JP2013078552A - System, method and program for examining brain function - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a method and an apparatus for examining a brain function, which enable dementia and the degree of aging of the brain function to be more accurately determined by examining a delicate finger motion function of handedness.SOLUTION: In this system, selection is performed between the case of the first performance of an examination and the case of the second or subsequent performance of the examination by a subject selecting means 101. In the case of the first performance, subject information is input by a subject information input means 102. Both a new examiner and a second or subsequent examiner are subjected to the examination by a new measurement data input means 103. Additionally, comparison of them with an able-bodied person's ability is performed by a calculation means 106, and the results of the comparison are stored in memory 107.

Description

  The present invention relates generally to the field of systems and methods for assessment of CNS aging and cognitive impairment induced by dementia in the elderly, rather than assessment of the developmental origin of the central nervous system (CNS). More particularly, the present invention analyzes brain function by analyzing whether a person suffers from or is at risk of cognitive dysfunction induced by dementia. The present invention relates to a system and method for indicating the degree of aging and the risk for dementia in% by age.

  The brain can be damaged in many different ways by an aging CNS, and changes in the CNS can precede the clinical basis of such decades-long changes. Changes in the CNS can be confirmed, for example, in mild cognitive impairment (MCI), small or large vascular disease, blood brain barrier damage, atherosclerosis, etc. Clinical symptoms of the ongoing brain damage process are It may not be apparent until a certain point in the progress of such a process is reached.

  Diseases that have accelerated such processes and have become clinically apparent include, for example, dementia, Alzheimer's disease (AD), and many other CNS diseases.

  Many people are affected by such diseases. Dementia and diseases related to dementia are actually the fourth leading cause of death in industrialized countries worldwide, following heart disease, cancer, and stroke. Even in Japan, which has a population of 127 million people, about 2.4 million people, or 1.9% of the population, suffer from dementia. The ratio of elderly people to the total population has increased due to the extension of life expectancy. According to statistics from the Ministry of Health, Labor and Welfare, the number of the elderly is 1,540,000 in 2002, 2.38 million in 2005, 3.2 million in 2010, and 446 in 2020. The number is expected to increase rapidly over time, reaching 5.45 million in 2030. Therefore, in order to be able to provide adequate treatment, it is necessary to identify as soon as possible those who are at risk of developing dementia or who have a certain degree of dementia.

  Conventionally, a definitive diagnosis method for dementia has not been established, and comprehensive diagnosis is performed in consideration of various test results. Image diagnosis is an auxiliary evaluation method for dementia. Computed tomography (CT scan) and MRI (Magnetic Resonance Imaging) are widely used today for clinical evaluation of brain diseases. In addition, SPECT (single photon emission tomography) is used in daily clinical examination scenes, and other techniques such as NIRS (optical topography) and PET (functional MRI) are used for cerebral blood flow, cerebral metabolic processes, and It is used for testing purposes to evaluate the function of neurotransmitters.

  One of the methods for testing for dementia is a neuropsychological test in which a subject is asked and answered, and is widely used because it does not require a special test tool and can be easily performed. For example, Japanese neuropsychological tests include the revised Hasegawa Intelligence Assessment Scale (HDS-R), the National Seken Type Dementia Screening Test, the N-type Psychiatric Function Test, the Kana Hiroi Test, and the Mini Mental State Examination (MMSE). Intelligent evaluation methods such as MMSE (minimum state examination) and ADAS (Alzheimer's Disease Assessment Coordinate Subscale) are available. In addition, the presence or absence of dementia and the severity thereof can be diagnosed by using CDR (Clinical Dimension Rating) and the like in consideration of behavioral evaluation.

  In addition, automated systems have been developed that perform cognitive tests using human pupillary light response, speech, touch, and the like. For example, it is disclosed by Unexamined-Japanese-Patent No. 2002-034920 or Japanese translations of PCT publication No. 2011-502564. Japanese Patent Application Laid-Open No. 2002-034920 discloses a brain function test apparatus that can test the degree of aging of brain function, brain disease such as autonomic nervous system disease, dementia, and Alzheimer's disease by subject's pupillary light reaction. ing. In Japanese translations of PCT publication No. 2011-502564, a brain function testing device for diagnosing the occurrence of brain dysfunction and the stage of cerebral dysfunction by analyzing a person's speech is disclosed. In addition, a tactile diagnostic method (Non-Patent Document 1) has been developed.

