简易精神状态量表与蒙特利尔认知评估量表对腔隙性脑梗死患者认知障碍筛查效能的比较  

Efficacy of the Mini-Mental State Examination versus the Montreal Cognitive Assessment in screening cognitive impairment in patients with lacunar cerebral infarction

作　　者：裴芳 孟涛 王思思 张凯旋 刘晓琴 米希婷[2] 王娟[2] 尉杰忠[3] 马存根 Pei Fang;Meng Tao;Wang Sisi;Zhang Kaixuan;Liu Xiaoqin;Mi Xiting;Wang Juan;Yu Jiezhong;Ma Cungen(Department of Neurology,Affiliated Hospital of Shanxi Datong University,Datong 037005,Shanxi Province,China;Shanxi Key Laboratory of Inflammatory Neurodegenerative Diseases,Medical School of Shanxi Datong University,Datong 037009,Shanxi Province,China;Department of Neurology,First Hospital of Shanxi Datong University,Datong 037006,Shanxi Province,China;Research Center of Neurobiology,Shanxi University of Chinese Medicine,Taiyuan 030619,Shanxi Province,China)

机构地区：[1]山西大同大学附属医院神经内科,大同037005 [2]山西大同大学医学院神经炎症及变性疾病基础与应用研究山西省重点实验室,大同037009 [3]山西大同大学附属第一医院神经内科,大同037006 [4]山西中医药大学神经生物学研究中心,太原030619

出　　处：《中国基层医药》2022年第1期45-50,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：山西省平台基地专项(201805D131005,201805D111009);山西省大同市社会发展重点研发计划项目(2019105,2019089);山西大同大学附属第一医院横向合作项目(HX-201927);山西大同大学重点实验室开放基金项目(KF2019005);山西省高等学校大学生创新创业训练计划项目(2020463);山西大同大学大学生创新创业训练计划项目(XDC2019132,XDC2020113)。

摘　　要：目的比较简易精神状态量表(MMSE)与蒙特利尔认知评估量表(MoCA)对腔隙性脑梗死(LI)患者认知功能障碍的筛查效能。方法选取符合纳入标准的山西大同大学附属医院2018年1月至2019年10月收治的LI患者138例,分别采用MMSE和MoCA评估患者认知功能状况;依据年龄或受教育年限中位数分组,应用χ^(2)检验比较采用MMSE与MoCA筛查各组LI患者认知障碍的敏感性和一致性;应用多重线性回归比较各组MMSE和MoCA认知总分和记忆、执行、视空间、注意、语言、定向等认知域评分。结果MoCA筛查低年龄组、高年龄组、低受教育年限组、高受教育年限组以及全人群LI患者认知障碍的敏感性(76.5%、75.7%、74.2%、77.8%、76.1%)均显著高于MMSE筛查(44.1%、65.7%、60.6%、50.0%、55.1%)(χ^(2)=12.17、13.13、9.33、15.75、23.86,均P<0.01)。各组对应的Kappa系数分别为0.336、0.391、0.358、0.389、0.373,均小于0.4(均P<0.01),提示两种量表筛查认知障碍的一致性较差。应用MMSE筛查高年龄组LI患者认知障碍阳性率(65.7%)显著高于低年龄组(44.1%)(χ^(2)=6.50,P<0.05)。高年龄组或低受教育年限组LI患者MMSE和MoCA认知总分及记忆、执行、视空间、注意、语言、定向各项认知域得分均显著低于低年龄组(t_(MMSE)=3.61、2.49、3.12、4.26、1.70、3.69、2.24,均P<0.01;t_(MoCA)=3.83、1.75、3.28、3.80、2.21、4.08、2.52,均P<0.05)或高受教育年限组(t_(MMSE)=-2.87、-2.32、-0.85、-2.54、-0.73、-2.57、-2.96,均P<0.01;t_(MoCA)=-2.95、-1.12、-3.39、-1.54、-1.52、-3.09、-3.02,均P<0.05)。结论MMSE和MoCA联合筛查LI患者认知损伤具有较高的临床应用价值,高龄、低受教育年限LI患者的认知障碍特点主要表现为记忆、执行、视空间、注意、语言、定向等多项认知域的损伤。Objective To investigate the efficacy of the Mini-Mental State Scale(MMSE)versus the Montreal Cognitive Assessment Scale(MoCA)in screening cognitive impairment in patients with a lacunar cerebral infarction.Methods 138 eligible patients who received treatment in the Affiliated Hospital of Shanxi Datong University from January 2018 to October 2019 were recruited for this study.They received cognitive function evaluation by the MMSE and MoCA.These patients were grouped according to the median number of age or the median number of years of education.The sensitivity and consistency of the MMSE versus MoCA in screening cognitive impairment in patients with a lacunar cerebral infarction were analyzed using theχ^(2) test.The total cognitive scores of the MMSE and MoCA,and the scores of each cognitive domain such as memory,execution,visual space,attention,language,and orientation,were compared between groups using multiple linear regression analysis.Results The sensitivity of MoCA in screening for cognitive impairment in low-age,high-age,low-year-education,and high-year-education groups and the whole population of patients with a lacunar cerebral infarction was 76.5%,75.7%,74.2%,77.8%,76.1%,respectively,which were significantly higher than those of MMSE(44.1%,65.7%,60.6%,50.0%,55.1%,χ^(2)=12.17,13.13,9.33,15.75,23.86,all P<0.01).The Kappa coefficients of low-age,high-age,low-year-education and high-year-education groups were 0.336,0.391,0.358,0.389,and 0.373,respectively,all of which were less than 0.4(all P<0.01).These findings suggest that the consistency of the two scales in screening cognitive impairment is poor.The cognitive impairment detection rate by the MMSE was significantly higher in the high-age group than in the low-age group(65.7%vs.44.1%,χ^(2)=6.50,P<0.05).The total cognitive scores of MMSE and MoCA and the scores of memory,execution,visual space,attention,language,and orientation in patients with a lacunar cerebral infarction were significantly lower in the high-age group or low-year-education group th

关 键 词：认知障碍 中风 腔隙性 脑梗死 精神状态检查表 认知评估 老年人 

分 类 号：R743.33[医药卫生—神经病学与精神病学]