无痴呆型血管性认知障碍患者认知功能量表的研究

Study of cognitive function scale in patients with vascular cognitive impairment no dementia

目的研究无痴呆型血管性认知障碍(VCIND)的认知损害特征,探讨蒙特利尔认知评估量表中文版(MoCA)在东营地区VCIND人群中筛查的应用价值,并与简易精神状态量表(MMSE)进行比较。方法对92例东营地区的受试者进行成套神经心理学测试,包括视空间执行功能、记忆力、命名、注意力等内容,研究VCIND的认知功能特点,并进行MoCA和MMSE量表的比较。采用SPSS 17.0统计软件进行处理,计量资料用均数±标准差(x珋±s)表示,组间比较采用独立样本t检验,计数资料应用χ2检验,相关分析采用Spearman相关性检验,P<0.05为差异有统计学意义。利用受试者工作特征曲线(ROC)分析MoCA筛查VCIND患者的灵敏度和特异度,并确定其最佳分界值。结果受教育程度对MoCA得分有显著影响,受教育年限≤9年者:MoCA评分除注意力和语言流畅性外,视空间执行功能、命名、计算力、抽象思维、记忆力及定向力各分项在两组间差异有统计学意义(t值分别为3.632、2.636、2.997、4.325、8.514、3.230,均P<0.05)。受教育程度>9年者:MoCA评分除注意力、计算力、定向力及语言流畅性外,视空间执行功能、命名、抽象思维及记忆力各分项在两组间差异有统计学意义(t值分别为1.962、3.579、3.941、5.241,均P<0.05)。受教育程度≤9年者:MoCA的筛查最佳分界值为24/25分,此时筛查VCIND的敏感度为87.5%,特异度为100%;受教育程度>9年者:MoCA的筛查最佳分界值为26/27分,此时筛查VCIND的敏感度为94.4%,特异度为70.0%。结论 (1)VCIND患者存在包括视空间执行功能、记忆力、抽象思维、计算力等多个领域认知功能的损害;(2)MoCA是筛查VCIND的一个简便、有效的工具,MoCA用于VCIND的筛查优于MMSE。

Objective To study the characteristics of cognitive impairment in vascular cognitive impairment no dementia（VCIND） and to investigate the value of Montreal cognitive assessment（MoCA） in identifying the patients with VCIND in Dongying, and compare the results with those of mini-mental state examination （MMSE）. Methods Ninety two patients with VCIND were tested with a wide neuropsychological battery of tests covering visual spatial skills and executive function, memory, naming and attention,et al. To study the neuropsychological characteristics in patients with VCIND and to compare the MoCA and MMSE. Sensitivities and specificities were calculated by using the recommended cut-off scores. SPSS 17.0 statistical software for processing, measurement data were discribed with ~ ＋ s, independent samples t test was performed to compare the differences between the two groups,x2 test was used to compare the count data, correlation analysis was analyzed by Spearman correlation, P 〈 O. 05 was considered statistically significant. Sensitivities and specificities were calculated by using the recommended cut-off scores, and ROC curve analysis were performed to determine optimal sensitivity and specificity. Results Education had statistical differences between MoCA and MMSE. For the patients with levels of education of 9 years and below, significant difference in each sub-item of MoCA were found between the two groups, except attention and language（t values were 3. 632,2. 636,2. 997,4. 325,8. 514,3. 230, all P 〈 0. 05 ）. The cut-off score for MoCA was 24/25 ,the sensitivity was 87. 5% ,specificity was 100%. For the patients with levels of education above the average of 9 years, significant difference in each sub-item of MoCA were found between the two groups, except attention, calculation, orientation and language （ t values were 1. 962,3. 579,3. 941,5. 241, all P 〈 0. 05 ）. The cut-off score for MoCA was 26/27, the sensitivity was 94. 4% , specificity was 70. 0%. Conclusion （1）Current study indicates that there are cognitive impairment in multiple domains including visual spatial skills and executive function, memory, abstraction and calculation in patients with VCIND. （2） MoCA is a more sensitive instrument than MMSE for the detection of VCIND.