頭部轉向徵兆有助於辨識阿茲海默氏症


  【24drs.com】一種稱為「頭部轉向徵兆(Head Turning Sign,HTS)」的簡單快速的檢測方法,或許有助於評估是否出現阿茲海默氏症(Alzheimer's disease,AD)。
  
  一篇新研究顯示,會將他們的頭轉向他們的照護者以尋求協助、或作為幫助他們回答簡單問題之線索的患者,比較可能是患有AD失智症,而不是輕度認知障礙(MCI)或額顳葉失智(FTD)。
  
  第一作者、葡萄牙Coimbra大學醫院神經內科Miguel Tabuas Pereira表示,對於AD,轉頭雖然不是特異性警訊,但應將轉頭視為一個警告信號,特別是在諮詢過程中一再出現時。
  
  他們也發現,出現這個徵兆與AD生物標記有關,包括腦脊液(CSF)中的tau與磷酸化tau。
  
  Pereira醫師在2016年歐洲神經科學院(EAN)研討會中發表研究結果。
  
  雖然HTS在20多年前就被提出,且曾經被認為在AD患者常見,Pereira醫師表示,對於這個測試診斷工具,相關的報告令人驚訝的少。
  
  這次的研究包括了78名健忘症MCI (aMCI)、AD或FTD患者,都有神經精神評估和CSF生物標記,包括:amyloid β、 tau與磷酸化tau,他們還必須有一個可信的護理人員陪伴他們評估。
  
  研究者排除了嚴重失智或失語性失智的患者,以及無法合作進行測試者。
  
  研究對象完成了簡易心智量表(MMSE)、Montreal認知評估、以及老年憂鬱量表;研究者也評估了研究對象對他們的認知障礙的看法。
  
  研究者將HTS定義為:在回應醫師連續發問的5個問題時,患者主動將頭部轉向坐在患者後方45度角、1公尺遠的照護者。這些問題包括:「你最近一次用餐是哪時候?」以及「今天的日期?」 HTS的給分為0到5分,分數取決於研究對象轉頭求助的次數。
  
  36名AD患者中有30人(83.3%)出現HTS,27名aMCI患者中有12人(44.4%)出現,AD患者的徵兆強度比較高(P = .015),MCI患者的平均值為0.0、AD患者的平均值為1.0。
  
  這篇研究顯示,有MCI的患者間、以及AD組和FTD組之間,HTS的嚴重度有統計上的顯著差異。
  
  Pereira醫師表示,我們發現,AD患者的這個徵兆的頻率,在統計上顯著高於MCI與FTD患者。
  
  對於AD,如果你考慮出現至少一次轉頭徵兆,它的敏感度約為80%、專一度為53%,它的陽性預測值為60%、陰性預測值為75%。
  
  研究者也發現,在CSF與MMSE分數(P = .021)方面,HTS和tau蛋白質(P = .002)與磷酸化tau (P = .002)之間有正相關;在看法或憂鬱症方面沒有顯著關聯。
  
  會議共同主持人、瑞士日內瓦大學臨床神經科前任主席、神經科榮譽教授Theodor Landis醫師,稱這篇為原創研究。他表示,發現這種相當有臨床導向的徵兆是很不尋常的。
  
  Landis醫師問研究者是否檢查了單側聽力障礙,如果患者聽力不佳,他們必須轉頭。
  
  Pereira醫師回答指出,研究人員並沒有客觀的測試這點,但他指出,他們已經排除了被視為耳聾的患者。
  
  資料來源: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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