威斯康星卡片分类测验在早中期帕金森病认知评估中的应用研究

Application of Wisconsin card sorting test in cognitive assessment of early and middle stage Parkinson’s disease

目的:将早中期帕金森病患者使用威斯康星卡片分类测验(WCST)与传统认知评估量表进行对比,分析使用WCST进行认知评估时认知功能损害特征及适用性情况。方法:回顾性分析2022年4月10日~11月15日在本院就诊的早中期原发性帕金森病患者53例,分别进行了WCST、简易智力状态检查量表(MMSE)、蒙特利尔认知功能评定量表(MoCA)、帕金森病认知功能评定量表(PD-CRS)评估,对WCST与各量表测试结果的异常率进行对比,并将WCST与各量表执行功能亚项得分进行相关性分析。结果:共纳入患者53名,Hoehn-Yahr(H-Y)分级≤3级,MMSE平均得分27.9,小于26分的患者共7名,异常率为13.21%;MoCA平均得分25.6,小于26分的患者共22名,异常率为41.51%;PD-CRS平均分85.2,小于80.5分的患者共19名,异常率为35.85%。WCST测试中得分异常的患者共34名,异常率为64.15%,WCST与传统认知量表相比筛查出认知障碍患者例数差异具有统计学差异(P<0.01)。相关分析显示WCST得分与MoCA执行功能得分及PD-CRS执行功能得分有不同强度的相关性,相关系数介于-0.312~0.515。MMSE总分、MoCA总分及PD-CRS总分正常的患者中分别有26例、17例、17例患者在WCST测试中结果异常,且WCST对于运动障碍、言语障碍及视力下降患者也适用。结论:WCST在帕金森病患者认知评估中较MMSE、MoCA及PD-CRS量表更容易检查出认知障碍患者人群、适用范围更广。

Objective:To compare the Wisconsin Card Sorting Test(WCST)used by patients with Parkinson’s disease in the early and middle stages with traditional cognitive assessment scales,and analyze the characteristics and applicability of cognitive impairment when using WCST for cognitive assessment.Method:A retrospective analysis was conducted on 53 patients with early to middle stage primary Parkinson’s disease who visited our hospital from April 10 to November 15,2022.They were evaluated with WCST,Mini mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),and Parkinson’s Disease Cognitive Rating Scale(PD-CRS),respectively.The abnormal rate of WCST was compared with the test results of various scales,and the correlation between WCST and the scores of the execution function sub items of each scale was analyzed.Results:A total of 53 patients were included,with H-Y staging ranging from 1 to 3 stages and an average MMSE score of 27.9.A total of 7 patients with scores less than 26 were included,with an abnormality rate of 13.21%;The average score of MoCA was 25.6,with a total of 22 patients scoring less than 26,with an abnormality rate of 41.51%;The average score of PD-CRS was 85.2,with a total of 19 patients with a score less than 80.5,and an abnormality rate of 35.85%.There were a total of 34 patients with abnormal scores in the WCST test,with an abnormality rate of 64.15%.There was a statistically significant difference in the number of patients with cognitive impairment screened by WCST compared to traditional cognitive scales(P<0.01).Correlation analysis showed that WCST scores had varying intensities of correlation with MoCA executive function scores and PD-CRS executive function scores,with cor-relation coefficients ranging from-0.312 to 0.515.Among patients with normal MMSE total score,MoCA total score,and PD-CRS total score,there were 26,17,and 17 patients with abnormal results in the WCST test,and WCST was also applicable to patients with motor disorders,speech disorders,and decreased vision.Conclusion:WCST is easier to detect the popula-tion of cognitive impairment patients and has a wider applicability in cognitive assessment of Parkinson’s disease patients than MMSE,MoCA,and PD-CRS scales.