阿尔茨海默症可以预测吗？写作测试也许提供了答案
Alzheimer’s Prediction May Be Found in Writing Tests
GINA KOLATA
2021年2月5日
Is it possible to predict who will develop Alzheimer’s disease simply by looking at writing patterns years before there are symptoms?
有没有可能在出现症状之前的几年里，仅仅通过观察书写模式来预测谁会患上阿尔茨海默症？
According to a new study by IBM researchers, the answer is yes.
根据IBM研究人员的一项新研究，答案是肯定的。
And, they and others say that Alzheimer’s is just the beginning. People with a wide variety of neurological illnesses have distinctive language patterns that, investigators suspect, may serve as early warning signs of their diseases.
而且，他们和其他一些研究人员表示，阿尔茨海默症的预测只是开始。研究人员怀疑，患有多种神经系统疾病的人都有着独特的语言模式，可能是他们疾病的早期预警信号。
For the Alzheimer’s study, the researchers looked at a group of 80 men and women in their 80s — half had Alzheimer’s and the others did not. But, seven and a half years earlier, all had been cognitively normal.
在阿尔茨海默症的研究中，研究人员观察了80名80多岁的男性和女性，其中一半患有阿尔茨海默症，另一半则没有。但在七年半前，他们的认知能力都是正常的。
The men and women were participants in the Framingham Heart Study, a long-running federal research effort that requires regular physical and cognitive tests. As part of it, they took a writing test before any of them had developed Alzheimer’s that asks subjects to describe a drawing of a boy standing on an unsteady stool and reaching for a cookie jar on a high shelf while a woman, her back to him, is oblivious to an overflowing sink.
这些人都是弗雷明汉心脏研究(Framingham Heart Study)的参与者，这是一个长期的联邦研究项目，参与者需要定期进行身体和认知测试。作为测试的一部分，在患上阿尔茨海默症之前，所有人都参加了一次写作测试。测试要求参与者描述一幅画，画中的一个男孩站在摇摇晃晃的椅子上，伸手去够高架子上的饼干罐，而一个背冲着他的女人对溢出的水槽视而不见。
The researchers examined the subjects’ word usage with an artificial intelligence program that looked for subtle differences in language. It identified one group of subjects who were more repetitive in their word usage at that earlier time when all of them were cognitively normal. These subjects also made errors, such as spelling words wrongly or inappropriately capitalizing them, and they used telegraphic language, meaning language that has a simple grammatical structure and is missing subjects and words like “the,” “is” and “are.”
研究人员利用一个人工智能程序，检查受试者的词汇使用情况，寻找语言上的细微差别。他们鉴定出一组受试者，在早期所有人的认知能力都正常的情况下，他们的用词重复情况更为严重。这些测试对象还会犯一些错误，比如拼写错误或者大写使用不当，而且会使用电报式语言——语法结构简单，漏掉主语以及“the”、“is”和“are”这样的词。
The members of that group turned out to be the people who developed Alzheimer’s disease.
这群人后来都患上了阿尔茨海默症。
The A.I. program predicted, with 75 percent accuracy, who would get Alzheimer’s disease, according to results published recently in The Lancet journal EClinicalMedicine.
根据《柳叶刀》(The Lancet)子刊《临床医学》(EClinicalMedicine)最近发表的研究结果，该人工智能能够预测谁将患上阿尔茨海默症，准确率达75%。
“We had no prior assumption that word usage would show anything,” said Ajay Royyuru, vice president of health care and life sciences research at IBM Thomas J. Watson Research Center in Yorktown Heights, N.Y., where the A.I. analysis was done.
“我们之前没有想到用词情况还有这个用途，”纽约州约克敦高地的IBM托马斯·沃森研究中心(IBM Thomas J. Watson Research Center)医疗保健和生命科学研究副总裁阿贾伊·罗伊尤鲁(Ajay Royyuru)说。人工智能分析就是在该中心进行的。
Alzheimer’s researchers were intrigued, saying that when there are ways to slow or stop the illness — a goal that so far remains elusive — it will be important to have simple tests that can warn, early on, that without intervention a person will develop the progressive brain disease.
