文盲者的认知特点及评估方法

The cognitive characteristics and assessment scales for the illiteracy

目的了解文盲老人的认知特点,提供量表改进建议。方法回顾性纳入2016年4月至2019年11月在南京鼓楼医院记忆门诊就诊的文盲患者及社区筛查登记的文盲老年人共358例。根据症状及简易智力状态检查(MMSE)量表、蒙特利尔认知评估(MoCA)量表评估分为正常对照组、主观认知下降(SCD)组、轻度认知损害(MCI)组和痴呆组,采用t检验或χ^(2)检验比较正常对照组与SCD组,SCD组与MCI组,MCI组与痴呆组MMSE量表和MoCA量表单项得分的差异。结果SCD组的时间定向差于正常对照组[4(5,3)分vs 5(5,4)分],差异具有统计学意义(t=3.047,P=0.003)。MCI组的的计算、重复(MMSE)、表达、绘图、画钟轮廓、数字、指针、倒背、敲击、流畅性、重复(MoCA)、命名(MoCA)、延迟回忆(MoCA)均差于SCD组[2(3,1)分vs 4(5,3)分;52(50.0%)例vs 38(76.0%)例;2(1.9%)例vs 10(20.0%)例;13(12.5%)例vs 27(54.0%)例;76(73.8%)例vs 47(94.0%)例;5(4.9%)例vs 25(50.0%)例;4(3.9%)例vs 19(38.0%)例;21(20.2%)例vs 29(58.0%)例;40(38.5%)例vs 43(86.0%)例;37(35.6%)例vs 42(84.0%)例;1(1.0%)例vs 11(22.0%)例;1(2,0)分vs 2(3,2)分;0(1,0)分vs 1(3,0)分],差异具有统计学意义(t=-5.941,P<0.001;χ^(2)=9.398,P=0.002;χ^(2)=15.357,P<0.001;χ^(2)=30.245,P<0.001;χ^(2)=8.725,P=0.003;χ^(2)=43.521,P<0.001;χ^(2)=30.673,P<0.001;χ^(2)=21.644,P<0.001;χ^(2)=30.169,P<0.001;χ^(2)=31.155,P<0.001;χ^(2)=20.594,P<0.001;t=6.022,P<0.001;t=4.937,P<0.001)。痴呆组的时间定向、地点定向、即刻回忆、计算、延迟回忆(MMSE)、指令、重复(MMSE)、敲击和分类提示均差于MCI组[2(3,1)分vs 4(5,2)分;4(5,3)分vs 5(5,5)分;2(3,1)分vs 3(3,2)分;1(1,0)分vs 2(3,1)分;0(1,0)分vs 2(2,0)分;2(3,1)分vs 3(3,3)分;25(27.8%)例vs 52(50.0%)例;16(17.8%)例vs 40(38.5%)例;0(1,0)分vs 1(1,0)分],差异具有统计学意义(t=-7.946,P<0.001;t=-6.012,P<0.001;t=-4.870,P<0.001;t=-6.927,P<0.001;t=-5.456,P<0.001;t=-6.997,P<0.001;χ^(2)=9.954,P=0.002;χ^(2)=9.483,P=0.002;t=2.745,P=0.007)。结论定向、即刻回忆、计算、重复、绘图、画钟指针和敲击测验对不同认知水平的文盲者有较好区分度,阅读、连线、立方体、命名(MMSE)的区分度较差,不适用于文盲者。

Objective To explore the cognitive characteristics of the illiterate elderly and provide advice for the improvement of cognitive scales.Methods 358 illiterate elderly people were retrospectively included from the memory decline clinic of Nanjing Drum Tower Hospital and community screening from April 2016 to November 2019.Subjects were divided into normal control,subjective cognitive decline(SCD),mild cognitive impairment(MCI)and dementia group according to mini-mental status examination(MMSE)and Montreal cognitive assessment(MoCA).Scores of each cognitive item were compared among the adjacent groups.Results The score of time-orientation was worse in SCD group than that in the normal control group[4(5,3)vs 5(5,4)]significantly(t=3.047,P=0.003).MCI group performed worse than SCD group in calculation,repeat,writing,copying,clock-contour,clock-numbers,clock-hands,digit-backward,tapping,fluency,repeat(MoCA),naming(MoCA)and delayed-recall(MoCA)[2(3,1)vs 4(5,3);52(50.0%)vs 38(76.0%);2(1.9%)vs 10(20.0%);13(12.5%)vs 27(54.0%);76(73.8%)vs 47(94.0%);5(4.9%)vs 25(50.0%);4(3.9%)vs 19(38.0%);21(20.2%)vs 29(58.0%);40(38.5%)vs 43(86.0%);37(35.6%)vs 42(84.0%);1(1.0%)vs 11(22.0%);1(2,0)vs 2(3,2);0(1,0)vs 1(3,0)]significantly(t=-5.941,P<0.001;χ^(2)=9.398,P=0.002;χ^(2)=15.357,P<0.001;χ^(2)=30.245,P<0.001;χ^(2)=8.725,P=0.003;χ^(2)=43.521,P<0.001;χ^(2)=30.673,P<0.001;χ^(2)=21.644,P<0.001;χ^(2)=30.169,P<0.001;χ^(2)=31.155,P<0.001;χ^(2)=20.594,P<0.001;t=6.022,P<0.001;t=4.937,P<0.001).In dementia group,the score in time orientation,space orientation,registration,calculation,delayed recall(MMSE),repeat(MMSE),command,tapping and classification-choice-cue were worse than that in MCI group[2(3,1)vs 4(5,2);4(5,3)vs 5(5,5);2(3,1)vs 3(3,2);1(1,0)vs 2(3,1);0(1,0)vs 2(2,0);2(3,1)vs 3(3,3);25(27.8%)vs 52(50.0%);16(17.8%)vs 40(38.5%);0(1,0)vs 1(1,0)]with significance(t=-7.946,P<0.001;t=-6.012,P<0.001;t=-4.870,P<0.001;t=-6.927,P<0.001;t=-5.456,P<0.001;t=-6.997,P<0.001;χ^(2)=9.954,P=0.002;χ^(2)=9.483,P=0.002;t=2.745,P=0.007).Conclusion Orientation,registration,calculation,repeat,copying,clock-hands,and tapping showed well discriminant power among groups.Reading,trail,cube,naming(MMSE)were inappropriate for the illiteracy.