4%)出现,AD患者的征兆强度比较高(P = .015),MCI患者的平均值为0.0、AD患者的平均值为1.0。
  
  这篇研究显示,有MCI的患者间、以及AD组和FTD组之间,HTS的严重度有统计上的显著差异。
  
  Pereira医师表示,我们发现,AD患者的这个征兆的频率,在统计上显著高于MCI与FTD患者。
  
  对于AD,如果你考虑出现至少一次转头征兆,它的敏感度约为80%、专一度为53%,它的阳性预测值为60%、阴性预测值为75%。
  
  研究者也发现,在CSF与MMSE分数(P = .021)方面,HTS和tau蛋白质(P = .002)与磷酸化tau (P = .002)之间有正相关;在看法或忧郁症方面没有显著关联。
  
  会议共同主持人、瑞士日内瓦大学临床神经科前任主席、神经科荣誉教授Theodor Landis医师,称这篇为原创研究。他表示,发现这种相当有临床导向的征兆是很不寻常的。
  
  Landis医师问研究者是否检查了单侧听力障碍,如果患者听力不佳,他们必须转头。
  
  Pereira医师回答指出,研究人员并没有客观的测试这点,但他指出,他们已经排除了被视为耳聋的患者。
  
  资料来源:http://www.24drs.com/
  
  Native link:Head Turning Sign May Help Identify Alzheimer's

Head Turning Sign May Help Identify Alzheimer's

By Pauline Anderson
Medscape Medical News

COPENHAGEN — A simple, rapid test called the Head Turning Sign (HTS) may help to assess the presence of Alzheimer's disease (AD) dementia.

Patients who turn their head toward their caregiver for assistance or cues to help them answer simple questions are more likely to have AD dementia than mild cognitive impairment (MCI) or frontotemporal dementia (FTD), a new study shows.

"Turning one's head should be regarded as a warning sign, although a nonspecific warning sign, for AD, especially if it's repeated throughout a consultation," said lead study author Miguel Tabuas Pereira, Neurology Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal. "The more frequent the sign, the more specific it is."

They also found that presence of the sign correlated with AD biomarkers, including tau and phosphorylated tau, in cerebrospinal fluid (CSF).

Dr Pereira presented the study here at the Congress of the European Academy of Neurology (EAN) 2016.

Although the HTS was first described more than 20 years ago and was once considered common in AD, there's "a surprising shortage of papers" on the diagnostic utility of this test, said Dr Pereira.

The current study included 78 patients with amnestic MCI (aMCI), AD, or FTD who had had a full neuropsychiatric evaluation and CSF biomarkers, including amyloid β, tau, and phosphorylated tau. They also had to have a trusted caregiver accompany them to assessments.

Researchers excluded patients with severe dementia or aphasic dementia and those who would be unable to cooperate for the tests.

Study participants completed the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment, and the Geriatric Depression Scale. Researchers also assessed the participants' insight into their cognitive deficits.

Researchers defined HTS as a voluntary head movement toward a caregiver seated at a 45-degree angle about a meter behind the patient when responding to five consecutive predetermined questions posed by a clinician. The questions included "When was your last meal?" and "What is the date?"0 HTS was graded on a 0-to-5 scale, with scores depending on how many times the participant turned for assistance.

HTS was present in 30 of 36 (83.3%) patients with AD and 12 of 27(44.4%) of those with aMCI. The intensity of the sign was higher in AD (P = .015). The median value was 0.0 in MCI and 1.0 in AD.

The study showed a statistically significant difference in severity of HTS between patients with MCI and those with MCI and between the AD group and the FTD group.

"We found that this sign is statistically significantly more frequent in AD than in MCI and FTD," said Dr Pereira.

"If you consider the presence of at least one time of the head turning sign for AD, it has a sensitivity of about 80% and specificity of 53%. It also has a positive predictive value of 60% and a negative predictive value of 75%."

The researchers also found a positive correlation between HTS and tau protein (P = .002) and phosphorylated tau (P = .002) in CSF and MMSE scores (P = .021).

There was no significant association with "insight" or depression.

Session co-chair, Theodor Landis, MD, honorary professor of neurology, University of Geneva, Switzerland, and former chair of that university's Department of Clinical Neurosciences, described the study as "original."

"It's unusual to find this kind of very clinically oriented signs" being used, he said.

Dr Landis asked whether the researchers checked for unilateral hearing impairment. "If patients don't hear well, they have a tendency to turn their head."

The researchers didn't objectively test for this, Dr Pereira responded, but noted they had excluded patients who were considered to be deaf.

The authors have disclosed no relevant financial relationships.

Congress of the European Academy of Neurology (EAN) 2016. Abstract O2110. Presented May 29, 2016.

    
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