MOCA量表在西安市军队干休所离退休干部轻度认知功能障碍诊断中的应用及修订
发布时间：2018-12-13 04:42
【摘要】：随着人口的老龄化，老年性痴呆(阿尔茨海默病Alzheimer’s disease,AD)的发生率日益增高。而轻度认知功能障碍(Mild cognitive impairment,MCI)的老年人是老年性痴呆的早期表现[1]。能够极早筛查并干预对AD的发生具有重要的临床价值。蒙特利尔认知评估(Montreal cognitive assessment,MOCA)量表[2]对快速筛查MCI患者，具有较高的灵敏度(Sensitivity,Se)和特异度(Specificity,Sp)[3-7]，被国际上广泛应用。2006年来我国学者应用MOCA量表对中国老年人研究表明，MOCA量表检验筛查轻度认知功能障碍患者优于简易智能精神状态检查(Mini—mentalstate examination，MMSE)量表，但由于东西方文化背景不同及生活习惯的差异，该量表对国人应用时存在插图陌生、词语生僻、理解困难、受试者不易接受等问题，具体操作中存在争议和难度，影响测试结果，需要进一步修订[8-15]。 本研究应用MOCA量表对西安军队干休所离退休干部进行轻度认知功能障碍的检验筛查，同时对相关危险因素进行流行病学调查和分析。并针对MOCA量表在国人中应用时存在的不足，结合国人的文化背景、生活习惯及中国老年人的生活经历等进行适合中国老年人的修订，并对修订的MOCA量表进行了信效度的检测。 研究目的 1．应用MOCA量表对西安军队干休所离退休干部进行轻度认知功能障碍的流行病学调查，分析相关危险因素。 2．针对MOCA原量表在中国人群实际应用中存在的不足，对其进行修订并对修订后的MOCA量表进行信度和效度检验并分析。 研究方法 随机、整群抽样选取西安市9所军队干休所304名离退休干部同时进行个人信息、患病情况、用药情况、MOCA原量表、修订后的MOCA量表(196名)及相关神经精神量表调查，并对修订后的MOCA量表1个月后随机抽样选取30名离退休干部进行重测。 研究结果 1．西安军队干休所离退休干部轻度认知功能障碍发生率为64.8%。 2．80岁以上轻度认知功能障碍(Mild cognitive impairment, MCI)的发生率(67.56%)高于70岁组(47.62%)，二者有显著性差异(P0.05)；教育年限小于6年者MCI的发生率(72%)高于7～12年及12年以上者，二者有显著性差异(P0.05)；不参加体育锻炼者MCI的发生率(80.95%)高于经常参加体育锻炼者(60.58%)，二者有显著性差异(P0.01)；有脑卒中者MCI的发生率(73.33%)高于无脑卒中者(57.64%)，，二者有显著性差异(P0.05)。 3．MOCA量表得分与MMSE量表得分相关分析显示，MOCA量表得分与MMSE量表得分显著相关，r=0.81。MOCA量表得分与日常活动能力量表、抑郁自评量表得分呈负相关。 4．修订后的MOCA量表内部一致性克朗巴赫α系数(Cronbach’s alpha)为0.862；Spearman-brown分半信度系数为0.862，两分半子量表得分的相关系数为0.669。1个月后随机抽样选取30名离退休干部进行重测，重测信度为0.831。具有较好的一致性信度和重测信度。 5．修订后的MOCA量表与原表各纬度(测试项目)进行相关性分析结果显示，各纬度(测试项目)间具有显著性相关，相关系数为0.501～0.942(P0.05)；修订的MOCA量表各因子(测试项目得分)与总分呈显著相关，相关系数在0.392～0.832之间。 6．修订后的MOCA量表与原MOCA量表总分具有相关性，相关系数为0.878(P0.01)。 7．修订后的MOCA量表具有较好的反应度：不同年龄间量表总分以及视空间、语言、延迟记忆、注意和抽象得分的差异具有统计学意义(P0.05)；不同性别量表总分以及视空间执行功能、延迟记忆能力得分差异有统计学意义(P0.05)；不同受教育时间间量表总分以及视空间执行功能、语言、注意、时空间定向能力得分差异有统计学意义(P0.05)。 8．截断点取28分时，修订后的MOCA量表ROC曲线下面积最大，为0.859（0.809～0.910）。 结论 1．西安市军队干休所离退休干部轻度认知功能障碍(MCI)发生率较高。 2．高龄、受教育年限低、不参加体育锻炼、有脑卒中者MCI的发生率高。 3．按照符合中国老年人的文化背景和生活习惯的指标进行修订的MOCA量表，更易于操作、更适用于我国老年人群轻度认知功能障碍的筛查和诊断。 4．修订后的MOCA量表具有较好的信度、效度和反应度。
[Abstract]:With the aging of the population, the incidence of Alzheimer's disease (AD) is increasing. The elderly with mild cognitive impairment (MCI) are the early manifestations of Alzheimer's disease[1]. can screen early and intervene to have important clinical value for the occurrence of AD. The Montreal Cognitive Assessment (MOCA) scale[2] has a high sensitivity (sensitivity, Se) and specificity (Specificity, Sp)[3-7] for the rapid screening of MCI patients. The patients with mild cognitive impairment were better than the simple mental state examination (MMSE) scale in the test of the MOCA scale, but due to the differences in the cultural background and the living habits of the East and the West, the scale was unfamiliar with the illustration in the Chinese application. The subject is not easy to accept, and there is a dispute and difficulty in the specific operation, and the test results are affected, and the[8-15] needs to be further revised. In this study, the MOCA scale was used to screen the light cognitive function of the retired cadres of the Xi 'an army, and the relevant risk factors were investigated and divided. The article analyses the deficiency of the MOCA scale in the Chinese people, and combines the cultural background, the living habits of the Chinese people and the living experience of the Chinese people to the revision of the Chinese old people, and the revised MOCA scale has been tested. Test. Objective To study the epidemiological investigation and analysis of the mild cognitive function of the retired cadres in Xi' an army by using the MOCA scale. the risk factor. 2. The deficiency in the actual application of the MOCA original scale in the Chinese population was revised and the revised MOCA scale was tested for reliability and efficiency test The study method was used to select 304 retired cadres in Xi 'an' an army to carry out personal information, illness, medication, MOCA original scale and revised MOCA scale (196). and the revised MOCA scale was selected by random sampling for 1 month. 0 out of service The results of the study are as follows: 1. The retired cadres of the Xi 'an army and the rest of the retired cadres The incidence of cognitive impairment was 64. 