非痴呆型血管性认知障碍患者MMSE与MoCA评分比较及其与C-反应蛋白、叶酸、维生素B12的相关性研究

  本文关键词：非痴呆型血管性认知障碍患者MMSE与MoCA评分比较及其与C-反应蛋白、叶酸、维生素B12的相关性研究，由笔耕文化传播整理发布。

        背景血管性认知障碍(vascular cognitive impairment, VCI)是指由脑血管病或脑血管病的危险因素引起的从轻度认知障碍到痴呆的一大类综合征，包括无痴呆型血管性认知障碍(vascular cognitive impairment no dementia, VCIND)、血管性痴呆(vasculardementia，VD)和混合性痴呆(mixed dementia，MD)。VCI是老年人慢性进展性认知损害最常见的类型，VCI中未达到痴呆诊断标准者被定义为VCIND。VCIND患者的认知功能损害是局灶性的或记忆相对保留，不足以引起严重的功能障碍，随时间推移和病情发展，大多数VCIND将发展为血管性痴呆(VD)。由于在VCIND阶段，有多种可干预的危险因素存在，，早期发现并在日常生活受到影响前进行干预，可避免发展到不可逆的VD晚期阶段。简易精神状态量表（Mini-menta1State Examination，MMSE)是一种被临床医生使用最广泛的认知功能障碍筛查量表，但很多已达到VCI诊断标准的患者，其MMSE得分仍在正常范围。MMSE敏感性较差，漏诊率高。目前MoCA在国内多是用于筛查、评估有轻度认知功能障碍(MCI)的患者，有较高的敏感性，但MoCA在VCIND患者中的应用研究较少。本研究主要探讨两种评估量表的差别及优缺点，以选择敏感度和特异度更高的神经心理学评估量表作为快速筛查有非痴呆型血管性认知功能障碍患者的工具。目前认为，VCI发病可能是在多种机制的共同作用下引起的，炎性因素在其中扮演着重要的角色。一些炎性因子在脑脊液和血液中的水平变化与VCI可能有一定的相关性。C-反应蛋白(CRP)为炎症时的急性时相蛋白，是临床最显著的炎症标记物。因此，检测相关炎性标志物并进一步了解其在认知损害中的作用，有助于VCI患者的早期防治。近年来的研究发现叶酸、Vitamin B12与血管性认知障碍有关。叶酸及Vitamin B12与VCI的关系及其作用国内外文献报道较少，而且结果、结论不一致。本文旨在探讨CRP、叶酸及Vitamin B12与无痴呆型血管性认知障碍的相关性。目的探讨MOCA与MMSE的特点，选择敏感度和特异度更高的量表作为筛查VCIND的工具；探讨CRP、叶酸及Vitamin B12与VCIND的相关性。方法2011年12月至2012年12月在苏州大学附属第二医院神经内科住院及门诊患者80例，其中VCIND患者41例和性别、年龄和文化程度相匹配的正常对照39例(normal control, NC)完成一系列神经心理学测验，包括总体认知水平、记忆力、注意力、命名、视觉空间能力、执行功能等各个认知领域，比较两组认知功能的差异。神经心理学测验包括简易精神状态量表（Mini-menta1State Examination，MMSE)和蒙特利尔认知量表(Montreal cognitive assessment，MoCA)。两组患者均于晨时抽取空腹血标本送我院检验科检测患者C-反应蛋白，血清叶酸和Vitamin B12水平。所有入选对象对试验方案均知情同意，并且通过伦理委员会批准。结果1. MMSE、MoCA总分在VCIND组和NC组都呈高度相关性，VCIND组r=0.897p<0.01； NC组r=0.883p<0.01； VCIND组MMSE评定总分低于NC组(22.57±4.21vs27.32±3.66)，MoCA评定总分也低于NC组(20.12±4.17vs25.08±4.41)；MoCA各项目得分中，VCIND组在视空间与执行功能、注意、延迟记忆、定向四个方面低于NC组(p>0.05)。2. NCIND组患者C-反应蛋白较NC组高，血清叶酸和VtimaniB12水平较NC组低。结论：1.MOCA量表中文版较MMSE量表用于筛查VCIND患者具有较高的特异度和敏感度，是筛查VCIND患者的较好的评估量表。2.血清C-反应蛋白浓度升高，血清叶酸、维生素B12缺乏与VCIND具有相关性，对VCIND患者的辅助诊断具有参考价值。

