Abstract: Objective To develop Chinese Card Sorting Test (CCST) as an efficient, brief test for evaluating executive function in Chinese elderly. Methods Thirty-five patients with mild Alzheimer's disease (AD), 69 cases with mild cognitive impairment (MCI) [amnesic MCI-single domain (aMCI-s), 25; amnesic MCI-multiple domain (aMCI-m), 24; non-amnesic MCI (naMCI), 20] and 124 cognitively normal controls (NC) were administered a battery of neuropsychological tests including CCST. Three sets (including figures, words and numbers) of cards were adopted. Each set had 6 cards. Subjects were asked to sort cards according to shape, number, color and meaning. Full mark was 4 for each set and 12 for total 3 sets. Results 1) Comparison among NC, MCI and AD: according to test score, in NC group, Set Ⅱ was most difficult while Set Ⅰ was the easiest. However, in MCI and AD group, patients' scores were similar among 3 sets, which indicated that the discriminative efficacy was same among 3 sets. Set Ⅰ and Ⅲ sorting started with "color" and followed with "meaning". Set Ⅱ sorting started with "meaning". The accuracy score for Set Ⅱ was the lowest which may due to the inhibition effect of "meaning" against other sorting strategy (similar as "the Stroop effect"). "Number" was the most difficult and least adopted sorting dimension. There were few misclassification which indicated that the test design produced few misunderstanding. When the total score of CCST ≤ 6, the sensitivity and specificity for differentiating AD was 94.32% and 74.24%, respectively. When the total score of CCST ≤ 5, the sensitivity and specificity for differentiating AD was 74.35% and 89.52%, respectively. For subjects with low education, optimal cut-off score should be selected as ≤ 5. For subjects with high education, optimal cut-off score should be set as ≤ 6. 2) Comparison among 3 MCI subgroups: the score in naMCI subgroup was the lowest (4.25 ± 2.07), while in aMCI-s subgroup was the highest (6.68 ± 1.65). The score in aMCI-m was between the 2 above subgroups (5.16 ± 2.26). There were significant differences among the 3 subgroups (P < 0.01, for all). CCST can be used to differentiate amnesic and non-amnesic MCI. There were significant differences between aMCI-s and naMCI for all 3 sets of cards. Significant differences only existed for Set Ⅱ between aMCI-m and naMCI. There were significant differences among 3 subgroups in "color" dimension. There were no differences among 3 subgroups in "number" and "meaning" dimension. There were significant differences between aMCI and naMCI in "color" and "number" dimension. There were no differences between aMCI and naMCI in "shape" and "meaning" dimension. Conclusion Chinese Card Sorting Test is an effective, rapid and usable test for differentiating amnesic and non-amnesic MCI.

Key words: Cognition disorders, Neuropsychological tests

摘要： 目的   编制适用于中国老年人群简短而有效的执行能力测验—— 中文卡片分类测验（CCST）。方法   选择不同亚型的轻度认知损害和阿尔茨海默病患者完成中文卡片分类测验等一系列的神经心理学测验，并与正常对照受试者进行比较，评价其临床适用性和检测效度。结果   （1）阿尔茨海默病组、轻度认知损害组与正常对照组受试者比较，3 套卡片评分差异均具有统计学意义（P < 0.01）。（2）所有受试者均较少采用“数量”维度。（3）当CCST 总评分≤ 6 分时，识别阿尔茨海默病的敏感度可达94.32%，特异度为74.24%；当CCST 总评分≤ 5 分时，识别阿尔茨海默病的敏感度为74.35%，特异度为89.52%。（4）在轻度认知损害各亚组中，以非遗忘型轻度认知损害组受试者CCST 总评分最低（4.25 ±2.07），单认知域遗忘型轻度认知损害组总评分最高（6.68 ± 1.65），而多认知域遗忘型轻度认知损害组介于二者之间（5.16 ± 2.26），组间差异具有统计学意义（P < 0.01）。结论   虽然中文卡片分类测验材料不同，由于设计的分类维度相同，故对3 组受试者的鉴别力颇为接近；受试者完成率高、耗时短，而且其总评分有助于鉴别遗忘型和非遗忘型轻度认知损害，鉴别效度良好，是一种有效、快速的执行能力检验方法，值得进一步推广应用。

关键词: 认知障碍, 神经心理学测验