8%. The incidence of mild cognitive impairment (MCI) at age 80 and over (67. 56%) was higher than that in the 70-year-old group (47. 62%) (P0.05). The incidence of MCI was less than 6 years (P <0.05). There was a significant difference between the two groups (P <0.05). The incidence of MCI in the non-physical exercise (80. 95%) was higher than that of the regular exercise (60. 58%). There was a significant difference between the two groups (P 0.01), and the incidence of MCI in the patients with stroke (73.3. 33).%) higher than stroke-free (57. 64%) There was a significant difference between the score of the MOCA scale and the score of the MMSE scale, and the score of the MOCA scale was significantly related to the score of the MMSE scale, r = 0.81. The score of the MOCA scale and the day-to-day The correlation coefficient of Cronbach's alpha and Cronbach's alpha in the revised MOCA scale was 0.862, the correlation coefficient of the score of Spearman-brown was 0.862, and the random sampling was selected after 1 month. The re-test of the retired cadres is carried out, and the retest reliability is The results of the correlation between the revised MOCA scale and the various latitude (test items) of the original table show that there is a significant correlation between the latitude (test items) and the correlation coefficient is 0.501-0.942 (P0.05); the revised MO The score of each factor (test item score) of the CA scale and the total score Significant correlation, the correlation coefficient was between 0.392 and 0.832. 6. The revised MOCA scale and the original MOCA scale The total score had a correlation, and the correlation coefficient was 0.878 (P0.01). 7. The revised MOCA scale had better response: the total score of the scales between different ages and the difference between the apparent space, the language, the delay memory, the attention and the abstract score were statistically significant. significance (P0.05); the total score of the different sex scales as well as the visual space execution function and the difference of the score of the delay memory ability were statistically significant (P0.05); the total score of the inter-education time scale and the visual space execution function and the language, Note: The difference of the time-space directional ability scores is statistically significant (P0.05). 8. When the cut-off point is 28 points, the revised MOCA scale R (c) OC The maximum area under the curve is 0.8559 (0.809-0.910). 1. The incidence of mild cognitive impairment (MCI) among the retired cadres in Xi' an army is higher. 2. The incidence of MCI in patients with stroke is high. 3. According to the cultural background and living habits of the Chinese people, the incidence of MCI is high. The MOCA scale is easier to operate and is more suitable for the mild cognition of the elderly population in China
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.16
本文编号：2375899
[Abstract]:With the aging of the population, the incidence of Alzheimer's disease (AD) is increasing. The elderly with mild cognitive impairment (MCI) are the early manifestations of Alzheimer's disease[1]. can screen early and intervene to have important clinical value for the occurrence of AD. The Montreal Cognitive Assessment (MOCA) scale[2] has a high sensitivity (sensitivity, Se) and specificity (Specificity, Sp)[3-7] for the rapid screening of MCI patients. The patients with mild cognitive impairment were better than the simple mental state examination (MMSE) scale in the test of the MOCA scale, but due to the differences in the cultural background and the living habits of the East and the West, the scale was unfamiliar with the illustration in the Chinese application. The subject is not easy to accept, and there is a dispute and difficulty in the specific operation, and the test results are affected, and the[8-15] needs to be further revised. In this study, the MOCA scale was used to screen the light cognitive function of the retired cadres of the Xi 'an army, and the relevant risk factors were investigated and divided. The article analyses the deficiency of the MOCA scale in the Chinese people, and combines the cultural background, the living habits of the Chinese people and the living experience of the Chinese people to the revision of the Chinese old people, and the revised MOCA scale has been tested. Test. Objective To study the epidemiological investigation and analysis of the mild cognitive function of the retired cadres in Xi' an army by using the MOCA scale. the risk factor. 