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Purpose of the experiment: test Chinese version auditory continuous addition test (the Chinese Paced Auditory Serial Addition Test, PASAT) in young and middle-aged population of China, the reliability, validity, and related factors, which is used to assess working memory impairment of MS patients in China situation. Lab: explore the differences and connections between the decline in information processing speed and accuracy of information processing in MS working memory impairment, preliminary related brain dysfunction possible mechanism, combined with Baddeley working memory model hypothesis, analysis of MS impairment of working memory and other cognitive impairment relationship. Experiment: 55 healthy people to participate in the study in May 2010 - October, excluding 3 (female, 57 years old, 55 years old; Male, 48 years old. Were primary school education), a total of 52 people into not fit research. Tested the purposes of the initial test by testers A independent, quiet room. (1) 52 subjects underwent: ① general investigation: name, sex, age, number of years of education, past history, family history, drug use, smoking and drinking; ② neuropsychological tests: PASAT, the mini-mental state amount Table (Mini-Mental State Examination, MMSE); ③ other neuropsychological assessment: Hamilton Depression Rating Scale (Hamilton Depression Rating Scale, HAMD), the fatigue severity scale (Fatigue Severity Scale, FSS), the Pittsburgh Sleep Quality Index (Pittsburgh sleep quality index, PSQI). (2) selected 20 subjects for the test-retest reliability, rater reliability testing: test-retest reliability is in 7 ± 2d accept the initial test, testers scoring after comparison with the initial test results. The rater reliability 7 ± 2d after the initial test, the purposes of testing by the testers B test by A, B duo record score at the same time, and the correlation test, in order to avoid the back and forth twice PASAT practice effects may exist. (3) extraction of 41 subjects construct validity test: related tests in the following order strict implementation of the (1) In general investigation; the ② neuropsychological test sequence: PASAT, the time prospective memory test (Time Based Prospective Memory Test, TBPM), auditory verbal memory test (the the Chinese Rey Auditory of Verbal and Learning Test, and CRAVLT) N1-7 event prospective memory test (Event Based Prospective Memory Test, EBPM), the MMSE, verbal fluency test (the Verbal Fluency Test, VFT), symbols digital conversion test (the Symbol Digit Modalities Test, SDMT), the connection test (the Chinese Trail Making Test, TMT), digit span test (the Digit Span Test, DS), Stroop color word test (the Chinese version of the Stroop Color - Word Test, Stroop), the similarity test (the the the Similarity Test SIML) CRAVLT (N8-9), the clock drawing test (Clock Drawing Test, CDT), Rey complex graphics memory tests (the Rey Complex Figure Test, RCFT) copying to learning; 3 neuropsychological assessment: HAMD, FSS, PSQI; ④ RCFT delayed memories. Construct validity full set of test time spent about 1.5 hours. Statistical analysis: SPSS 13.0 statistical software for statistical analysis. Less than 50 cases using the Shapiro-Wilk normality using the Kolmogorov-Smirnov method assessment information on more than 50 cases of sample variable. The PASAT task internal consistency reliability using Cronbach'sα detection and evaluation of 52 subjects; the initial test PASAT-A, A retest scores were B meet normality and homogeneity of variance, paired t test was used to compare the pairs between difference, if not meet normality and homogeneity of variance, the differences between paired rank sum test evaluation pairs; internal correlation coefficient (ICC mixed-effects model) assessment between the the PASAT-A initial test A test-retest retest reliability A retest and B rated rater reliability; other neuropsychological test scores meet normality and homogeneity of variance, Pearson correlation analysis and evaluation of the correlation between them and the PASAT, if not satisfied, Spearson correlation analysis and evaluation of them in order to discuss the correlation between the PASAT, PASAT cognitive structure that construct validity; age, level of education, depression score, fatigue index, index of sleep meet normality and homogeneity of variance sex, PASAT do between Pearson relevant discussion, if not meet, with Spearson correlation analysis; One-Way ANOVA comparing PASAT scores by age, occupational groups, if the groups are to meet normality and homogeneity of variance, LSD method for multiple comparisons, if not satisfied, Tamhane's T2 multiple comparisons. The inspection level α = 0.05, to select the two-sided test. Experiment II: 20 MS patients and 57 healthy volunteers participated in the study in May 2010 -2011 February. MS patients were from the Southern Hospital, Guangdong Provincial Hospital two hospitals, not with the completion of the test excluded 3 (female, 62 years old, 53 years old, 37 years old), a total of 17 MS patients entered the study. Sex with the MS subjects were selected in a 1:1 ratio in 57 healthy volunteers, age, years of education matching to a total of 17 healthy volunteers were enrolled in the study. Tested in