事件相关电位P300和蒙特利尔认知评估量表对不同部位脑卒中患者早期认知功能的评估价值研究

The Value of Event Related Potential P300 and Montreal Cognitive Assessment in Assessing Early Cognitive Function of Patients with Stroke in Different Brain Areas

目的探讨事件相关电位P300和蒙特利尔认知评估量表(MoCA)对不同部位脑卒中患者早期认知功能的评估价值。方法根据入选和排除标准选取2011年7月—2012年8月在我院神经内科住院部或门诊就诊的脑卒中患者101例为病例组,选取非脑卒中患者100例为对照组。根据梗死/出血灶的解剖部位,病例组患者又分为5组:额叶卒中组、颞叶卒中组、顶叶卒中组、枕叶卒中组、基底核区卒中组。应用MoCA、P300和简明精神状态检查表(MMSE)对所有受试者进行认知功能评估。结果病例组患者的MoCA评分、P300波幅均较对照组低,差异有统计学意义(P<0.05);P300潜伏期较对照组延长,差异亦有统计学意义(P<0.05)。与对照组比较:额叶、颞叶卒中组MoCA评分减低,P300波幅减低,P300潜伏期延长;顶叶卒中组MoCA评分减低;基底核区卒中组MoCA评分减低,P300潜伏期延长,差异均有统计学意义(P<0.05)。组间比较:额叶、颞叶、基底核区卒中组与顶叶、枕叶卒中组比较,P300潜伏期延长;额叶、颞叶卒中组与基底核区卒中组比较,MoCA评分减低,P300潜伏期延长,差异均有统计学意义(P<0.05)。病例组患者的执行功能/视空间、命名、延迟回忆、定向力得分较对照组低,差异均有统计学意义(P<0.05)。病例组MoCA和P300潜伏期最佳临界值为22分和397 ms,灵敏度和特异度分别为91.5%、85.7%和85.7%、55.3%。与MMSE比较Kappa值分别为0.712和0.654(P<0.01)。结论额叶、颞叶卒中患者认知功能受损最明显,MoCA和P300可识别不同部位脑卒中患者早期认知功能损害,截断值分别为22分和397 ms时,有较高的敏感度和特异度。

Objective To evaluate the value of event related potential P300（P300） and Montreal cognitive assessment（MoCA） in assessing early cognitive function of patients with stroke in different brain areas.Methods A total of 101 patients with stroke who visited the Inpatients and / or Outpatients of Neurology of our hospital between July 2011 and August 2012 were selected based on the inclusion and exclusion criteria and assigned as the study group,and another 100 patients without stroke were assigned as the control group.The patients in the study group were further divided according to the anatomic site of the infarction / bleeding lesion into five subgroups which were frontal lobe group,temporal lobe group,parietal lobe group,occipital lobe group,and basal ganglia group.The MoCA,P300,and mini mental state examination（MMSE） were used to determine the cognitive function of all subjects.Results The patients in the study group had lower MoCA score and P300 amplitude,but longer P300 latency than the control group（P〈 0.05）.Compared with the control group,the frontal lobe and temporal lobe subgroups had lower MoCA score and P300 amplitude,but longer P300 latency;The parietal lobe subgroup had lower MoCA score;The basal ganglia subgroup had lower MoCA and longer P300 latency（P〈 0.05）.The frontal lobe,temporal lobe,and basal ganglia subgroups had longer P300 latency than the parietal lobe and the occipital lobe subgroups,while the frontal lobe and temporal lobe subgroups had lower MoCA score and longer P300 latency than the basal ganglia subgroup（P〈 0.05）.The patients in the study group had lower scores in executive function / visual space,naming,delayed recall,and orientation than the control group（P〈 0.05）.The best cutoff value of MoCA was 22 score,with a sensitivity of 91.5% and a specificity of 85.7%,and that of P300 latency was 397 ms,with a sensitivity of 85.7% and a specificity of 55.3% in the identification of cognitive dysfunction in the stroke patients.The Kappa value was 0.712 and 0.654 compared with MMSE（P〈 0.01）.Conclusion Stroke in the frontal and temporal lobe may cause more serious cognitive dysfunction than stroke in other areas.MoCA and P300 latency can evaluate early cognitive function in stroke patients with high sensitivity and specificity at cutoff value of 22 score and 397 ms.