2. The deficiency in the actual application of the MOCA original scale in the Chinese population was revised and the revised MOCA scale was tested for reliability and efficiency test The study method was used to select 304 retired cadres in Xi 'an' an army to carry out personal information, illness, medication, MOCA original scale and revised MOCA scale (196). and the revised MOCA scale was selected by random sampling for 1 month. 0 out of service The results of the study are as follows: 1. The retired cadres of the Xi 'an army and the rest of the retired cadres The incidence of cognitive impairment was 64. 8%. The incidence of mild cognitive impairment (MCI) at age 80 and over (67. 56%) was higher than that in the 70-year-old group (47. 62%) (P0.05). The incidence of MCI was less than 6 years (P <0.05). There was a significant difference between the two groups (P <0.05). The incidence of MCI in the non-physical exercise (80. 95%) was higher than that of the regular exercise (60. 58%). There was a significant difference between the two groups (P 0.01), and the incidence of MCI in the patients with stroke (73.3. 33).%) higher than stroke-free (57. 64%) There was a significant difference between the score of the MOCA scale and the score of the MMSE scale, and the score of the MOCA scale was significantly related to the score of the MMSE scale, r = 0.81. The score of the MOCA scale and the day-to-day The correlation coefficient of Cronbach's alpha and Cronbach's alpha in the revised MOCA scale was 0.862, the correlation coefficient of the score of Spearman-brown was 0.862, and the random sampling was selected after 1 month. The re-test of the retired cadres is carried out, and the retest reliability is The results of the correlation between the revised MOCA scale and the various latitude (test items) of the original table show that there is a significant correlation between the latitude (test items) and the correlation coefficient is 0.501-0.942 (P0.05); the revised MO The score of each factor (test item score) of the CA scale and the total score Significant correlation, the correlation coefficient was between 0.392 and 0.832. 6. The revised MOCA scale and the original MOCA scale The total score had a correlation, and the correlation coefficient was 0.878 (P0.01). 7. The revised MOCA scale had better response: the total score of the scales between different ages and the difference between the apparent space, the language, the delay memory, the attention and the abstract score were statistically significant. significance (P0.05); the total score of the different sex scales as well as the visual space execution function and the difference of the score of the delay memory ability were statistically significant (P0.05); the total score of the inter-education time scale and the visual space execution function and the language, Note: The difference of the time-space directional ability scores is statistically significant (P0.05). 8. When the cut-off point is 28 points, the revised MOCA scale R (c) OC The maximum area under the curve is 0.8559 (0.809-0.910). 1. The incidence of mild cognitive impairment (MCI) among the retired cadres in Xi' an army is higher. 2. The incidence of MCI in patients with stroke is high. 3. According to the cultural background and living habits of the Chinese people, the incidence of MCI is high. The MOCA scale is easier to operate and is more suitable for the mild cognition of the elderly population in China
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.16
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