罗兰量表在轻型卒中患者认知评定中的效能

The efficacy of the Rowland universal dementia assessment scale in the cognitive assessment in patients with mild stroke

目的:使用罗兰量表(Rowland universal dementia assessment,RUDAS)对轻型脑卒中患者认知功能进行评定,通过与MMSE量表进行比较分析,明确罗兰量表在轻型脑卒中患者认知功能评定中的诊断效能。方法:纳入224例2018—2020年常州市第一人民医院收治的轻型脑卒中患者作为试验组,另选取年龄、性别和受教育年限相匹配的健康志愿者33例作为对照组。所有参与者均由经过专业培训的康复医师分别使用MMSE量表和RUDAS量表完成认知功能测评。对数据进行秩和检验、相关性分析、天花板和地板效应分析、ROC曲线分析。结果:(1)使用RUDAS量表及MMSE量表评估试验组及对照组的认知功能,结果显示试验组两量表总分项及除判断项目(P=0.833)外各分项与对照组均存在显著性差异(P<0.05)。(2)试验组RUDAS总分与MMSE总分呈正相关(r=0.629,P<0.001)。(3)两量表无明显地板效应,RUDAS仅在躯体定向和言语两分项存在较高天花板效应。(4)RUDAS量表的曲线下面积(0.854±0.025)与MMSE(0.893±0.024)无显著性差异(Z=1.213,P=0.2253)。RUDAS量表的最佳截值为24.5分,敏感度72.5%,特异度97.1%;MMSE量表的最佳截值为28.5分,敏感度82.1%,特异度82.9%。结论:罗兰量表可用于轻型脑卒中患者认知功能障碍的筛查,RUDAS诊断效能与MMSE相当,但量表衰减效应优于MMSE,适于临床应用。

Objective:To use the Rowland universal dementia assessment scale(RUDAS)to evaluate the cognitive function in patients with mild stroke,and to compare and analyze the Rowland scale with the MMSE scale to determine the diagnostic efficacy of RUDAS in the cognitive function assessment of patients with mild stroke.Method:Two hundreds and twenty-four mild stroke patients admitted to Changzhou First People's Hospital from 2018 to 2020 were included as the experimental group,and 33 healthy volunteers with matched age,gender and years of education were selected as the control group.All participants were assessed by professionally trained rehabilitation physicians using the MMSE scale and the RUDAS scale respectively.Rank sum test,correlation analysis,ceiling and floor effect analysis,and ROC curve analysis on the data were performed.Result:Every sub-item scale and total scale were significantly different(P<0.05)between two groups except the judgment item(P=0.833).The total score of RUDAS was positively correlated with the total score of MMSE(r=0.629,P<0.001)in the experimental group.The two scales have no obvious floor effect,but RUDAS has a higher ceiling effect in sub-items of body orientation and speech.The area under the curve of the RUDAS scale(0.854±0.025)and MMSE(0.893±0.024)are not significantly different(Z=1.213,P=0.2253).The best cut-off value of the RUDAS scale is 24.5 points,the sensitivity is 72.5%,and the specificity is 97.1%;the best cut-off value of the MMSE scale is 28.5 points,the sensitivity is 82.1%,and the specificity is 82.9%.Conclusion:RUDAS scale can be used to screening cognitive dysfunction in patients with mild stroke.In the cognitive screening of mild stroke,the diagnostic efficacy of RUDAS is equivalent to that of MMSE,and the scale attenuation efficacy is better than that of MMSE.RUDAS is appropriate for clinical application.