洛文斯顿作业疗法认知评定量表在脑卒中认知评定中的临床应用

Clinical application of the Loewenstein occupational therapy cognitive assessment in assessing the cognition of stroke patients

目的探讨洛文斯顿（Loewenstein）作业疗法认知评定量表（LOTCA）在脑卒中患者认知功能评定及疗效观察中的应用价值。方法采用简易精神状况检查（MMSE）量表筛查脑卒中认知障碍患者30例（认知障碍组）和脑卒中无明显认知障碍患者30例（卒中对照组），另选30例健康志愿者（健康对照组）。3组间性别、年龄、文化程度相匹配，均行LOTCA检测，3组在治疗2个月后重复评定一次。结果认知障碍组LOTCA各项评分均明显低于卒中对照组和健康对照组（P〈0．01），以思维运作、定向力、视运动组织亚项受累最明显；卒中对照组定向力、空间知觉、视运动组织、思维运作、注意力评分明显低于健康对照组（P〈0．01），以思维运作和视运动组织评分降低为著。治疗后与治疗前比较，LOTCA各项评分均有明显提高（P〈0．01）。结论LOTCA可用于评定脑卒中患者的认知障碍程度及特点，能有效鉴别认知障碍的存在和改善、反映患者的认知水平，且具有较好的临床应用价值。

Objective To explore the applicability of the Loewenstein occupational therapy cognitive assessment （LOTCA） in evaluating cognitive function and observing the curative effect of stroke treatment. Methods Thirty stroke patients with cognitive impairment （the cognitive impairment group） and thirty stroke patients without marked cognitive impairment （the stroke control group） were screened using the mini-mental status examination （MMSE） , and thirty healthy subjects served as a normal control group. The gender distributions, ages and levels of education of the three groups were matched. All cases were examined with the LOTCA. After two months of treatment, the three groups were assessed again. Results The average total scores and the scores on the LOTCA subitems were significantly lower in the cognitive impairment group than in the stroke control group and were even lower than those in the normal control group. Particularly conspicuous were their lower scores on the thinking operations and orientation and visuo-motor organization LOTCA sub-items. In the stroke control group the average scores on the thinking operations, visuo-motor organization, attention, orientation and spatial perception sub-items were all significantly lower than those in the normal control group, especially on the thinking operations and visuo-motor organization sub-items. After treatment, the LOTCA scores in all three groups had improved significantly compared with before treatment. Conclusion The LOTCA can assess the severity and characteristics of cognitive impairment in stroke patients. It offers an effective method for identifying cognitive impairment and tracking any improvements. The scores reflect patients＇ cognitive levels, and so have clinical value.