認知機能検査の【長谷川式スケール】とは?

長谷川式スケールと呼ばれる、認知症に関する検査についてご存じですか?家族の診察で、長谷川式スケールを聞いたことがある方もいらっしゃるはずです。この記事は、長谷川式スケールについて現役看護師が執筆し、まとめています。

目次

長谷川式スケールとは

長谷川式スケールの正式名称は、「長谷川式認知症スケール」で、「長谷川式」や「HDS-R」とも呼ばれています。

もともとは精神科の医師長谷川 和夫氏が、認知症の早期発見につながる検査法として、1974年に発表した、「長谷川式簡易認知症評価スケール(HDS-R)」が最初です。この検査は、認知症が疑われる場合や、認知機能が低下していると考えられる場合に、認知症の可能性があるか、否かをふるいにかけるためのテストです。

長谷川式簡易認知症評価スケールは、1991年にさらなる改訂がなされ「改定長谷川式簡易認知評価スケール」となり、現在テスト内で使用されている質問項目や採点の基準になっています。

認知症は早期発見と早期治療が大切だと言われています。この長谷川式認知症スケールを使用することで、認知症の早期発見ができ、早期治療につなげることができます。

長谷川式スケールの中身は、どんな内容なの?

長谷川式認知症スケールは、医師から患者に対し、9つの質問を行い、認知症の可能性を評価します。主に記憶力を確認することを中心とした質問内容で、5-10分でテストが終了する上に、寝た切りの患者であったとしても、テストをすることが、可能です。

30点満点中のうち、20点以下の場合は“認知症疑い”の判定で、21点以上は認知症の疑いはないとしています。

テストは、主に次のような内容の質問となっています。

▼質問や評価項目についての解説

①年齢についての評価をします。正しい年齢より、±2歳の誤差については、正解とします。

②日付や場所の見当識についての評価をします。見当識とは、自身が置かれている状況・周囲の関係を結びつけて考えることができる機能のことをいいます。

③については、いくつかのヒント(「家ですか?病院ですか?」など)を与え、答えられる場合は、1点とします。

④即時の記憶についての評価をします。新しい記憶がどれだけ正しく脳内に記録されたかが分かります。患者が答え終わったら、「あとでまた質問しますので、覚えておいてください」と伝えましょう。

⑤計算能力の評価です。1回目、100から7を引くため、正解は93。2回目86と答えられたら正解とします。

⑥逆唱の評価を行います。「3-7-6」と質問した場合「6-7-3」 「4-2-7-8」と質問した場合「8-7-2-4」とそれぞれ答えた場合、正解とします。

⑦遅延再生の評価を行います。覚えた事柄を、一定期間置いたあとに、思い出す機能を遅延再生と呼びます。答えられない場合、「植物、動物、乗り物」などとヒントを伝えてみます。ヒントがあり、答えられた場合は1点とします。

⑧視覚記憶の評価を行います。時計・櫛・スプーン・カギ・硬貨など、相互に関係しないものを用意します。

⑨語想起・流暢性の評価を行います。限られた時間内に、あるワードに想起される言葉をいくつ思い出せるかという内容です。5個以内しか答えられない場合は、0点になります。

自宅でやってみよう!長谷川式認知症スケールのテスト

ご自身で長谷川式認知スケールを行ったことはありますか?実は、自宅でもテストに取り組むことができます。自宅で長谷川式認知症スケールを行う場合は、次のものを用意します。

  1. 長谷川式認知症テストの評価用紙 (評価用紙はこちらをクリック)
  2. 道具5つ(定規・櫛(くし)・時計・歯磨き粉・皿など)相互に関係のないものであれば、他の物に代用しても問題はありません。
  3. 筆記用具

また、スマートフォンをお持ちの方は、長谷川式認知症スケールを参考としているアプリをお使いになるもの良いでしょう。ここでは国立大学医学部神経内科チームが作成された

CADi2をご紹介致します。IOSまたはAndroidいずれでも使用できますので、アプリをインストールし、試してみましょう。

当記事でご紹介している内容は、病院へ診察に行く前の参考としてのチェックテストとお考え頂き、自己診断にて出た結果から、認知症であるという診断に結びつくわけではない、という点を、改めてお伝えします。

本来、このテストは医師や臨床心理士が行うものであり、認知症を診断するには、長谷川式認知症スケールの他にも、血液検査やMRIといった諸検査が必要となります。自己診断でテストを行い、結果が思わしくなかった場合や、何か心配ことがある場合は、必ず、医師に相談しましょう。

かかりつけ医がいる場合は、最初にかかりつけ医に相談することから、おすすめします。
定期的に通っている医療機関であれば、患者の状態について、経過を把握してるからです。
かかりつけ医がいない場合は、脳神経内科、脳神経外科、精神科、老年科といった診療科を設けている、クリニックや病院に問い合わせを行いましょう。

まとめ

長谷川式認知症スケール(HDR-S)は、認知症の診断をするためのスクリーニングテストの一つです。5-10分程度と短時間で、患者が寝た切りの場合でも、おこなうことができます。自宅で長谷川式認知症スケールのテストを行うことも可能ですが、本来医師などの専門家が行うテストであり、自己診断で認知症であると診断しないように注意が必要です。

テストの結果、認知症が心配になった場合は、かかりつけ医や脳神経科や精神科等の専門の診療科を受診しましょう。

介護の相談窓口
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看護師解説認知症

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