independent, quiet room, the purposes of all testing by a single test. Subjects accepted according the following order: ① general investigation: name, sex, age, number of years of education, past history, family history, drug use, smoking and drinking; 2 MS disease status survey: MS genotyping, EDSS scores, from sick time, number of recurrences, the main symptom, imaging performance (healthy volunteers omitted); ③ neuropsychological tests: PASAT ,2-Back CRAVLT (N1-7), the MMSE, the VFT, SDMT, TMT, DS, Stroop, SIMI , CRAVLT (N8-9), the clock drawing test, RCFT copying learn; ④ neuropsychological assessment: HAMD, FSS, PSQI global score; ⑤ RCFT delayed recall. Statistical analysis: SPSS 13.0 statistical software for statistical analysis. The sample size is less than 50, Evaluating the Shapiro-Wilk normality. Meet normality and homogeneity of variance test of working memory and other neuropsychological test, two-sample t-test was used to compare the health group and the MS group differences; if not satisfied, you are using two independent samples rank sum test; if most of the tests not satisfied, the two independent samples rank sum test. Health group SDMT scores 5% of the value of community, the MS group was further divided into SDMT-retention group SDMT-disorder group, health group and the SDMT-retention groups, health groups and SDMT-disorder group between two independent samples rank sum test comparison. Another averaged ideological compare MS group working memory test standardized results, the MS group and each variable value divided by the average of the variables of the healthy group, divided by 17, the formula is: Xij '= Σ (Xij / xi) / 17 (3.2-1) i (variable 1, variable 2, variable 3 ......), j represents an individual (such as patients, patients 2 patients 3 ......) in the MS group, on behalf of a variable xi is a variable of the healthy group mean, Xij is an individual of the MS group specific values ??of the corresponding variables, the standardized mean of a variable xij for the MS group. For non-forward variables (the bigger the better non-test scores variables, such as time-consuming number), you need to do variable transformation whichever standardized countdown rear the formula: Xij '= Σ (1/Xij · xi) / 17 ( 3.2-2) 2-Back Test 1 - error rate data transformation. The small amount of missing data using the number of alternatives within the same group. The inspection level α = 0.05, to select the two-sided test. Results Experiment I: the Chinese version PASAT internal consistency reliability (Cronbach's = 0.900), test-retest reliability (ICC = 0.837, P = 0.000), rater degree (ICC = 0.999, P = 0.000), short-term within a practice effect (Z = -3.304, P = 0.001); executive function, working memory, verbal memory, the time prospective memory and logic inductive reasoning involved in PASAT task is completed; affected by years of education and PASAT scores significantly positive correlation (r = 0.582 , P = 0.000). Experiment II: (1) simple working memory task accuracy test, the breadth of the MS group of figures the total score, Stroop-word correct number of the Stroop-color correct number was no significant difference between the Stroop-interference correct number of healthy control group ( respectively, t = 1.411, Z = -0.703, -0.491, -0.746; P = 0.168,0.482,0.623,0.456).; require a higher working memory test (PASAT-3 'for the time PASAT-2', SDMT 2-Back), and consuming consuming Stroop-color with simple working memory tasks, the Stroop-interference consuming MS group than in the healthy control group, the presence of significant obstacles (t = 2.989,2.496, Z = -2.706, - 2.554, -2.017, -2.240; P = 0.005,0.018,0.007,0.011,0.044,0.025). (2) MS group compared with the healthy group neuropsychological test results, the MS group and the healthy group, in addition to the the RCFT-copying total score, RCFT-copy time-consuming, RCFT memories score, RCFT-memories of the time-consuming, the connection test - B the number of errors, the verbal fluency test group no significant difference (Z = -1.086, -1.482, -1.330, -1.381, -1.484, -1.397; (P = 0.277,0.138,0.183,0.167,0.138,0.162) ), a statistically significant difference between the other test groups. Test these exist significant differences, the MS group forward scored rank test (MMSE, clock drawing test CRAVLT-score, the similarity test) were lower than the healthy group (Z = -2.590, - 2.682, t = 4.245, Z = -2.883; P = 0.010,0.007,0.000,0.004), mean rank were negative scoring Test (TMT-A time-consuming, TMT-B time-consuming, TMT-A number of errors) higher than the healthy group (Z = -3.810, -3.514, -2.905; and P = 0.000,0.000,0.004). (3) working memory task, MS-SDMT retention group positive test (PASAT-3 ', PASAT-2', SDMT, the Stroop-words in the correct number, the Stroop-color correct number, the Stroop-interference is the correct number, digit span) and a negative test (the Stroop-words-consuming, and the Stroop-color time-consuming, Stroop-interference consuming ,2-Back) between the two groups was not statistically significant (respectively, Z = -1.080, -0.788, -0.117, - 0.212, -0.817, -0.236, -0.442; P = 0.280,0.431,0.907,0.832,0.414,0.814,0.659). MS-SDMT the obstacles set of positive test (PASAT-3 ', PASAT-2', SDMT), a negative test (2-back) average rank difference with