MMSE评分、MoCA评分和事件相关电位P300对不同部位脑卒中患者认知功能的评价研究
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摘要
目的通过对不同部位脑卒中患者进行MMSE评分、MoCA评分和事件相关电位P300评估研究,了解不同部位脑卒中患者的认知功能障碍情况。方法选取2015年9月至2017年5月间在本院治疗的脑卒中患者126例为观察组,按患者责任病灶不同又分为额叶(34例)、颞叶(25例)、基底核(43例)、脑干(24例)共4组,选取同期来本院就诊的非脑卒中患者50例为对照组。全部患者均采用MMSE、MoCA和事件相关电位P300评估认知功能。结果观察组的MMSE各子项目和总的评分均较对照组低(P<0.05);观察组的MoCA中定向力、回忆力、命名、视空间和执行能力及总的评分较对照组低(P<0.05);观察组的潜伏期要长于对照组(P<0.05),波幅低于对照组(P<0.05);不同部位脑卒中组间比:额叶组、颞叶组的MMSE和MoCA评分低于基底核组(P<0.05),P300潜伏期长于基底核组(P<0.05)。额叶组、颞叶组和基底核组的P300潜伏期长于脑干组(P<0.05);与对照组比较:额叶组、颞叶组、基底核组的MMSE和MoCA评分降低(P<0.05),P300潜伏期延长(P<0.05);额叶组、颞叶组的P300波幅下降(P<0.05)。结论 MoCA和MMSE及事件相关电位P300可较好的检出脑卒中患者认知功能障碍,额叶与颞叶部位脑卒中患者认知功能障碍最为明显。
Objective To analyze the value of MMSE score, Mo CA score and evaluation of event-related potential P300 for the cognitive function of stroke patients in different parts. Method 6150 cases of stroke patients, who were hospitalized in our hospital from September 2015 to May 2017, were selected as the observation group. And according to the different patients' responsibility, they were divided into 5 groups: frontal lobe(34 cases), temporal lobe(25 cases), basal ganglia(43 cases), brainstem(24 cases) and thalamus(24 cases). 50 cases of non stroke patients, who came to our hospital in the same period, were selected as control group. All patients were used to assess cognitive function by using event-related potential P300, MMSE, and Mo CA. Results The MMSE sub projects and total scores of the observation group were lower than those of the control group(P<0.05); The orientation, recollection, naming, visual space, executive ability and total score of the Mo CA in the observation group were lower than those in the control group(P<0.05). The incubation period of the observation group was longer than that of the control group(P<0.05), and the amplitude of the observation group was lower than that of the control group(P <0.05). Comparison of cerebral apoplexy in different parts: The scores of MMSE and Mo CA in the frontal group and temporal group were lower than those in the basal ganglia group(P<0.05), and the latency of P300 was longer than that in the basal ganglia group(P<0.05). The latency of P300 in the frontal group, the temporal group and the basal ganglia group were longer than those in the brainstem group and the thalamus group(P<0.05). The latency of P300 in the frontal group, the temporal group and the basal ganglia group were longer than those in the brainstem group and the thalamus group(P<0.05). Compared with the control group: The scores of MMSE and Mo CA in the frontal group, the temporal lobe group, the basal ganglia group and the thalamus group were decreased(P<0.05). The latency of P300 in the frontal group, the temporal group and the basal ganglia group was prolonged(P<0.05). The amplitude of P300 in the frontal group and the temporal group decreased(P<0.05). Conclusion Mo CA and MMSE and event-related potential P300 can better detect the condition of cognitive impairment in stroke patients, and the frontal lobe and temporal lobe are the most serious parts of cognitive dysfunction after stroke.
