简易智力状况检查表在颅脑外伤后智力伤残评估中的应用

Utility and limits of the mini mental state examination in evaluating the recognition impairment after brain injury

目的分析简易智力状况检查表(MMSE)在颅脑外伤后智力伤残评估中的作用及局限性。方法对221例合作实施智力伤残鉴定的脑外伤患者的MMSE资料进行分析,并与韦氏智力测验成绩、成人智残评分、专家诊断结果进行对比。结果①无脑损伤至极重度脑损伤5组患者的MMSE总分、时间定向、地点定向和短时记忆因子分的差异具有统计学意义(P<0.01或P<0.05),并呈递减趋势。②MMSE总分与韦氏FIQ、VIQ、PIQ及11个分量表分均呈显著正相关(P<0.01)。③MMSE对脑外伤后认知功能缺损筛查的假阳性率为3.8%(3/78);假阴性率为44.1%(63/143)。结论MMSE能一定程度反映急性脑外伤后认知功能损害的状况,可作为该类认知损害评估的参考工具,但应注意其使用时的假阴性问题。

Objective To explore utility and limits of the Mini Mental State Examination （MMSE） in evaluating the recognition impairment after brain injury. Methods To analyze the results of MMSE in 221 cases with cerebral trauma, and comparing with the performances of Wechsler Adults Intelligence Test（ WAIS）, Adult intelligence deficit scale and experts diagnosis on intelligent impairment. Results ① There were significant differences in total score and 3 dimensions of time orientation, location orientation and sort-time memory of MMSE among the five degrees of brain damage（P 〈 0. 01 or P 〈0.05） , and with decrease by brain damage degrees. ②There were significant relationships between the total score of MMSE and FIQ.VIQ.PIQ of WAIS and the performances of 11 subscales（P 〈 0. 01 ）. ③ The false positive rate of MMSE on screening cognitive functional impairments for the patients with brain injury was 3.8% （3/78） ;and the false negative rate was 44. 1% （63/143）. Conclusions MMSE is useful scale to evaluate cognitive functional impairments for the patients with brain injury, but need to pay attention to the problem of its false negative.