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5种认知功能筛查量表在老年人中的应用效果分析OACSTPCD

Application effect analysis of five cognitive function screening scales in the elderly

中文摘要英文摘要

目的:评价三级甲等综合医院记忆门诊常用的5种认知筛查量表的应用效果,以期为临床医护人员进行神经认知障碍的评估和诊断提供参考依据.方法:选取2020年10月—2022年5月就诊于记忆门诊且主诉记忆减退的155例病人,经神经内科医生初诊,在征得病人同意后,开具认知障碍筛查处方,病人预约后由具有认知筛查培训资质的护士依次对病人及家属完成中文版认知功能检查量表-Ⅲ(ACE-Ⅲ)、简易智力状态检查量表(MMSE)、画钟测试4分法(CDT4)、蒙特利尔认知评估量表(MoCA)、认知障碍自评量表(AD8)和日常生活能力(ADL)量表的筛查,病人携带认知筛查结果、相关实验室及影像学检查结果到神经内科初诊专家处进行诊疗.结果:155例病人中,正常对照组72人,认知障碍组38例,痴呆组45例.5种认知筛查量表与相关因素间相关性比较结果显示,年龄、教育年限、认知障碍程度与中文版ACE-Ⅲ、MoCA相关性更为显著;认知障碍组病人中文版ACE-Ⅲ、MMSE、MoCA和AD8的受试者工作特征曲线下面积为0.698~0.788,MoCA、中文版ACE-Ⅲ和AD8对轻度认知障碍诊断的特异性分别为78.9%、76.3%和73.7%,敏感性分别为70.8%、58.3%和56.9%;痴呆组病人的中文版ACE-Ⅲ、MMSE、MoCA量表的受试者工作特征曲线下面积为0.915~0.931,其中MMSE、中文版ACE-Ⅲ和MoCA对痴呆诊断的敏感性分别为91.7%,84.7%和83.3%,特异性分别为86.7%、84.4%和84.4%.结论:对于具有记忆力减退、高龄、具有一定学历的病人宜选用MoCA、中文版ACE-Ⅲ在三级甲等综合医院记忆门诊筛查使用;认知筛查量表对轻度认知障碍筛查的准确性依次为MoCA>中文版ACE-Ⅲ>AD8,对痴呆筛查的准确性MMSE>中文版ACE-Ⅲ>MoCA.

Objective:To explore the application effect of cognitive screening scales commonly used in memory clinics of tertiary Grade A general hospitals,so as to provide a reference for the diagnosis of neurocognitive disorders.Methods:A total of 155 patients who were admitted to the memory clinic from October 2020 to May 2022 and complained of memory loss were selected.After initial diagnosis by a neurologist,they were prescribed cognitive impairment screening with the consent of the patients.After the appointment,the Chinese version of ACE-Ⅲ,MMSE,CDT4,MoCA,AD8 and ADL scales were screened by nurses with cognitive screening training qualification.The patients brought the cognitive screening results,relevant laboratory and imaging examination to the neurology department for diagnosis and treatment.Results:Among the 155 patients,72 were in the normal group,38 were in the MCI group,and 45 were in the dementia group.The correlation between five cognitive screening scales and related factors showed that age,years of education,degree of cognitive impairment were more significantly correlated with the Chinese version of ACE-Ⅲ and MoCA.The area under the ROC curve of Chinese ACE-Ⅲ,MMSE,MoCA and AD8 in MCI group was 0.698-0.788,and the specificity of MoCA,Chinese ACE-Ⅲ and AD8 in MCI diagnosis was 78.9%,76.3%and 73.7%,respectively.The sensitivity was 70.8%,58.3%and 56.9%,respectively.The area under ROC curve of the Chinese version of ACE-Ⅲ,MMSE and MoCA was between 0.915-0.931.The sensitivity of MMSE,Chinese version of ACE-Ⅲ and MoCA for dementia diagnosis was 91.7%,84.7%and 83.3%,and the highest specificity was 86.7%,84.4%and 84.4%,respectively.Conclusion:MoCA and the Chinese version of ACE-Ⅲ should be used in the memory clinic of ClassⅢGrade A general hospitals for elderly patients with memory loss and certain educational background.The accuracy of cognitive screening scale in MCI screening was MoCA>Chinese ACE-Ⅲ>AD8,and the accuracy of dementia screening was MMSE>Chinese ACE-Ⅲ>MoCA.

张晓静;孙佶英;肖卫忠;张丽丽;任宁;杨振华

北京大学第三医院,北京 100085

认知功能评估工具老年人轻度认知障碍痴呆量表

cognitive functionevaluation toolsthe elderlymild cognitive impairmentdementiascale

《护理研究》 2024 (007)

1162-1167 / 6

10.12102/j.issn.1009-6493.2024.07.005

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