    Background Vascular cognitive impairment(VCI) include all levels of cognitivedecline resulting from cerebrovascular disease (CVD) or risk factors for CVD, rangingfrom mild deficits in one or more cognitive domains to a broad dementia-likesyndrome.Three broad clinical subtypes are included: vascular cognitive impairment nodementia(VCIND), vascular dementia (VD) and mixed dementia (MD). VCI cases that donot meet the criteria for dementia can also be labeled as vascular cognitive impairment nodementia(VCIND). With the time and progression of disease,the most patients of VCINDmay develop to vascular dementia (VD).In the stage of VCIND there are many risk factorswhich can be intervened, so to early discover cognitive impairment before daily life iseffected and to interfere in it may avoid the late stage of VD.MMSE (Mini-menta1State Examination, MMSE) is the most widely used screeningscale of cognitive function disorder for clinician. A lot of patients have reached theVCI,but the MMSE score is in the normal range. The sensitivity of MMSE is low, the rateof misdiagnosis is high.MoCA have high sensitivity for screening and assessing patientswith mild cognitive impairment (MCI), but MOCA used for patients with VCIND is less.This study investigates the differences, advantages and disadvantages of the two scales, toselect a higher degree of sensitivity and specificity of neuropsychological assessment scaleas a rapid screening tool of vascular cognitive impairment no dementia(VCIND).Currently,VCI disease may be caused by the combined effect of a variety ofmechanism, and the inflammatory factor play an important role. Some inflammatoryfactors may have some relevance in the cerebrospinal fluid and blood levels with VCI.C-reactive protein (CRP) is the acute phase proteins of inflammation，and it is the mostsignificant clinical markers of inflammation.Therefor,detecting the inflammatory markers and learning more about its role in the cognitive impairment, contribute to prevent andtreat the patients with VCI early. The recent studies have found that folic acid, VitaminB12have relation with VCI. The relations and role of folic acid and Vitamin B12with VCIreported in the literature is less,the results and conclusions is inconsistent. This article aimsto explore the relevance of the CRP, folic acid and Vitamin B12with VCI.Objective To investigate the characteristics of MOCA and MMSE, select the highersensitivity and specificity scale as a screening tool for VCIND; to explore the relevance ofCRP, folic acid and Vitamin B12with VCIND.Method December2011to December2012, the Second Affiliated Hospital ofSoochow University Department of Neurology, inpatient and outpatient patients with80cases, including39cases of patients with VCIND41cases and gender, age andeducation-matched normal control (NC) completed a series of neuropsychological tests,including the overall level of cognitive, memory, attention, naming, differences invisual-spatial ability, executive function and other cognitive domains were comparedcognitive function.Neuropsychological tests, including the Mini-Mental State Examination(MMSE) and Montreal Cognitive Assessment (MoCA).Patients in both groups fastingblood samples in the morning were sent to our hospital clinical laboratory testing inpatients with C-reactive protein, serum folate and vitamin B12level. All selected objectson the pilot program, informed consent, and approved by the Ethics Committee.Results (1)Totle scores of MoCA were correlated with that of MMSE,(VCINDgroup r=0.897，p<0.01;NC group r=0.883, p<0.01); The scores of MoCA’s subitems werecorrelated with totle scores of MoCA; The totle scores of MMSE in VCIND group werelower than the NC group,(22.57±4.21vs27.32±3.66);The totle scores of MoCA inVCIND group were lower than the NC group (20.12±4.17vs25.08±4.41);Some sub-itemscore of MoCA in VCIND group were lower than the NC group.In VCIND group,the scoreof Visuospatial/Executive,Abstraction subitem,Delayed recall and Orientation were lowerthan the NC group.(p<0.05)(2) Compared with NC group,C-reactive protein of NCIND group increased,folateand vitamin B12reduced.Conclusion1.The sensitivity and Specificity of MOCA is higher than MMSE forscreening patients with VCIND, it can be used as a good scale for screening patients withVCIND. 2.C-reactive protein, folic acid and vitamin B12have a correlation with the VCIND,ithas a reference value for the diagnosis of patients with VCIND.

非痴呆型血管性认知障碍患者MMSE与MoCA评分比较及其与C-反应蛋白、叶酸、维生素B12的相关性研究

中文摘要4-6Abstract6-8引言10-13    参考文献12-13资料与方法13-16结果16-20讨论20-27参考文献27-31结论31-32附录32-35综述35-45    参考文献42-45研究生期间发表的论文45-46致谢46-47

  本文关键词：非痴呆型血管性认知障碍患者MMSE与MoCA评分比较及其与C-反应蛋白、叶酸、维生素B12的相关性研究，由笔耕文化传播整理发布。