简易精神状态量表评分正常慢性阻塞性肺疾病患者脑认知功能研究(1)
[摘要]目的 探讨简易精神状态量表(MMSE)得分正常的慢性阻塞性肺疾病(COPD)患者是否存在脑认知功能障碍。方法 选择2012年7月～2015年3月在我院就诊的60例MMSE评分正常的稳定期COPD患者和60例正常对照组。利用蒙特利尔认知评估量表(MoCA)对两组受试者进行评分，分别对其MoCA总分和视空间执行力、命名能力、注意力、语言流畅、抽象思维、延迟回忆和空间定向能力等子项分析比较。结果 COPD组与正常对照组MMSE总评分、MoCA总评分比较，差异有统计学意义(P<0.05)。MoCA子项中COPD组较正常对照组的视空间执行能力(P=0.028)、命名能力(P=0.024)及延迟回忆(P<0.001)有明显下降；而注意力、语言流畅、抽象思维、空间定向比较，差异无统计学意义。结论 MMSE正常的COPD患者仍然存在脑认知功能障碍，MoCA筛查COPD患者脑认知障碍能力优于MMSE。
[关键词]慢性阻塞性肺疾病；简易精神状态量表；蒙特利尔认知评估量表；脑认知障碍
[中图分类号] R563 [文献标识码] A [文章编号] 1674-4721(2016)07(a)-0036-03
[Abstract]Objective To investigate whether there is brain cognitive impairment in patients with chronic obstructive pulmonary disease(COPD) whose mini-mental state examination(MMSE) score are normal.Methods Sixty patients with stable COPD whose MMSE score were normal in our hospital and sixty normal controls from the local community from July 2012 to March 2015 were recruited.All subjects were assessed with the montreal cognitive assessment scale(MoCA) including visuospatial and executive function，naming ability，attention，language fluency，abstraction，memory and orientation.The differences of the MoCA scores were analyzed and compared respectively between two groups.Results The MMSE total score，MoCA total score of COPD patients was lower that in normal controls respectively with statistical difference(P<0.05).Visuospatial and executive function(P=0.028)，naming ability(P=0.024) and memory(P<0.001) were significantly worse in COPD than normal controls，but there were no significant differences in attention， language fluency，abstraction，orientation.Conclusion There is still brain cognitive impairment of the patients with COPD whose MMSE score are normal.It is better to use MoCA than MMSE screening COPD patients in cognitive impairment.
[Key words]Chronic obstructive pulmonary disease(COPD)；Mini-mental state examination(MMSE)；Montreal cognitive assessment scale(MoCA)；Brain cognitive impairment
慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)以持续不完全可逆气流受限为特征，与气道和肺对有害物质慢性炎症反应有关。据世界卫生组织研究，至2020年COPD将成为全球第三大致死疾病，世界疾病经济负担的第五位[1]。COPD不仅涉及肺部及气道炎症反应，还可引起显著全身反应，尤其对中枢神经系统的损害更为明显。简易精神状态量表(mini-mental state examination，MMSE)是临床应用最广泛的认知筛查工具，但近年来在筛查轻度认知功能障碍(mild cognitive impairment，MCI)中的能力越来越受到质疑[2]。而蒙特利尔认知评估量表(montreal cognitive assessment，MoCA)因其较高的信度和效度，逐渐受到临床的推荐。本研究对60例MMSE得分正常的COPD患者进行MoCA评估，观察MoCA是否能筛查出COPD患者是否存在脑认知功能障碍。
1资料与方法
1.1一般资料
选取2012年7月～2015年3月到我院就诊的稳定期COPD患者及电话随访曾经住院且近6个月没有急性加重的稳定期COPD患者60例，并选取年龄、性别、受教育程度与COPD组相匹配的60例体检者为正常对照组。其中COPD组男性43例，女性17例，平均年龄(53.7±12.3)岁；正常对照组男性39例，女性21例，平均年龄(50.7±12.2)岁。所有受试者参加本研究前均被告知本研究的相关内容，并签署知情同意书。 (汪春荣 邱士军 沈比先)
[关键词]慢性阻塞性肺疾病；简易精神状态量表；蒙特利尔认知评估量表；脑认知障碍
[中图分类号] R563 [文献标识码] A [文章编号] 1674-4721(2016)07(a)-0036-03
[Abstract]Objective To investigate whether there is brain cognitive impairment in patients with chronic obstructive pulmonary disease(COPD) whose mini-mental state examination(MMSE) score are normal.Methods Sixty patients with stable COPD whose MMSE score were normal in our hospital and sixty normal controls from the local community from July 2012 to March 2015 were recruited.All subjects were assessed with the montreal cognitive assessment scale(MoCA) including visuospatial and executive function，naming ability，attention，language fluency，abstraction，memory and orientation.The differences of the MoCA scores were analyzed and compared respectively between two groups.Results The MMSE total score，MoCA total score of COPD patients was lower that in normal controls respectively with statistical difference(P<0.05).Visuospatial and executive function(P=0.028)，naming ability(P=0.024) and memory(P<0.001) were significantly worse in COPD than normal controls，but there were no significant differences in attention， language fluency，abstraction，orientation.Conclusion There is still brain cognitive impairment of the patients with COPD whose MMSE score are normal.It is better to use MoCA than MMSE screening COPD patients in cognitive impairment.
[Key words]Chronic obstructive pulmonary disease(COPD)；Mini-mental state examination(MMSE)；Montreal cognitive assessment scale(MoCA)；Brain cognitive impairment
慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)以持续不完全可逆气流受限为特征，与气道和肺对有害物质慢性炎症反应有关。据世界卫生组织研究，至2020年COPD将成为全球第三大致死疾病，世界疾病经济负担的第五位[1]。COPD不仅涉及肺部及气道炎症反应，还可引起显著全身反应，尤其对中枢神经系统的损害更为明显。简易精神状态量表(mini-mental state examination，MMSE)是临床应用最广泛的认知筛查工具，但近年来在筛查轻度认知功能障碍(mild cognitive impairment，MCI)中的能力越来越受到质疑[2]。而蒙特利尔认知评估量表(montreal cognitive assessment，MoCA)因其较高的信度和效度，逐渐受到临床的推荐。本研究对60例MMSE得分正常的COPD患者进行MoCA评估，观察MoCA是否能筛查出COPD患者是否存在脑认知功能障碍。
1资料与方法
1.1一般资料
选取2012年7月～2015年3月到我院就诊的稳定期COPD患者及电话随访曾经住院且近6个月没有急性加重的稳定期COPD患者60例，并选取年龄、性别、受教育程度与COPD组相匹配的60例体检者为正常对照组。其中COPD组男性43例，女性17例，平均年龄(53.7±12.3)岁；正常对照组男性39例，女性21例，平均年龄(50.7±12.2)岁。所有受试者参加本研究前均被告知本研究的相关内容，并签署知情同意书。 (汪春荣 邱士军 沈比先)