阿尔茨海默症的研究人员对此很该兴趣，他们说，如果有办法减缓或者阻止这种疾病——到目前为止这个目标依旧遥遥无期——有简单的测试可用就非常重要了，它可以在早期发出警告，如果不进行干预的话，就会发展出渐进性的大脑疾病。
“What is going on here is very clever ” said Dr. Jason Karlawish, an Alzheimer’s researcher at the University of Pennsylvania. “Given a large volume of spoken or written speech, can you tease out a signal?”
“这个研究太聪明了，”宾夕法尼亚大学(University of Pennsylvania)研究阿尔茨海默症的贾森·卡拉维什(Jason Karlawish)博士说。“从大量的口头或书面讲话中，你就能梳理出一个信号？”
For years, researchers have analyzed speech and voice changes in people who have symptoms of neurological diseases — Alzheimer’s, ALS, Parkinson’s, frontotemporal dementia, bipolar disease and schizophrenia, among others.
多年来，研究人员一直在分析有神经系统疾病症状的人的语言和声音变化情况，这些疾病包括阿尔茨海默氏症、肌萎缩侧索硬化症、帕金森氏症、额颞叶痴呆、双向情感障碍和精神分裂症等等。
But, said Dr. Michael Weiner, who researches Alzheimer’s disease at the University of California, San Francisco, the IBM report breaks new ground.
但是，在加利福尼亚大学旧金山分校(University of California, San Francisco)研究阿尔茨海默症的迈克尔·韦纳博士(Michael Weiner)说，IBM的研究报告带来了新的突破。
“This is the first report I have seen that took people who are completely normal and predicted with some accuracy who would have problems years later,” he said.
“这是我见过的第一份以完全正常者为对象，并以一定的准确率预测出数年后谁会出现问题的报告，”他说。
The hope is to extend the Alzheimer’s work to find subtle changes in language use by people with no obvious symptoms but who will go on to develop other neurological diseases.
研究者希望将阿尔茨海默氏症的研究工作扩展到发现没有明显症状，但会发展为其他神经系统疾病者在语言使用方面的细微变化。
Each neurological disease produces unique changes in speech, which probably occur long before the time of diagnosis, said Dr. Murray Grossman, a professor of neurology at the University of Pennsylvania and the director of the university’s frontotemporal dementia center.
宾夕法尼亚大学神经学教授、额颞叶失智中心主任默里·格罗斯曼(Murray Grossman)博士说，每一种神经系统疾病都会导致言语方面的独特变化，这种变化可能早在疾病确诊之前就已发生。
He has been studying speech in patients with a behavioral form of frontotemporal dementia, a disorder caused by progressive loss of nerves in the brain’s frontal lobes. These patients exhibit apathy and declines in judgment, self control and empathy that have proved difficult to objectively quantify.
他一直在研究一种行为型额颞叶失智患者的语言能力，这是由大脑额叶神经的进行性丧失引起的疾病。这些病人表现出冷漠，以及判断力、自我控制能力和共情能力下降，这些症状被证明难以客观量化。
Speech is different, Dr. Grossman said, because changes can be measured.
而语言就不同了，格罗斯曼说，因为语言的变化是可以测量的。
Early in the course of that disease, there are changes in the pace of the patients’ speech, with pauses distributed seemingly at random. Word usage changes, too — patients use fewer abstract words.
在该疾病的早期阶段，患者语速会发生变化，出现看似随机分布的停顿。词汇的使用也发生了变化——患者使用的抽象词汇会减少。
These alterations are directly linked to changes in the frontotemporal parts of the brain, Dr. Grossman said. And they appear to be universal, not unique to English.
格罗斯曼说，这些变化与大脑额颞部的变化直接相关。它们似乎普遍存在，而不是英语所独有。
Dr. Adam Boxer, director of the neurosciences clinical research unit at the University of California, San Francisco, is also studying frontotemporal dementia. His tool is a smartphone app. His subjects are healthy people who have inherited a genetic predisposition to develop the disease. His method is to show subjects a picture and ask them to record a description of what they see.
加利福尼亚大学旧金山分校神经科学临床研究组主任亚当·博克瑟(Adam Boxer)博士也在研究额颞叶失智。他的工具是一个智能手机应用，研究对象是继承这种疾病遗传倾向的健康人。他的方法是向受试者出示一幅图片，并让他们记录对所见图片的描述。
“We want to measure very early changes, five to 10 years before they have symptoms,” he said.
