临床常用神经心理量表的纵向稳定性:一项横断面研究  

Longitudinal stability of clinically used neuropsychological scales:a cross-sectional study

作　　者：仇宇悦 金蔚 尚丽 褚姗姗 王添艺 姜宇涵 包嘉璐 王文君 李博 黄益炫 董立羚 毛晨晖 王建勇[2] 高晶 Qiu Yuyue;Jin Wei;Shang Li;Chu Shanshan;Wang Tianyi;Jiang Yuhan;Bao Jialu;Wang Wenjun;Li Bo;Huang Yixuan;Dong Liling;Mao Chenhui;Wang Jianyong;Gao Jing(Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,State Key Laboratory of Complex Severe and Rare Diseases,Beijing 100730,China;Department of Computer Science and Technology,Tsinghua University,Beijing 100084,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经科,疑难重症及罕见病国家重点实验室,北京100730 [2]清华大学计算机科学与技术系,北京100084

出　　处：《中华神经科杂志》2025年第1期17-25,共9页Chinese Journal of Neurology

基　　金：科技部重点研发计划(2020YFA0804500,2022YFA0804501);中国医学科学院医学与健康科技创新工程(2021-I2M-1-020);北京协和医院中央高水平医院临床科研专项(2022-PUMCHA-254,2022-PUMCH-D-007);科技创新2030-“脑科学与类脑研究”重大项目(2021ZD0201106)。

摘　　要：目的探讨简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)的纵向测量稳定性。方法回顾性分析2021年1月至2024年1月北京协和医院神经科痴呆与脑白质病门诊收治的68例痴呆患者,收集其MMSE、MoCA、ADL评分的多次随访数据,采用两种不同规则(规则1:当前评估结果优于前次记为异常;规则2:当前评估结果优于前数次平均得分记为异常,若患者仅进行2次认知评估,规则2结果与规则1相同)分析量表总分及分项异常率,并在进一步排除焦虑抑郁状态患者后重复以上统计。结果在量表总分方面,MMSE显示出最低的异常率[规则1下为27.2%(31/114),规则2下为29.8%(34/114)],而MoCA异常率最高[分别为41.3%(26/63)和46.0%(29/63)],ADL异常率分别为27.7%(23/83)和33.7%(28/83)。MoCA分项中,分类提示、多选提示、第二次瞬时记忆、定向力及画钟项目表现出较高的异常率[分别为31.7%(20/63)、30.2%(19/63)、23.8%(15/63)、22.2%(14/63)、22.2%(14/63)]。排除焦虑抑郁状态患者后,MMSE和ADL各分项异常率无显著变化,MoCA分项中定向力的异常率有所降低。结论MMSE和ADL在痴呆患者的长期监测中展现出良好的稳定性,可作为评估及随访认知功能变化的重要工具。Objective To investigate the longitudinal stability of the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),and the Activity of Daily Living Scale(ADL).Methods The longitudinal cognitive assessment results of 68 dementia patients admitted to the Dementia and Leukoencephalopathy Outpatient Clinic,Department of Neurology,Peking Union Medical College Hospital,from January 2021 to January 2024,were retrospectively analyzed,including the total and sub-items scores of the MMSE,MoCA,and ADL.Two different rules were applied to analyze the abnormality rates:rule 1,where the current test result being better than the previous one was considered an abnormality;rule 2,where the current test result being better than the previous average score was considered an abnormality(If a patient had only 2 cognitive assessments,rule 2 was considered the same as rule 1).Two rules were used to analyze the abnormality rates of the scales.The statistical analyses were repeated after excluding patients with possible anxiety and depression status.Results In assessing the total score stability,MMSE showed the lowest abnormality rates[27.2%(31/114)under rule 1 and 29.8%(34/114)under rule 2],while MoCA had the highest abnormality rates[41.3%(26/63)and 46.0%(29/63),respectively].The ADL abnormality rates were 27.7%(23/83)and 33.7%(28/83),respectively.Among MoCA sub-items,category cue,multiple choice cue,second memory trial,orientation,and clock showed higher abnormality rates[31.7%(20/63),30.2%(19/63),23.8%(15/63),22.2%(14/63),22.2%(14/63),respectively].After excluding population with possible anxiety and depression status,the relative abnormality rates of MMSE and ADL sub-items did not significantly change,while the abnormality rate of orientation in MoCA sub-items decreased relatively.Conclusion The MMSE and ADL exhibit good stability in long-term monitoring of dementia patients,serving as essential tools for assessing and following up cognitive changes.

关 键 词：神经心理学测验 痴呆 简易精神状态检查量表 蒙特利尔认知评估量表 日常生活能力量表 

分 类 号：R741[医药卫生—神经病学与精神病学]