计算机化神经认知评估工具预测老年患者早期术后认知功能障碍的价值

The value of a computerized neurocognitive assessment tool in predicting early postoperative cognitive dysfunction in elderly patients

目的探讨计算机化神经认知评估工具预测老年患者早期术后认知功能障碍(POCD)的价值。方法选择2021年7月至2022年7月安徽医科大学第二附属医院骨科行初次单侧髋关节置换的65~85岁患者70例,于术前1 d和术后一周进行神经心理学测试和计算机化测试。神经心理学的测试内容包括简易智力量表(MMSE)、修订韦氏记忆量表和连线测试。计算机化神经认知评估工具主要包括诱饵辨别指数(LDI)和识别记忆分数(REC)。根据Z计分法判定是否发生POCD,进一步将患者分为POCD组(n=16)和非POCD组(n=54),借助受试者工作特征曲线(ROC)分析LDI和REC值预测及筛查早期POCD的效能。结果POCD组术前术后LDI均明显低于非POCD组(P<0.05),POCD组术后REC明显低于非POCD组(P<0.05)。POCD组术前计算机化神经认知评估工具诊断的准确率为67.2%,截断值为0.1567,敏感度为87.5%,特异度为44.4%,约登指数为0.319;POCD组术后计算机化神经认知评估工具诊断的准确率为69.8%,截断值为0.0917,敏感度为81.3%,特异度为59.3%,约登指数为0.406。结论计算机化神经认知评估工具有助于预测和筛查老年患者早期POCD的发生。

Objective The study aims to explore the value of a computerized neurocognitive assessment tool in predicting early postoperative cognitive dysfunction(POCD)in elderly patients.Methods 70 patients aged 65-85 years old who underwent initial unilateral hip arthroplasty were selected to undergo neuropsychological tests and computerized tests one day before and one week after surgery.The neuropsychological tests included the Mini-Mental State Examination(MMSE),the Modified Wechsler Memory Scale and the Trail Making Test(TMT).The computerized neurocognitive assessment tool consisted of the Lure Discrimination Index(LDI)and the Recognition Index(REC).The patients were divided into POCD group(n=16)and non-POCD group(n=54)based on the occurrence of POCD which was determined according to the Z-score method.The efficacy of LDI and REC values in predicting and screening early POCD was analyzed by means of the Receiver Operator Characteristic Curve(ROC).Results The preoperative and postoperative LDI of the POCD group were significantly lower than those of the non-POCD group(P<0.05),and the postoperative REC of the POCD group was significantly lower than that of the non-POCD group(P<0.05).The diagnostic accuracy of the preoperative computerized neurocognitive assessment tool in the POCD group was 67.2%,with a cutoff value of 0.1567,sensitivity of 87.5%,specificity of 44.4%,and Youden index of 0.319.The diagnostic accuracy of the postoperative computerized neurocognitive assessment tool in the POCD group was 69.8%,with a cut-off value of 0.0917,sensitivity of 81.3%,specificity of 59.3%,and Youden index of 0.406.Conclusion The computerized neurocognitive assessment tool contributes to predict and screen the occurrence of early POCD in elderly patients.