“我们希望在患者出现症状的五到十年之前就能测量出非常早期的变化，”他说。
“The nice thing about smartphones,” Dr. Boxer added, “is that you can do all kinds of things.” Researchers can ask people to talk for a minute about something that happened that day, he said, or to repeat sounds like tatatatata.
“智能手机的好处是，”博克瑟还说，“你可以用它来做各种各样的事。”他说，研究人员可以让人们花一分钟时间谈论当天发生的事情，或者重复类似“哒哒哒哒”的声音。
Dr. Boxer said he and others were focusing on speech because they wanted tests that were noninvasive and inexpensive.
博克瑟说，他和其他人之所以关注语言方面的研究，是因为希望进行非侵入性和成本低廉的测试。
Dr. Cheryl Corcoran, a psychiatrist at Icahn School of Medicine at Mount Sinai in New York, hopes to use speech changes to predict which adolescents and young adults at high risk for schizophrenia may go on to develop the disease.
纽约西奈山伊坎医学院(Icahn School of Medicine)的精神病学家谢丽尔·科克伦(Cheryl Corcoran)博士希望利用言语变化来预测哪些精神分裂症高危的青少年和年轻人的状态可能会继续发展，最终患上这种疾病。
Drugs to treat schizophrenia may help those who are going to develop the disease, but the challenge is to identify who the patients will be. A quarter of people with occasional symptoms saw them go away, and about a third never progressed to schizophrenia although their occasional symptoms persisted.
治疗精神分裂症的药物可能会帮助那些即将发病的人，但困难在于要确定哪些人最终会患病。四分之一偶尔出现症状的人最终症状消失了，大约三分之一的人没有发展到精神分裂症，尽管偶发症状还持续存在。
Guillermo Cecchi, an IBM researcher who was also involved in the recent Alzheimer’s research, studied speech in 34 of Dr. Corcoran’s patients, looking for “flight of ideas,” meaning the instances when patients were off track when talking and spinning off ideas in different directions. He also looked for “poverty of speech,” meaning the use of simple syntactic structures and short sentences.
IBM研究员吉列尔莫·切奇(Guillermo Cecchi)也参与了最近的阿尔茨海默氏症研究，他研究了科克伦的34名患者的语言，寻找“想法逃逸”迹象，即患者在说话时脱离轨道，想法转向不同方向的例子。他还寻找“言语贫乏”，也就是使用简单句法结构和短句的情况。
In addition, Dr. Cecchi and his colleagues studied another small group consisting of 96 patients in Los Angeles — 59 of whom had occasional delusions. The rest were healthy people and those with schizophrenia. He asked these subjects to retell a story that they had just heard, and he looked for the same telltale speech patterns.
切奇和同事们还研究了洛杉矶另一个由96名患者组成的小组，其中59人偶尔产生妄想，其余的是健康人和精神分裂症患者。他要求这些受试者复述他们刚刚听过的一个故事，并寻找同样能够说明问题的语言模式。
In both groups, the artificial intelligence program could predict, with 85 percent accuracy, which subjects developed schizophrenia three years later.
在两个小组中，人工智能程序都能以85%的准确率，预测出哪些受试者会在三年后患上精神分裂症。
“It’s been a lot of small studies finding the same signals,” Dr. Corcoran said. At this point, she said, “we are not at the point yet where we can tell people if they are at risk or not.”
“很多小型研究都发现了同样的信号，”科克伦说。她说，在这一点上，“我们还没有达到可以告诉人们是否存在风险的地步。”
Dr. Cecchi is encouraged, although he realizes the studies are still in their infancy.
切奇受到了鼓励，尽管他意识到这些研究仍处于起步阶段。
“For us, it is a priority to do the science correctly and at scale,” he said. “We should have many more samples. There are more than 60 million psychiatric interviews in the U.S. each year but none of those interviews are using the tools we have.”
“对我们来说，正确地、大规模地进行科学研究是当务之急，”他说。“我们应该有更多的样本。美国每年有超过6000万宗精神病学交谈，但它们都没有使用我们现有的工具。”
