老年冠心病患者2年后蒙特利尔认知评估量表评分下降与主观记忆障碍及相关因素分析

Risk factors for decreased MoCA score 2 years later and subjective memory complaint in elderly patients with coronary heart disease

目的探讨蒙特利尔认知评估量表(MoCA)评分正常的老年冠心病患者,2年后MoCA评分改变情况与主观记忆障碍(SMC)及其他相关危险因素的关系。方法选择进行冠状动脉造影或CT证实的老年冠心病患者92例(冠心病组),选择同期体检的49例为对照组;其中完成2年随访冠心病组74例,对照组40例,复测MoCA。根据MoCA评分将冠心病组分为评分正常组48例及评分下降组26例。比较各组相关危险因素。结果与对照组比较,评分正常组和评分下降组患者高血压、吸烟比例增高(58.3%、53.8%vs 32.5%,41.7%、38.5%vs 12.5%),差异有统计学意义(P<0.05)。评分下降组慢性心力衰竭、睡眠障碍需用药、延迟记忆评分下降值、视空间和执行评分下降值显著高于评分正常组和对照组,差异有统计学意义(P<0.05,P<0.01)。logistics回归分析显示,2年后MoCA评分下降的主要危险因素是SMC(OR=11.18,95%CI:2.63~47.50,P=0.001)。结论老年冠心病伴SMC患者,2年后更易出现MoCA评分下降,尤其在延迟记忆及视空间执行力方面。

Objective To study the risk factors for decreased MoCA score 2 years later and subjective memory complaint（SMC）in elderly patients with coronary heart disease（CHD）.MethodsNinety-two elderly CHD patients diagnosed by coronary arteriography or CT angiography served as a CHD group and 49 subjects undergoing physical exmination served as a control group in this study.Seventy-four patients in CHD group and 40 subjects in control group were followed up for 2 years,during which their MoCA scores were recorded.The patients in CHD group were further divided into normal MoCA score group（n=48）and low MoCA score group（n=26）.The risk factors for decreased MoCA score and SMC were compared between the 2groups.Results The incidence of hypertension and the ratio of smokers were significantly higher in normal MoCA score group and low MoCA score group than in control group（58.3% and 53.8% vs 32.5%,41.7%and 38.5%vs 12.5%,P〈0.05）.The incidence of heart failure was significantly higher while the ratio of treatment used for dyssomnia and the decreased MoCA scores of delayed memory,visual space and execute performance were significantly higher in low MoCA score group than in normal MoCA score group（P〈0.05,P〈0.01）.Logistic regression analysis showed that decreased MoCA score 2 years later was a major risk factor for SMC.Conclusion MoCA score,especially that of delayed memory,visual space and performance,is easy to decrease 2 years later in elderly CHD patients with SMC.