JP 2002-034920 A Special table 2011-502564 gazette

Jiajia Yang, Takashi Ogasa, Yasuyuki Ohta, Koji Abe, Jinglong Wu: Decline of Human Tactile Angle Discrimination in patients with Mild Cognitive Impairment and Alzheimer's Disease, Journal of Alzheimer's Disease 22 (1): 225-34,2010.

  Image diagnosis such as CT, MRI, SPECT, etc. requires expensive inspection equipment and medical staff to perform the inspection, it takes a long time, and inspection costs are high except for diseases. Have problems.

  In addition, since the neuropsychological test can be easily performed, it is suitable for a screening test performed before a detailed test that requires a large amount of money and time, and there is an advantage that it can be performed by an examiner other than a medical worker. However, in the above-mentioned neuropsychological examination, the cooperation of the subject is indispensable, the examination result may be affected by the approach, and the examination result may change depending on how the examiner asks the question, There is also a possibility that the inspection results may be biased due to the subjective inspection method.

  Research papers have reported that there is a significant difference between Alzheimer-type dementia patients and healthy individuals in dominant hand-skilled movements that are noninvasive measurement targets. It has also been suggested that Alzheimer's type dementia, which has been difficult to diagnose using conventional methods, can be tested. Further, many studies on aging and skillful movements have been conducted so far, and it is known that skillful movement ability develops with growth and decreases with age.

  However, in the conventional sophisticated motion test, the index of sophisticated motion for each age is not shown, and if it is used as it is, the accuracy of the test is expected to be limited. Furthermore, it is considered difficult to determine the degree of aging of brain function.

  The present invention has been made in view of the above problems, and its object is to provide a brain function test method and apparatus, brain function test system, and brain function that can accurately test brain function with a simple method. It is to provide an inspection service method and a program and apparatus thereof.

  The present invention is a system for inspecting the brain function of a subject using the return motion of the middle peg among the six subtests of the patent No. 4431729 “system, method and program for inspecting skillful movement ability of fingers”. One side of the board using nine pegs having different colors at both ends and a board in which the pegs are detachable and three holes are arranged in 3 rows and 9 holes are arranged at equal intervals vertically and horizontally The pegs inserted in the three rows are pulled out one by one by the operation of only the dominant hand, and then the time for the return operation to be inserted upside down is measured, and the measured value input means for inputting the measured value; Ability to calculate brain function that indicates the risk of dementia by age, based on the standard values for healthy people previously determined for healthy individuals and the standard values for people with dementia of the same age A calculating means is provided.

  Moreover, it is a system which test | inspects the brain function which shows a subject's risk with respect to dementia, Comprising: The said measured value is an average value of the time of two same movements, It is characterized by the above-mentioned.

  Further, it is a method for examining a brain function indicating a risk of dementia of a subject constructed using a computer, and the measurement value input means provided in the computer includes nine pegs having different colors at both ends. The pegs are detachable, and the pegs inserted in three rows on one side of the board are used only by the dominant hand using a board in which nine holes are arranged in three rows and three holes in a row and are arranged at equal intervals vertically and horizontally. After pulling out one by one, measuring the time of the return operation to insert upside down, inputting the measured value, and then the ability calculation means provided in the computer, the previously measured value and the healthy person To calculate the brain function indicating the risk of dementia for each age group based on the standard value for healthy persons determined for patients and the standard value for persons with dementia of the same age It is characterized by.

  In addition, a method for examining a brain function indicating a risk of dementia of a subject, wherein nine pegs having different colors at both ends and the pegs are detachable, each having three columns in three rows Using a board in which nine holes are arranged at equal intervals in the vertical and horizontal directions, and after pulling out one by one, measuring the return operation time by inserting it upside down, obtaining the measured value, and then measuring the measured value And the brain function indicating the risk of dementia by age based on the healthy person reference value obtained in advance for healthy persons and the dementia person reference value obtained for persons with dementia of the same age Including a process.

