洛文斯顿作业疗法认知评定量表在腔隙性脑梗死患者中的应用价值

Application of Loewenstein Occupational Therapy Cognitive Assessment in Patients with Lacunar Infarction

目的探讨洛文斯顿作业疗法认知评定量表(Loewenstein occupational therapy cognitive assessment,LOTCA)在脑小血管病所致腔隙性脑梗死患者认知功能损伤中的应用价值。方法采用简易精神状态检查(mini-mental state examination,MMSE)量表及LOTCA量表对64例脑小血管病所致腔隙性脑梗死患者的认知功能进行检测。结果 MMSE总分与LOTCA总分呈正相关(r=0.532,P<0.01)。脑小血管病所致腔隙性脑梗死患者左、右侧大脑半球损伤在MMSE总分(P=0.001)、地点定向、延迟记忆、语言阅读理解、语言听理解、造句、注意力和计算能力等分项中存在差异(均P<0.05)。LOTCA量表评定显示左侧大脑半球损伤在时间定向、重叠图形、空间知觉、运用、Riska无组织形状分类和图片排列等分项评分低于右侧大脑半球损伤,右侧大脑半球损伤在地点定向、不完整物体识别、视运动组织、几何推理及LOTCA总分等评分低于左侧大脑半球损伤,左、右侧大脑半球损伤在定向力、视运动组织及思维运作等方面差异有统计学意义(P<0.05)。结论脑小血管病所致腔隙性脑梗死患者左、右侧大脑半球损伤后的各种认知功能障碍表现不一,LOTCA量表适合于脑小血管病所致腔隙性脑梗死患者认知功能的评定。

Objective To explore the application value of Loewenstrein occupational therapy cognitive assessment （LOTCA） in evaluating the cognitive impairment of the patients with lacunar infarction （LI） induced by cerebral small vessel disease. Methods The mini-mental state examination （MMSE） and LOTCA were applied in assessing the cognitive function of 64 patients with LI induced by cerebral small vessel disease. Results The total scores of MMSE was in positive correlation to the total scores of LOTCA （r=0.532, P〈0.01）; there existed statistical differences in the total score of MMSE and the scores of some sub-items, such as orientation to place, delayed recall, language understanding, sentence writing, attention and calculating capacity, between the left hemisphere lesion （LHL） and the right hemisphere lesion （RHL） in patients with LI induced by cerebral small vessel disease （P〈0.05）; the LOTCA scores of the LHL in orientation to time, overlapping graphic, spatial perception, application and Riska disorganized shape classification were significantly lower than those of the RHL while the LOTCA scores of the RHL in orientation to place, incomplete object recognition, visuomotor organization, geometric reasoning and the total LOTCA scores were significantly lower than those of the LHL; there existed statistical differences in orientation, visuomotor organization and thinking between the RHL and the LHL （P 〈 0.05）. Conclusions There are different cognitive function disorders between the LHL and RHL in patients with LI induced by cerebral small vessel disease, LOTCA is fit for the assessment of cognitive function of the patients.