Objective To analyze the value of MMSE score, Mo CA score and evaluation of event-related potential P300 for the cognitive function of stroke patients in different parts. Method 6150 cases of stroke patients, who were hospitalized in our hospital from September 2015 to May 2017, were selected as the observation group. And according to the different patients' responsibility, they were divided into 5 groups: frontal lobe(34 cases), temporal lobe(25 cases), basal ganglia(43 cases), brainstem(24 cases) and thalamus(24 cases). 50 cases of non stroke patients, who came to our hospital in the same period, were selected as control group. All patients were used to assess cognitive function by using event-related potential P300, MMSE, and Mo CA. Results The MMSE sub projects and total scores of the observation group were lower than those of the control group(P<0.05); The orientation, recollection, naming, visual space, executive ability and total score of the Mo CA in the observation group were lower than those in the control group(P<0.05). The incubation period of the observation group was longer than that of the control group(P<0.05), and the amplitude of the observation group was lower than that of the control group(P <0.05). Comparison of cerebral apoplexy in different parts: The scores of MMSE and Mo CA in the frontal group and temporal group were lower than those in the basal ganglia group(P<0.05), and the latency of P300 was longer than that in the basal ganglia group(P<0.05). The latency of P300 in the frontal group, the temporal group and the basal ganglia group were longer than those in the brainstem group and the thalamus group(P<0.05). The latency of P300 in the frontal group, the temporal group and the basal ganglia group were longer than those in the brainstem group and the thalamus group(P<0.05). Compared with the control group: The scores of MMSE and Mo CA in the frontal group, the temporal lobe group, the basal ganglia group and the thalamus group were decreased(P<0.05). The latency of P300 in the frontal group, the temporal group and the basal ganglia group was prolonged(P<0.05). The amplitude of P300 in the frontal group and the temporal group decreased(P<0.05). Conclusion Mo CA and MMSE and event-related potential P300 can better detect the condition of cognitive impairment in stroke patients, and the frontal lobe and temporal lobe are the most serious parts of cognitive dysfunction after stroke.
引文
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[13]Zeng Q,Dong X,Ruan C,et al.Cognitive impairment in Chinese IIDDs revealed by Mo CA and P300[J].Mult Scler Relat Disord,2017,16:1-7.
[14]Zheng HZ,Jiang W,Zhao XF,et al.Electroacupuncture induces acute changes in cerebral cortical mi RNA profile,improves cerebral blood flow and alleviates neurological deficits in a rat model of stroke[J].Neural Regen Res,2016,11(12):1940-1950.
[15]Radanovic M,Mansur LL,Azambuja MJ,et al.Contribution to the evaluation of language disturbances in subcortical lesions:a pilot study[J].Arq Neuropsiquiatr,2004,62(1):51-57.
[2]Biernaskie J,Chernenko G,Corbett D.Efficacy of rehabilitative experience declines with time after focal is chemic brain injury[J].Neurosci,2004,24(5):1245-1254.
[3]全国第四届脑血管病学术会议.脑血管疾病分类、诊断要点、脑卒中患者临床神经功能缺损程度评分标准[J].中华神经科杂志,1996,29(4):379-381.
[4]张国明.精神科评定量表手册[M].(第二版)长沙:湖南科学技术出版社,1998:166-168,184-188.
[5]王炜,王鲁宁.“蒙特利尔认知评估量表”在轻度认知损伤患者筛查中的应用[J].中华内科杂志,2007,46(5):414-416.
[6]夏宪军.P300及SSR对抑郁症患者认知及自主神经功能评价的应用研究[D].银川:宁夏医科大学,2012.
[7]Stoodley CJ,Mac More JP,Makris N,et al.Location of lesion determines motor vs.cognitive consequences in patients with cerebellar stroke[J].Neuroimage Clin,2016,12:765-775.
[8]Frodl T,Hampel H,Juckel G,et al.Value of event-related P300subcomponents in the clinical diagnosis of mild cognitive impairment and Alzheimer's disease[J].Psychophysiology,2002,39(2):175-181.
[9]Li F,Takechi H,Kokuryu A,et al.Longitudinal changes in performance on cognitive screening tests in patients with mild cognitive impairment and alzheimer disease[J].Dement Geriatr Cogn Dis Extra,2017,7(3):366-373.
[10]Nasreddine ZS,Phillips NA,Bédirian V.The montreal cognitive assessment,Mo CA:a brief screening tool for mild cognitive impairment[J].J Am Geriatr Soc,2005,53(4):695-699.
[11]Rosli R,Tan MP,Gray WK,et al.Cognitive assessment tools in Asia:a systematic review[J].Int Psychogeriatr,2016,28(2):189-210.
[12]Roca P,Mulas F,Gandia R,et al.Executive functioning and evoked potentials P300 pre-andpost-treatment in attention deficit hyperactivity disorder[J].Rev Neurologia,2013,56(Suppl 1):S107-S118.
[13]Zeng Q,Dong X,Ruan C,et al.Cognitive impairment in Chinese IIDDs revealed by Mo CA and P300[J].Mult Scler Relat Disord,2017,16:1-7.
[14]Zheng HZ,Jiang W,Zhao XF,et al.Electroacupuncture induces acute changes in cerebral cortical mi RNA profile,improves cerebral blood flow and alleviates neurological deficits in a rat model of stroke[J].Neural Regen Res,2016,11(12):1940-1950.
[15]Radanovic M,Mansur LL,Azambuja MJ,et al.Contribution to the evaluation of language disturbances in subcortical lesions:a pilot study[J].Arq Neuropsiquiatr,2004,62(1):51-57.