洛文斯顿作业治疗用认知评定量表在脑外伤早期患者认知功能评定中的效能

Efficacy of Loewenstein Occupational Therapy Cognitive Assessment in Evaluating Cognitive Function after Traumatic Brain Injury

目的探讨洛文斯顿作业治疗用认知评定量表（LOTCA）评定颅脑外伤早期患者认知功能的效能。方法 2013年1月~2014年10月收治的脑外伤患者72例为损伤组,与损伤组年龄、性别、受教育年限匹配的健康人30名为健康组。采用LOTCA及简易精神状态检查（MMSE）进行评定。结果 MMSE总分与LOTCA总分正相关（r=0.56,P〈0.01）。损伤组LOTCA各分项评分均明显低于健康组（P〈0.01）,其中定向、视运动组织、思维运作能力受损更严重。损伤组LOTCA定向力、视运动组织、思维运作、注意力中重度损伤人数明显多于健康组,其中思维运作更突出。接受者操作曲线（ROC）下面积,LOTCA为（0.84±0.04）,小于MMSE的（0.91±0.03）（P〈0.05）。结论脑外伤患者有较全面认知损伤,其中知觉损伤较少,思维运作损伤偏多。LOTCA判定脑外伤后认知障碍的效能不如MMSE。

Objective To investigate the clinical efficacy of Loewenstein Occupational Therapy Cognitive Assessment （LOTCA） battery for patients at the early stage of traumatic brain injury （TBI）. Methods 72 patients with TBI hospitalized from January, 2013 to October, 2014 and 30 healthy controls matched gender, age and educational background were assessed with the Chinese version of LOTCA battery and Mini-Mental State Examination （MMSE） respectively. Results The score of MMSE and LOTCA were correlated （r=0.56, P〈0.01）. Compared with the controls, the scores of all the subtests of LOTCA decreased （P〈0.0 l） in the patients, especially the orientation, visuomo- tot organization and thinking operation; with the more incidence of medium and serious dysfunction of all the subtests of LOTCA except perception （P〈0.01）, in which thinking operation was the most and attention was the least. The area under the receiver operating curve （ROC） was （0.84＋0.04） in LOTCA, less than that of （0.91±0.03） in MMSE （P〈0.05）. Conclusion Cognition is widely impaired in patients after TBI, most involved thinking operation. LOTCA is less effective to identify cognitive dysfunction than MMSE, and can be used as an al- ternation or a supplement.