测试时间对蒙特利尔认知评估量表检查脑卒中后老年人认知功能异常检出率的影响

Test time affects the detection of cognitive dysfunction by Montreal Cognitive Assessment in elderly patients after stroke

目的对比上午或下午进行蒙特利尔认知评估量表（MoCA）检查脑卒中后老年人认知功能异常检出率的影响。方法前瞻性纳入2015年6月至2017年1月沧州中西医结合医院神经内科，年龄≥65岁的老年急性缺血性脑卒中患者，且美国国立卫生研究院卒中量表（NIHSS）≤3，共378例。年龄65～82岁，平均（72．5±6．2）岁，住院后1个月使用MoCA进行评估。采用随机数字表将患者分为上午测试组（早上9点至中午12点）和下午（下午12点至下午5点）测试组，由专人进行测试。收集患者临床资料，行RANKIN量表（mRS）检查。根据MoCA评分，患者被分为重度认知受损（SCI）（评分〈20），轻度认知受损（MCI）（评分20～25）和无认知受损（NCI）（评分〉26）。结果上午测试组患者189例（50．0％），下午测试组患者189例（50．0％）。两组年龄、性别、教育程度、残疾程度（mRS评分〉1），高血压史、糖尿病史、高脂血症史、吸烟史、房颤史差异均无统计学意义（均为P〉0．05）。211例患者诊断为NCI，142例MCI，25例SCI。对于SCI，下午测试的阳性率12．2％（23／189）高于上午测试的阳性率1．1％（2／189），且差异有统计学意义（P=0．000）；对于MCI，上午测试的阳性率40．2％（76／189）高于下午测试的阳性率34．9％（66／189），且差异有统计学意义（P=0．013）；对于NCI，上午测试的阳性率56．6％（107／189）略高于下午测试的阳性率55．0％（104／189），但差异无统计学意义（P=0．214）。结论测试时间可能对MoCA检查脑卒中后老年人认知功能异常检出率的有影响，临床上进行MoCA检查时应考虑检查时间。

Objective To compare if the Montreal cognitive assessment （MoCA） performed in the morning or afternoon would affect abnormal rate of cognitive function in the elderly with stroke. Methods A total of 378 senile patients （≥ 65 years） with acute ischemic stroke and low NIHSS score （≤ 3） were enrolled in the prospective study, which was held in the Department of Neurology at Cangzhou Hospital of Integrated Traditional Chinese Medicine. MoCA was assessed after one month of hospitalization. Based on the time of MoCA assessment, all patients were randomly divided into the group A （assessed in the morning,9 am-12 am） and the group B （assessed in the afternoon,12 am to 5 pm）. Clinical data were collected, and RANKIN scale （mRS） examination was performed. Moreover, patients were further divided into severe cognitive impairment （SCI） subgroup （score 〈 20）, mild cognitive impairment （MCI） subgroup （score 20-25） and no cognitive impairment （NCI） subgroup （score 〉 26） according to the MoCA score. Results There were 189 patients in the group A （50%）,and 189 cases in the group B （500/00）. There was no significant difference in age, gender, education level, disability （mRS score 〈 1 ）, history of hypertension, diabetes, hyperlipidemia, smoking and atrial fibrillation between the two groups. Based on the MoCA score, 211 cases had NCI, 142 had MCI,and 25 had SCI. Compared with patients in group B, patients in group A was associated with significantly higher positive rate of SCI[12.2% （23/189）vs. 1.1% （2/189）,P=0. 000],MCI[40.2% （76/189）vs. 34.9% （66/189）,P=0.013]and slightly higher positive rate of NCI[56.6% （107/189） vs. 55.0% （104/189） ,P=0. 214]. Conclusions The test time of MoCA may have an effect on the cognitive function detection rate in elderly patients with stroke, and the time of MoCA examination should be considered in clinical examination.