多系统萎缩患者的认知、情感及日常生活能力评估

Assessment of cognitive function, emotions and activities of daily living in patients with multiple system atrophy

目的 评估多系统萎缩（MSA）患者的认知功能、情感状态及日常生活能力.方法 收集2009年10月至2012年11月海军总医院神经内科门诊和住院收治的MSA患者32例和38名健康对照组,对两组进行认知功能、情感及日常生活能力评估.认知功能的评估采用中文版蒙特利尔认知评估量表（MoCA）和简易精神状态量表（MMSE）,情感评估采用抑郁自评量表（SDS）和焦虑自评量表（SAS）,日常生活能力评估采用日常生活能力量表（ADL）.统计学采用SPSS 19.0版软件进行分析：计量数据均以（-x）±s表示,组间比较采用独立样本t检验,相关性检验采用Pearson相关性分析,以P＜0.05为差异有统计学意义.结果 71.9％的MSA患者存在轻到中度的认知功能障碍.MSA组患者的MoCA、MMSE的评分均低于对照组,ADL、SDS、SAS的评分高于对照组,两组比较差异有统计学意义（P＜0.05）；MSA组患者的视空间/执行功能、延迟记忆、语言、抽象思维及注意力评分明显低于对照组,两组比较差异有统计学意义（P ＜0.05）；MSA组患者的MoCA、MMSE评分与病程之间存在显著负相关（P＜0.01）；MSA组患者的SDS、SAS评分与ADL评分及病程存在显著正相关（P＜0.05）,且SDS与SAS之间存在显著正相关（P ＜0.01）；MSA组患者的ADL评分与病程存在显著正相关（P＜0.05）.结论 MSA组患者存在一定程度的认知功能障碍、情感障碍及日常生活能力受损,尤其认知功能损伤比既往的认识更普遍,因此MSA的诊断不应将认知障碍作为其排除标准之一.而且,本研究推测MSA患者上述认知功能障碍的特征具有一定的临床参考价值.

Objective To explore the cognitive function,emotional status and activities of daily living in patients with multiple system atrophy （MSA）.Methods Thirty-two MSA patients and 38 healthy controls from October 2009 to November 2012 were recruited from our hospital.Their cognitive function,emotional status and activities of daily living were assessed.Cognitive function was assessed by Montreal cognitive assessment （MoCA） and mini-mental state examination （MMSE） ; emotional status by self-rating depression scale （SDS） and self-rating anxiety scale （SAS） ; daily living and activities by activities of daily living scale （ADL）.Data analysis was performed with SPSS 19.0.And the results were presented as the mean ± standard deviation.Comparison of means was performed with independent sample t test.And Pearson＇s correlation test was used for correlation analysis.A P-value 〈 0.05 was considered significant.Results Mild or moderate cognitive impairment was documented in 71.9% of MSA patients.The scores of MoCA and MMSE in the MSA group were significantly lower than those in the control group.And the scores of ADL,SDS and SAS in the MSA group were significantly higher than those in the control group （P 〈 0.05）.MoCA subitems such as space/executive function,attention,abstraction,language and delayed memory of the MSA group were significantly lower than those of the control group （P 〈 0.05）.A negative correlation existed between the scores of MoCA and MMSE with disease duration （P 〈 0.01）.There was a positive correlation between the scores of SDS and SAS with ADL and disease duration （P 〈 0.05）.And the relationship was significant between the scores of SDS and SAS （P 〈 0.01）.A positive correlation existed between scores of ADL with disease duration （P 〈 0.05）.Conclusion MSA patients have certain degrees of cognitive impairment,emotion disorders and impaired ADL.Cognitive impairment in MSA patients may be more common than previously.Furthermore,the clinical features of cognitive impairment in these patients may have some clinical values for references.