蒙特利爾認(rèn)知評估在輕度認(rèn)知障礙轉(zhuǎn)化隨訪研究中的應(yīng)用

趙梅珍 徐曉云 張蔚 金磊 馮春花

【摘要】 目的：蒙特利爾認(rèn)知評估在輕度認(rèn)知障礙（MCI）轉(zhuǎn)化隨訪研究中的應(yīng)用。方法：選擇2012年10月-2015年10月到筆者所在醫(yī)院記憶門診就診的184例患者為研究對象，進行認(rèn)知功能評估（MOCA）和臨床資料收集，平均隨訪（2.70±0.80）年。根據(jù)納入標(biāo)準(zhǔn)分為MCI組（99例）、正常組（30例）和AD組（55例），采用MOCA評估比較MCI轉(zhuǎn)化的神經(jīng)心理學(xué)變化特征。結(jié)果：MCI組隨訪MOCA總分較基線增加，AD組隨訪延遲回憶評分較基線增加，差異均有統(tǒng)計學(xué)意義（P<0.05）。MCI組有10例轉(zhuǎn)化為AD，18例逆轉(zhuǎn)為正常，71例保持MCI狀態(tài)。轉(zhuǎn)為AD組基線MOCA總分低于保持MCI組，保持MCI組基線MOCA總分低于轉(zhuǎn)為正常組，差異均有統(tǒng)計學(xué)意義（P<0.05）。轉(zhuǎn)為AD組基線視空間/執(zhí)行力、延遲回憶、語言能力、定向力評分均低于保持MCI組，差異均有統(tǒng)計學(xué)意義（P<0.05）;轉(zhuǎn)為AD組基線視空間/執(zhí)行力、命名能力、延遲回憶、語言能力、定向力評分均低于轉(zhuǎn)為正常組，差異均有統(tǒng)計學(xué)意義（P<0.05）。轉(zhuǎn)為AD組隨訪MOCA總分較基線下降，轉(zhuǎn)為正常組隨訪MOCA總分較基線增加，差異均有統(tǒng)計學(xué)意義（P<0.05）。轉(zhuǎn)為正常組隨訪延遲回憶評分較基線增加，差異有統(tǒng)計學(xué)意義（P<0.05）。保持MCI組和轉(zhuǎn)為正常組隨訪MOCA各分項評分、基線MOCA各分項評分比較，差異均無統(tǒng)計學(xué)意義（P>0.05）。結(jié)論：MCI早期階段的總體認(rèn)知功能可發(fā)生好轉(zhuǎn)甚至逆轉(zhuǎn)為正常。視空間/執(zhí)行力、延遲回憶、語言能力、定向力基線MOCA評分較低可以預(yù)測MCI轉(zhuǎn)化為AD。MCOA作為MCI隨訪研究工具有一定預(yù)測作用。

【關(guān)鍵詞】 輕度認(rèn)知功能障礙 蒙特利爾認(rèn)知評估 阿爾茨海默病 神經(jīng)心理學(xué)

doi：10.14033/j.cnki.cfmr.2019.30.079 文獻標(biāo)識碼 B 文章編號 1674-6805（2019）30-0-03

[Abstract] Objective： To study the application of Montreal cognitive assessment in follow-up study of mild cognitive impairment conversion. Method： A total of 184 patients who visited the memory clinic of the authors hospital from October 2012 to October 2015 were selected as subjects for the study. All patients underwent cognitive function assessment （MOCA） and clinical data collection. The average follow-up time was （2.70±0.80） years. According to the inclusion criteria， patients were divied into the MCI group （99 cases）， the normal group （30 cases） and the AD group （55 cases）. The neuropsychological characteristics of MCI conversion were evaluate by MOCA. Result： The total score of MOCA at follow-up in the MCI group was higher than that of baseline， and the delayed recall score at follow-up in the AD group was higher than that of baseline， and the differences were statistically significant （P<0.05）. In the MCI group， 10 cases converted to AD， 18 cases reversed to normal， and 71 cases maintained MCI status. The total score of MOCA at baseline in the conversion AD group was lower than that of the maintenance MCI group， and the total score of MOCA at baseline in the maintenance MCI group was lower than that of the conversion normal group， and the differences were statistically significant （P<0.05）. Visuospatial/executive， delayed recall， language ability， and orientation scores at baseline in the conversion AD group were all lower than those of the maintenance MCI group， and the differences were statistically significant （P<0.05）. Visuospatial/executive ability， naming ability， delayed recall， language ability and orientation scores at baseline in the conversion AD group were all lower than those of the conversion normal group， and the differences were statistically significant （P<0.05）. The total score of MOCA at follow-up in the conversion AD group was lower than that of baseline， and the total score of MOCA at follow-up in the conversion normal group was higher than that of baseline， and the differences were statistically significant （P<0.05）. Delayed recall score at follow-up in the conversion normal group was higher than that of baseline， and the difference was statistically significant （P<0.05）. Subscore of MOCA at follow-up and subscore of MOCA at baseline were compared between the maintenance MCI group and the conversion normal group， and the differences were not statistically significant （P>0.05）. Conclusion： In the early stage of MCI， the general cognitive function can improve or even reverse to normal. Low scores of visuospatial/executive ability， delayed recall， language ability， and orientation at baseline can predict MCI converte to AD. MCOA as a follow-up study tool of MCI has a certain predictive effect.

[Key words] Mild cognitive impairment Montreal cognitive assessment Alzheimer disease Neuropsychology

First-authors address： Zhoupu Hospital in Pudong New Area of Shanghai， Shanghai 201318， China

輕度認(rèn)知功能障礙（mild cognitive impairment，MCI）是一種介于正常衰老與癡呆間的過渡狀態(tài)，此階段的老年人存在主觀或客觀上的認(rèn)知功能障礙[1]。因此，作為癡呆的前驅(qū)癥狀，此階段是癡呆早期預(yù)防的可行階段。目前，蒙特利爾認(rèn)知評估（MoCA）彌補了簡易智能精神狀態(tài)檢查量表（MMSE）的缺陷，可用于篩查MCI和輕度AD，應(yīng)用范圍較廣，適合于多種認(rèn)知障礙的評價[2-3]。

1 資料與方法

1.1 一般資料

（1）AD納入標(biāo)準(zhǔn)：按照美國精神病學(xué)會的精神障礙診斷、統(tǒng)計手冊第四修訂版（DSM-IV）標(biāo)準(zhǔn)、美國國立神經(jīng)及交流疾病研究所及AD相關(guān)疾病協(xié)會（NINCDS-ADRDA）制定的“很可能的AD”診斷標(biāo)準(zhǔn)，患者出現(xiàn)記憶力下降、失語、失用、失認(rèn)癥及執(zhí)行力障礙等認(rèn)知能力退化表現(xiàn)中至少1項;社會角色功能或職業(yè)能力減退;認(rèn)知能力呈現(xiàn)進行性減退?！?br>