  Further, a program for causing a computer to function as a means for examining a cognitive function indicating a risk of dementia of a subject, the computer comprising nine pegs having different colors at both ends and the peg Using a board that is detachable and has 3 holes vertically arranged in 3 rows and 9 holes arranged at equal intervals vertically and horizontally, after removing the pegs inserted in 3 rows on one side of the board one by one, Measure the time of the return operation to insert upside down, let it function as a measurement value input means for inputting the measurement value, then the computer, the measurement value and a healthy person reference value obtained in advance for a healthy person And based on the dementia reference value calculated | required targeting at the dementia person of the same age, it is made to function as an ability calculation means to calculate the brain function which shows the risk of dementia for every age.

  According to the present invention configured as described above, it is a system for inspecting brain function by measuring the hand skillful movement ability of the dominant hand of the subject, and a healthy person reference value obtained in advance for a healthy person, and In order to calculate the brain function that shows the risk of dementia by age group based on the dementia standard value obtained for people with dementia of the same age, more accurate considering the decrease in brain function due to aging It becomes possible to show the result. In this system, an inspector is not required, and the inspection result is automatically displayed by performing the inspection based on the instruction shown on the screen, and the contents based on the result are automatically explained.

  In addition, when there is a language disorder such as aphasia, it is difficult to perform a cognitive function test using a questionnaire such as HDS-R. However, operability tests such as skillful movements can be performed even on subjects who have language problems. In addition, the examination by the questionnaire requires an inspector by a medical staff, but in the present invention, the medical staff does not necessarily need to perform the examination, and it is expected to be applied to self-care that is examined by the subject himself for early detection. Is done.

  As an inspection method, analysis with a healthy person is possible by a result of performing a “returning operation” in which nine pegs are turned over and inserted into the same hole on the board. Also, if the implementation limit time is 60 seconds and the “returning operation” of 9 pegs cannot be performed within that time, the analysis can be performed with the number of pegs that can be implemented, so the inspection time is very short. .

  In addition, when the age is entered according to the instructions displayed on the screen and the test is performed, a comparison with the brain function of healthy people of the same age is automatically shown in%, and the result of brain function showing the risk of dementia by age Is displayed, and the contents are explained based on the results.

  As described above, the brain function testing system of the present invention is easy to test, can be tested even if there is a language disorder such as aphasia, can be easily carried, and automatically without requiring an examiner. It shows how much ability is compared with the brain function of healthy people of the same age, and in the case of the prefecture lower than the average of healthy people of the same age, the result of brain function showing the risk of dementia by age is displayed. Since the contents are explained based on the risk, the risk for dementia can be evaluated and discriminated.

It is a basic configuration of the present invention. It is a flowchart at the initial stage of inspection. It is a flowchart of the new measurement process in a test | inspection. It is a flowchart of an inspection data edit process. It is a flowchart of a test result display process. It is a block diagram of a brain function inspection system.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings.

  FIG. 1 shows a basic configuration of a brain function test system. This brain function test system is a system that automatically analyzes and evaluates test results of a patient with a hand and finger disability, and includes a brain function test apparatus 100.

  In the brain function testing apparatus 100 that tests the brain function of a subject, a large peg with a 3 cm diameter peg and an 8 cm length, a peg with a 1.5 cm peg diameter and a 5 cm length peg is used. The brain function test instrument into which these pegs are inserted has three vertical holes arranged at equal intervals in three horizontal rows, for a total of nine holes. The size of the brain function testing instrument is 28 cm long × 18 cm wide, and is easy to carry. The examination is designed to be completed by using nine pegs, taking into account the physical and psychological durability of subjects with illnesses and disabilities, and making it easier for elderly people to understand. ing.

The brain function testing apparatus 100 shows a procedure for performing a test on the subject on the screen, and the subject inputs information on the subject, performs test measurement, and inputs the result according to the procedure. Storage and analysis / evaluation, and the result evaluation can be shown to the subject on the screen.
[Relationship between sophisticated movement and cognitive function]

  IPUT skillful motion test (IPUT), which was commercialized using our patent No. 4431729 “system, method and program for testing skillful motion ability of fingers”, is used in many medical situations as an index of skillful motion. The revised Hasegawa simplified intelligence evaluation scale (HDS-R) was used as an indicator of cognitive function for 563 healthy persons aged 20 to 94 who are physically and cognitively engaged in daily life. The results are classified by age from 20 to 5 years old, and the correlation between IPUT and HDS-R is shown for each of the 6 subtests performed by subject attributes, number of persons, and left and right hands. The subject subjects were prepared by performing a total of 12 actions for each of both hands for 6 subtests of IPUT.

