首发脑肿瘤病人认知功能状况及影响因素研究
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摘要
[目的]了解首发脑肿瘤病人认知功能水平,探讨影响其认知的相关因素,为今后有关脑肿瘤认知功能研究提供一定的理论依据。[方法]选取2017年5月—2017年12月上海市某三级甲等医院神经外科136例首发脑肿瘤病人,应用一般情况调查表、蒙特利尔认知评估量表(MoCA)、卡氏行为功能状况量表(KPS)、改良版Barthel指数(MBI)、医院焦虑抑郁量表进行调查,应用SPSS 20.0进行t检验、方差分析、秩和检验,采用Spearman和Pearson相关分析法,认知功能障碍的影响因素采用二元Logistic回归分析。[结果]首发脑肿瘤病人MoCA总分为(23.94±3.77)分,认知障碍者79例(58.1%),认知受损领域依次为延迟记忆、视空间执行能力、抽象能力、注意力、语言功能、命名能力、定向力;年龄、WHO肿瘤病理分级、病人工作状况、焦虑得分、抑郁得分与脑肿瘤病人MoCA总分呈负相关(P<0.05),文化程度、肿瘤部位、KPS得分、MBI得分与MoCA总分呈正相关(P<0.05);年龄、焦虑得分、WHO肿瘤病理分级是其危险因素,文化程度是其保护因素。[结论]首发脑肿瘤病人存在认知功能损害,主要表现在延迟记忆、视空间执行能力、注意力等方面,建议医护人员应注重早期评估首发脑肿瘤病人的认知功能水平,重点关注高龄、文化程度较低、高级别肿瘤以及存在焦虑病人。
Objective:To investigate the cognitive function of patients with first-episode brain tumors and to explore the related factors affecting their cognition,to provide some theoretical basis for the study of cognitive function of brain tumors patients in the future.Methods:From May to December 2017,136 patients with first-episode brain tumors were selected in neurosurgery department in a third grade A Hospital in Shanghai,were investigated with the General Information Questionnaire,Montreal Cognitive Assessment(MoCA),Karnofsky Performance Status(KPS),Modified Barthel Index(MBI),and Hospital Anxiety and Depression Scale(HADS).SPSS 20.0 software was used for t-test,ANOVA and rank sum test.Spearman and Pearson correlation analysis was carried out.The influencing factors of cognitive impairment were analyzed by binary Logistic regression analysis.Results:The total score of MoCA in patients with first-episode brain tumor was(23.94±3.77).There were 79 cases(58.1%)with cognitive impairment.The areas of cognitive impairment as followed were delayed memory,visual space execution ability,abstract ability,attention,language function,naming ability and orientation.Age,WHO tumor pathological grade,work status,anxiety score,and depression score were negatively correlated with the total MoCA score of brain tumor patients(P<0.05).Education level,tumor location,KPS score,and MBI score were positively correlated with the total MoCA score(P<0.05).Age,anxiety score,and WHO tumor pathological grade were the risk factors,and the education level was the protective factor.Conclusions:There were cognitive impairments in patients with first-episode brain tumors,including delayed memory,visual space executive ability,attention,etc.It was suggested that medical staff should pay attention to the early evaluation of cognitive function of patients with brain tumors,especially the patients with advanced age,lower education,high-grade tumors and anxiety patients.
Objective:To investigate the cognitive function of patients with first-episode brain tumors and to explore the related factors affecting their cognition,to provide some theoretical basis for the study of cognitive function of brain tumors patients in the future.Methods:From May to December 2017,136 patients with first-episode brain tumors were selected in neurosurgery department in a third grade A Hospital in Shanghai,were investigated with the General Information Questionnaire,Montreal Cognitive Assessment(MoCA),Karnofsky Performance Status(KPS),Modified Barthel Index(MBI),and Hospital Anxiety and Depression Scale(HADS).SPSS 20.0 software was used for t-test,ANOVA and rank sum test.Spearman and Pearson correlation analysis was carried out.The influencing factors of cognitive impairment were analyzed by binary Logistic regression analysis.Results:The total score of MoCA in patients with first-episode brain tumor was(23.94±3.77).There were 79 cases(58.1%)with cognitive impairment.The areas of cognitive impairment as followed were delayed memory,visual space execution ability,abstract ability,attention,language function,naming ability and orientation.Age,WHO tumor pathological grade,work status,anxiety score,and depression score were negatively correlated with the total MoCA score of brain tumor patients(P<0.05).Education level,tumor location,KPS score,and MBI score were positively correlated with the total MoCA score(P<0.05).Age,anxiety score,and WHO tumor pathological grade were the risk factors,and the education level was the protective factor.Conclusions:There were cognitive impairments in patients with first-episode brain tumors,including delayed memory,visual space executive ability,attention,etc.It was suggested that medical staff should pay attention to the early evaluation of cognitive function of patients with brain tumors,especially the patients with advanced age,lower education,high-grade tumors and anxiety patients.
