北京版蒙特利尔认知评估量表在成人OSAHS认知功能评估中的应用及可靠性验证

Application and reliability verification of Beijing-based cognitive assessment scale of montreal in cognitive function of adult OSAHS

目的:应用北京版蒙特利尔认知评估量表(MoCA-BJ)分析成人OSAHS患者认知功能状况,探讨其用于评估成人OSAHS患者认知功能的可靠性和有效性。方法:使用MoCA-BJ和简易智能精神状态检查量表(MMSE)对94例轻、中及重度OSAHS患者与28例健康对照者进行认知功能评估。14d后,随机对健康对照组中10例受试者进行MoCA-BJ重新测试,采用克朗巴赫系数α检测分析MoCA-BJ的内部一致性、Pearson相关系数测试重测信度。此外,通过与MMSE对比来评估MoCA-BJ的同时效度。结果:克朗巴赫系数α检测的MoCA-BJ内部一致性是可靠的(0.810)。Pearson相关系数测试重测信度较高(r=0.898,P<0.001)。对照组的MoCA-BJ总评分显著高于OSAHS组(P<0.01)。视觉空间能力方面,重度OSAHS组的表现显著弱于对照组(P<0.01)及非重度患者(P<0.01)。执行能力方面,对照组显著高于OSAHS组(P<0.05)。重度OSAHS患者执行能力的表现弱于非重度组(P<0.01)及对照组(P<0.05),而连线试验各组无差异。注意力方面,对照组与患者组差异有统计学意义(P<0.01),而重度患者与非重度患者之间无差异。在语言总得分方面,对照组与患者组差异有统计学意义(P<0.01),而重度与非重度患者之间无差异。该研究还发现,在语言重复能力、延迟回忆方面结果与语言总得分完全一致。定向力方面,对照组与重度患者组之间差异明显(P<0.05),重度组与非重度组之间差异有统计学意义(P<0.05)。对照组和患者组之间的最佳截止值为25.5分(总MoCA得分)。此外,在视觉空间子量表中,非重度组和重度组之间的截止值为2.5分。MoCA总分与MMSE总分之间的相关性分析显示两者相关性显著(r=0.764,P<0.01)。结论:MoCA-BJ评价成人OSAHS认知功能可靠、稳定且有效。MoCA-BJ能够通过视觉空间、执行能力和总得分检测认知功能障碍,同时在注意力、语言总得分、语言重复能力、延迟回忆方面可以区别健康对照及OSAHS患者,但不能区分重度与非重度OSAHS患者。此外,定向能力在区分健康对照与重度患者、重度与非重度患者方面起作用,但不能区分健康对照与OSAHS患者。

Objective：To evaluate the cognitive function of adult OSAHS patients by MoCA-BJ,and to evaluate the reliability and efficacy of MoCA-BJ.Method：A study was conducted on the cognitive function of 94 patients with mild,moderate and severe OSAHS and 28 healthy controls using the MoCA-BJ and the simple mental state examination scale（MMSE）.After 14 days,10 subjects in the healthy control group were tested for MoCA-BJ again.The internal consistency of MoCA-BJ and the Pearson correlation coefficient were used to test the retest reliability.In addition,the simultaneous validity of MoCA-BJ was assessed by comparison with MMSE.Result：The MoCA-BJ internal consistency of the Kronbach coefficientαwas reliable（0.810）.The Pearson correlation coefficient test was highly reproducible（r=0.898,P〈0.001）.The overall score of MoCA-BJ in the control group was significantly higher than that in the OSAHS group（P〈0.01）.In the visual spatial ability,the performance of severe OSAHS group was significantly weaker than that of the control group（P〈0.01）and non-severe patients（P〈0.01）.In the executive ability,the control group was significantly higher than the OSAHS group（P〈0.05）,and the performance of patients with severe OSAHS was weaker than that of non-severe group（P〈0.01）and control group（P〈0.05）,but there was no difference among every group in the trail making test.Attention,the difference between the control group and the patients was significant（P〈0.01）,but no difference between severe patients and non-severe patients.The total score of the language,the difference between the control group and the patient group was significant（P〈0.01）,while there was no difference between severe and non-severe patients.The study also found that the results of language repetition,delayed recall and the total score of the language was exactly the same.Orientation,there was also significant difference between the control group and the severe group（P〈0.05）.There was also significant difference between the severe and non-severe patients（P〈0.05）.The optimal cutoff between the control and patient groups was 25.5 points（total MoCA score）.In addition,in the visual spatial subscale,the cutoff between non-severe and severe OSAHS groups was 2.5 points.The correlation between MoCA score and MMSE score was statistically significant（r=0.764,P〈0.01）.Conclusion：In summary,our study shows that MoCA-BJ is reliable,stable and effective in evaluating adult OSAHS cognitive function.MoCA-BJ can detect cognitive dysfunction through visual space,executive ability and total score,while distinguishing healthy controls and OSAHS patients from attention,language total score,language repetition,delayed recall,but can not distinguish between severe and non-severe OSAHS patients.In addition,Orientation in the distinction between normal controls and severe patients,severe and non-severe patients play a role,but can not distinguish between normal controls and OSAHS patients.