  563 healthy people aged 20 to 94 years showed significant high negative negative correlation between 12 subtests of IPUT and HDS-R with correlation coefficient -0.41 to -0.52. (In the return movement of the medium peg used in the brain function test, the correlation coefficient showed a significant negative correlation coefficient as high as -0.5). In addition, there was no significant correlation difference between the 12 subtests and the HDS-R. In healthy individuals, a close negative relationship between skillful movement ability and cognitive function was suggested.

  IPUT was used as an indicator of skillful movement and HDS-R was used as an indicator of cognitive function for 172 patients with dementia. When dementia is classified every 5 years up to 55 to 100 years old, the target is 70 people who are deceased from 55 to 69 years old and 95 to 100 years old whose age is 10 or less. It was classified into five ages until ~ 94 years old. Considering the influence of the dominant hand, for left-handed subjects in the analysis, the left hand data was corrected to the right hand and the right hand data was corrected to the left hand. The results were classified according to the age of every 70 to 5 years other than the 55 to 69 years of age, which showed a correlation between IPUT and HDS-R for each subject attribute, number of people, and 12 subtests. Is. The subject subjects were prepared by performing a total of 12 actions for each of both hands for 6 subtests of IPUT.

  HDS-R and age / IPUT subtest correlation coefficients for people with dementia were negatively correlated and were significant between -0.16 and -0.34 except for the two subtests on the left in age and return (In the return movement of the medium peg used in the brain function test, the correlation coefficient was -0.20, showing a significant negative correlation coefficient). In people with dementia, a negative relationship between skillful movement ability and cognitive function was suggested.

[Creation of age-specific reference values for brain function tests]
Table 3 shows the subject attributes and the number of persons for creating a brain function test reference value. The reference value was created by performing a total of 12 movements twice for each of both hands for 6 subtests of the IPUT for 1607 people aged 5 to 94 years who have daily life without physical or cognitive problems.

  A bar graph of the average value of 12 movements for each of the 2 sub-hands of 1607 IPUT subtests in Table 3 and the average value of HDS-R performed on 563 healthy subjects aged 20 to 94 years Is FIG.

  The IPUT's six subtests, with left and right hands, improved skillful movement function from 5 years old, peaked from about 15-24 years old to 55-64 years old, and then skillful movement function declined by aging I drew a U curve. On the other hand, HDS-R, which is an index of cognitive function, showed almost no change from the 20s to the 50s to 54s, but gradually decreased with age after the 55s. This showed that skillful movement function and cognitive function decreased with aging after 55 years old.

From these results, it is considered that skillful movement ability can be used as an index of brain function reflecting cognitive function. The 12 subtests of IPUT showed almost the same result. It is conceivable that the brain function test reflecting the cognitive function is shown by performing one of the 12 subtests of the PUT.
Older people who perform brain function tests often have visual impairments such as cataracts. For this reason, the brain function test was performed with the return motion, not the transfer motion, which has a large visual influence. The pegs used were not small pegs that are difficult to see for elderly people who are visually impaired or large pegs that are too large to carry, but medium pegs that are easy to carry and handle for elderly people. In addition, in patients with dementia who lose what they have learned, previous studies have shown that there is a higher relationship between the dexterous movement of the dominant hand and cognitive function than the non-dominant hand. For these reasons, we decided to move the middle peg with a dominant hand in the brain function test.