healthy group are larger, the difference is significant (respectively, Z = -3.220 , -3.131, -4.127, -3.429; P = 0.001,0.002,0.000,0.001); Srtoop-words, colors, interference consuming an average rank significantly larger than the healthy group (Z = -4.019, -3.078, respectively - 2.832; P = 0.000,0.002,0.005), and accuracy-related Stroop-word, color, interfere with the correct number did not find a significant difference between the two groups (Z = -1.263, -1.501, -0.949; P = 0.207 digit span test group, 0.133,0.343); significant difference (Z = -1.744, P = 0.081). (4) other tests of cognitive function, the SDMT reserved groups only positive test mean rank CRAVLT-score was significantly lower than that of the healthy group (Z = -2.949, P = 0.003), a negative test TMT-A time-consuming , TMT-B time-consuming, TMT-A number of errors mean rank significantly higher than the healthy group (Z = -2.189, -2.127, -2.106; P = 0.029,0.033,0.035) and the rest of the test were not found significant differences . MS-SDMT obstacles set of forward test (MMSE, clock drawing test CRAVLT-(?) Total score, similar tests of verbal fluency) average rank significantly lower than that of the healthy group (Z = -3.118, -3.041 , -2.510, -3.730, -2.323; P = 0.002,0.002,0.012,0.000,0.020), a negative test (TMT-A time-consuming, TMT-B time-consuming, TMT-A number of errors, TMT-B the number of errors ) were significantly higher than that of the control group (Z = -3.531, -3.938, -3.331, -2.142; P = 0.000,0.000,0.001,0.032), only RCFT with the healthy group, the difference was not statistically significant (RCFT-copy consumption when memories consuming copying Score, recalls score Z = -1.947, -1.485, -0.783, -1.483; P = 0.052,0.137,0.433,0.138). (5) The SDMT-disorder group working memory test results normalized, the SDMT standardized mean minimum for 0.468; PASAT-3 ', PASAT-2', the Stroop test - time-consuming 'standardized mean followed, respectively 0.622,0.656 , 0.624,0.677,0.728; Digit Span the ,2-Back correct rate standardized mean similar were 0.821,0.809; the RCFT-I copying consuming ', RCFT-memories consuming more than one' standardized mean were 1.119,1.099 . Conclusions experiment: Chinese version of PASAT has good reliability, suggesting that the test has good reproducibility, stability, and good correlation with working memory test, the cue validity. In addition, the test no gender differences in their general cognitive ability, years of education, can have some influence, but the age of their relationship to be further discussed. In healthy people, occupational and depression, fatigue, sleep neuropsychological characteristics of the Chinese version of the PASAT correlation is not obvious. PASAT implementation is simple, less time-consuming, high sensitivity, does not depend on the visual-spatial ability and physical activity capacity, neuropsychological studies, working memory impairment check good tool for young Chinese population. Experiment II: This study discusses the MS working memory impairment and other cognitive dysfunction and the healthy control group, it was found the MS group in addition to visuospatial memory, verbal fluency, overall cognitive function, working memory, verbal memory, executive function, logical induction capacity was significantly decreased compared with the healthy control group. MS group is below the healthy control group SDMT scores 5% as the boundary SDMT-retention group the SDMT-disorder group divided into the SDMT-retention groups only obvious difference with the healthy control group in verbal memory, executive function, SDMT- obstacle group Stroop accuracy, digit span, little difference in graphics memory with the healthy control group, overall cognitive function, working memory, verbal memory, executive function, logical induction ability, word fluency were significant obstacles. The reasoning is as follows: working memory obstacles: 1.MS working memory impairment of the central executive system, the processing speed of the scenarios buffer damaged, rather than the accuracy of the content of the information processing; task increased the requirements of the Central Executive , information processing speed disorder is becoming increasingly apparent, so the expense of the accuracy of the content of the information processing may occur to compensate for this deficiency. In addition to the presence of information processing speed decline words information the temporary holding capacity obstacles may also be one of the characteristics of MS patients working memory impairment. Other cognitive functions: 1.MS patient information processing speed decline may be a key factor in causing various cognitive impairment, but still can not rule out the possibility of other cognitive functions itself that there is no damage, this assumption needs to improve test The design further confirmation. Perhaps MS semantic processing of information and structure information in the same experimental paradigm damage there is non-parallel, or visuospatial ability relative retention can play a compensatory role. This study is limited by the sample size, these assumptions are needed in the future to expand the sample size, and to further improve the experimental design argument.
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