情绪健康和生活质量对癫痫后轻微认知功能障碍的影响

Impacts of emotional health and quality of life on the cognitive functions of epileptics

目的目前癫痫患者发生认知障碍的危险因素并不十分清楚,文中旨在评估成年癫痫患者临床特征、情绪健康及生活质量对轻微认知功能障碍(MCI)的影响。方法选择2015年10月至2016年10月南京军区南京总医院神经内科门诊就诊的成年癫痫患者109例,采用蒙特利尔认知评估量表(Mo CA)及简易精神状态量表(MMSE)评估患者的认知功能,汉密尔顿抑郁量表(HAMD-24)评价其情绪健康,生活质量评定量表-31(QOLIE-31)评定其生活质量;采用调查问卷收集患者的临床基线资料。结果 MCI患者67例(61.5%)。居住地区(OR=0.226,95%CI:0.082~0.627)是癫痫后MCI最有价值的预测因素,HAMD-24(OR=0.770,95%CI:0.644~0.921)、QOLIE-31总分(OR=0.712,95%CI:0.575~0.880)、生活质量(OR=1.070,95%CI:1.015~1.128)、自我认知功能(OR=1.120,95%CI:1.043~1.203)以及社会活动(OR=1.103,95%CI:1.035~1.175)是癫痫后MCI的危险因素。结论成人癫痫患者MCI的发生率偏高,临床工作中更应重视常规进行认知功能、情绪健康和生活质量的评估,可以有效延缓癫痫后认知障碍的发生和发展。

Objective At present, the risk factors for cognitive impairment in epilepsy patients are not quite clear. This study was to explore the impacts of the clinical features, emotional health and quality of life （QOL） on the cognitive function of the a- dult patients with mild cognitive impairment （MCI）. Methods Using the Montreal Cognitive Assessment （MoCA） and Mini Mental State Examination （MMSE） scales, we evaluated the cognitive functions of the 109 adult epileptics of the outpatient clinic of neurology in Jinling Hospital. We assessed their emotional health with Hamilton Depression Scale-24 （HAMD-24）, estimated their QOL withQuality Of Life in Epilepsy-31 （QOLIE-31）, and collected their baseline clinical data by questionnaire survey. Results There were 67 cases of MCI （61.5%） among the 109 patients. The residential ar- ea was the strongest predictor of MCI in the adult epileptics （ OR = 0.226, 95% CI： 0.082-0.627）. Among other risk factors of post-epi- leptic MCI were the total scores of HAMD-24 （OR= 0.770, 95% CI： 0.644-0.921） and QOLIE-31 （OR=0.712, 95% CI： 0.575- 0.880）, QOL （OR= 1.070, 95% CI： 1.015-1.128）, cognitive func- tion （ OR = 1. 120, 95% CI： 1. 043 - 1. 203） , and social function （OR= 1.103, 95% CI： 1.035-1.175）. Conclusion The incidence of MCI is high in adult patients with epilepsy. The development and progression of post-epileptic MCI can be delayed by more emphasis on the evaluation of cognitive function, emotional health, and quality of life.