Table 4 shows the average value of brain function tests using the results of the return operation of the middle peg of IPUT in 1607 healthy subjects (Table 3) and the return operation of the middle peg of IPUT in 172 patients with dementia It is a dementia average value of a brain function test using a result (Table 2). The average value of dementia was based on the average value / SD (standard deviation) of 70-74 years old. The range that 68 out of 100 healthy people enter, statistically speaking, the range of mean ± SD (standard deviation) (including 68.3% of all measurers) is the standard range for healthy subjects, 100 patients with dementia The range that 68 of the people can enter was defined as the dementia standard range. “Normal level” up to the average value + SD that is the lowest value of the healthy person reference range, “Danger level”, “Normal level” and “Danger level” that are below the average value −SD that is the highest value of the dementia reference range The interval was taken as the “attention level” and calculated for each age.
The average value of healthy / demented persons is the reference value, the reference value of the demented person is the risk value, and the ratio of the dementia reference value to the healthy person reference value (the reference value of the healthy person × 100 ÷ the standard of the demented person Value) as a risk factor.

  The “normal level” of each age is approximately 90% or more, and the “risk level” is 60% to 90% or less, and the ratio increases with age. In addition, the “attention level” is broader as the age is younger and the range decreases as the age increases.

  Based on this reference value, it can be applied to the following formula 1, and the brain function of the subject with respect to the brain function of the healthy person of the same age can be expressed in%. Note that Equation 1 is used when the subtest is completed within 60 seconds.

    [Formula 1] 100 × reference value (second) ÷ measured value (second)

  If it cannot be completed within the prescribed time of 60 seconds, the brain function is determined using Table 5 based on the number of pegs that could be implemented in 60 seconds. Table 5 shows the brain function of the subject with respect to the brain function of healthy subjects of the same age in%. Each value is calculated based on Equation 2 below.

    [Formula 2] 100 × reference value ÷ (540 ÷ [number of pegs implemented within 60 seconds])

FIG. 2 is a flowchart showing the process of the brain function test. Activate the inspection system and follow the instructions on the screen to enter your age and gender. Next, according to the instructions on the screen of the brain function test apparatus, the brain function test performs the return operation of nine pegs in 60 seconds. If it was possible within 60 seconds, the implemented time (seconds) is measured. If nine peg operations could not be performed in 60 seconds, the number of pegs that could be implemented was measured.
Next, the age which is subject information is input. The new subject who has entered the existing subject and subject information measures the return motion of the nine pegs (Process 1). When editing the measured value data, the process proceeds to process 2. If the result is to be displayed, the process proceeds to process 3.

FIG. 3 is a flowchart showing a new measurement process in the finger skillful movement ability inspection system. When performing a new measurement, it is divided into the case of following the instructions on the screen and the method of manual input independently. Follow the on-screen instructions and practice. Next, when the practice operation is completed, the measurement is started.
The brain function test involves nine peg operations in 60 seconds. If it was possible within 60 seconds, enter the implemented time (in seconds), and if 9 peg operations could not be implemented in 60 seconds, enter the number of pegs that could be implemented.
The age at the time of measurement is automatically calculated from the date of measurement and the date of birth of the subject entered in advance.
In both cases of following the instructions on the screen and manually entering manually, the reference values obtained for healthy subjects of the same age are compared, and the brain function is calculated based on the reference values of healthy people of the same age. If the brain function based on the reference value for healthy subjects is less than 100%, the reference value for people with dementia of the same age is taken as the risk value, and the ratio of the risk value to the reference value for healthy people of the same age The result of calculating “reference value × 100 ÷ reference value of persons with dementia” ”is stored. In addition, regarding the risk factor, the “normal level”, “caution level”, and “danger level” are discriminated and the meaning of each result is displayed on the screen.

  FIG. 4 is a flowchart showing a data editing process in the brain function testing system. In accordance with the screen of the brain function test system, the past data of the subject is called, and when the brain function test is performed and nine peg operations can be performed in 60 seconds, the measurement time (seconds) is 9 in 60 seconds. If the peg operation of the book could not be performed, the number that could be implemented is automatically input. When the brain function based on the reference value of the healthy person of the same age and the result of calculating the brain function based on the reference value of the healthy person of the same age and the brain function based on the reference value of the healthy person of the same age are less than 100% Is the result of calculating the risk ratio “percentage of dementia standard value (standard value of healthy person × 100 ÷ standard value of dementia)” relative to the standard value of healthy people of the same age, taking the standard value of people with dementia of the same age as the risk value Save the file. In addition, regarding the risk factor, the “normal level”, “caution level”, and “danger level” are discriminated and the meaning of each result is displayed on the screen.

  FIG. 5 is a flowchart showing a result display process in the finger skillful movement capability inspection system. Based on the results stored in process 1 (new measurement process) or process 2 (data editing process), measurement results are extracted and selected, results are evaluated, and measurement results and evaluation results are displayed.

  FIG. 6 is a block diagram of this system. In the brain function test system, the subject selection means 101 performs selection for the first test execution and for the second and subsequent tests. In the first case, the subject information is input by the subject information input means 102. Both the new inspector and the second and subsequent inspectors use the left and right hands in the new measurement data input means 103 to select necessary tests from the six subtests and input the results. Correction of new and existing data is performed in the existing data editing means 104. The data that has passed through the new measurement data input means 103 and the existing data editing means 104 is compared with the ability of the normal person (ability calculation) by the calculation means 106, and the result is stored in the memory 107. When the brain function based on the reference value of the same age healthy person is less than 100% in the result display means 105 in the result display means 105, the information from the calculation means 106 and the memory 107 is taken as the risk value as the reference value of the same age demented person. The result of calculating the risk rate “the ratio of the dementia standard value (normal standard value × 100 ÷ dementia standard value)” with respect to the standard value is stored. In addition, regarding the risk factor, the meaning of each result is displayed on the screen together with the discrimination of “normal level”, “caution level”, and “danger level”.

Claims (4)

  A system for inspecting the finger's skillful movement ability of a subject, wherein nine pegs having different colors at both ends and the pegs are detachable, and three holes are arranged vertically in three rows of nine holes. Using a board arranged at equal intervals in the vertical and horizontal directions, after pulling out one by one, measuring the time of return operation to insert upside down, measuring value input means for inputting the measured value, the measured value, previously healthy Comparing the reference values obtained for the elderly, calculating the brain function based on the reference values of healthy people of the same age, and the risk factor for the normal values of healthy people of the same age with the reference value of the same age dementia as the risk value A system comprising ability calculating means for calculating a ratio of a dementia standard value (standard value of healthy person × 100 ÷ standard value of dementia).   A method for inspecting the finger skillful movement ability of a subject constructed using a computer, wherein the computer is equipped with nine measurement values input means with different colors at both ends, and the pegs are detachable Then, using a board with 9 holes arranged in 3 rows vertically and 9 rows arranged in equal intervals vertically and horizontally, after pulling out one by one, measure the time of return operation to insert upside down and measure A step of inputting a value, and then the ability calculation means provided in the computer compares the measured value with a reference value obtained in advance for a healthy person, and based on the reference value of a healthy person of the same age, And calculating the risk rate for the same-aged healthy person standard value as a risk value, “Ratio of dementia standard value (standard value for healthy person × 100 ÷ standard value for people with dementia)” It is characterized by performing the calculation how to.   A method for examining a brain function of a subject, wherein nine pegs having different colors at both ends and the pegs are detachable, and nine holes are arranged in three rows vertically and horizontally. Using a board arranged at intervals, after pulling out one by one, measuring the time of return operation to insert upside down, obtaining the measurement value, then, the measurement value and the healthy subject in advance Comparing the obtained reference values, calculating the brain function based on the reference values of healthy people of the same age, and using the reference value of people with the same age as dementia as the risk value, A method comprising a step of calculating a ratio of values (reference value of healthy person × 100 ÷ reference value of person with dementia) ”.   A program for causing a computer to function as a means for inspecting the hand skillful movement ability of a subject, wherein the computer includes nine pegs having different colors at both ends, and the pegs are detachable, Using a board with 9 holes arranged in 3 rows vertically and 9 holes arranged at equal intervals in the vertical and horizontal direction, after pulling out one by one, measure the time for the return operation to insert upside down and input the measured value A step of calculating a brain function based on a reference value of a healthy person of the same age by causing the computer to function as a measurement value input means and then comparing the measurement value with a reference value obtained in advance for a healthy person And the ability to calculate the risk ratio “percentage of dementia standard value (standard value of healthy person × 100 ÷ reference value of dementia)” relative to the standard value of healthy people of the same age, taking the standard value of people with dementia of the same age as the risk value To function as a calculation means A program characterized by

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