引文
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[12]孙振晓,刘化学,焦林瑛,等.医院焦虑抑郁量表的信度及效度研究[J].中华临床医师杂志(电子版),2017,11(2):198-201.SUN Z X,LIU H X,JIAO L Y,et al.Reliability and validity of Hospital Anxiety And Depression Scale[J].Chin J Clinicians(E-lectronic Edition),2017,11(2):198-201.
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[14]张红波,穆林森,孙彦辉,等.脑肿瘤患者围手术期认知功能障碍的临床研究[J].中华神经外科杂志,2015,31(3):225-227.ZHANG H B,MU L S,SUN Y H,et al.The clinical research of perioperative neurocognitive dysfunction in brain tumor patient[J].Chin J Neurosurg,2015,31(3):225-227.
[15]SATOER D,VISCH-BRINK E,DIRVEN C,et al.Glioma surgery in eloquent areas:can we preserve cognition?[J].Acta Neurochir(Wien),2016,158(1):35-50.
[16]TAPHOORN M J,KLEIN M.Cognitive deficits in adult patients with brain tumours[J].Lancet Neurol,2004,3(3):159-168.
[17]VAN KESSEL E,BAUMFALK A E,VAN ZANDVOORT M,et al.Tumor-related neurocognitive dysfunction in patients with diffuse glioma:a systematic review of neurocognitive functioning prior to anti-tumor treatment[J].J Neurooncol,2017,134(1):9-18.
[18]钱海鹏,万经海,李学记,等.应用MMSE量表分析脑肿瘤患者认知功能的影响因素[J].中国医刊,2016,51(5):71-74.QIAN H P,WAN J H,LI X J,et al.Application of MMSE scale analysis the influence factors of cognitive function in patients with brain tumors[J].Chinese Journal of Medicine,2016,51(5):71-74.
[19]HENDRIX P,HANS E,GRIESSENAUER C J,et al.Neurocognitive function surrounding the resection of frontal WHO grade Imeningiomas:a prospective matched-control study[J].World Neurosurgery,2017,98:203-210.
[20]NOLL K R,WEINBERG J S,ZIU M,et al.Neurocognitive changes associated with surgical resection of left and right temporal lobe glioma[J].Neurosurgery,2015,77(5):777-785.
[21]MCALEER M F,BROWN P D.Neurocognitive function following therapy for low-grade gliomas[J].Semin Radiat Oncol,2015,25(3):210-218.
[22]VAN DER VOSSEN S,SCHEPERS V P,BERKELBACH VANDER SPRENKEL J W,et al.Cognitive and emotional problems in patients after cerebral meningioma surgery[J].J Rehabil Med,2014,46(5):430-437.
[2]CHEN W,ZHENG R,BAADE P D,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3]Van LOON E M P,HEIJENBROK-KAL M H,van LOON W S,et al.Assessment methods and prevalence of cognitive dysfunction in patients with low-grade glioma:a systematic review[J].Journal of Rehabilitation Medicine,2015,47(6):481-488.
[4]BOONE M,ROUSSEL M,CHAUFFERT B,et al.Prevalence and profile of cognitive impairment in adult glioma:a sensitivity analysis[J].J Neurooncol,2016,129(1):123-130.
[5]张驰,金玉红,金月香,等.基于Web of Science数据库的颅内肿瘤护理研究热点及可视化分析[J].中华现代护理杂志,2017,23(15):2050-2053.ZHANG C,JIN Y H,JIN Y X,et al.Research hotspot and visualization analysis of intracranial tumor nursing based on the Web of Science database[J].Chinese Journal of Modern Nursing,2017,23(15):2050-2053.
[6]MESKAL I,GEHRING K,RUTTEN G J,et al.Cognitive functioning in meningioma patients:a systematic review[J].J Neurooncol,2016,128(2):195-205.
[7]王凯,张姝,施露,等.2016年世界卫生组织中枢神经系统肿瘤分类概述[J].磁共振成像,2016,7(12):881-896.WANG K,ZHANG S,SHI L,et al.The 2016 World Health Organization classification of tumors of the central nervous system:a summary[J].Chin J Magn Reson Imaging,2016,7(12):881-896.
[8]NASREDDINE ZIAD S,高晶.蒙特利尔认知评估量表:一个检测轻度认知功能障碍和早期痴呆的工具[J].中华神经科杂志,2012,45(2):135-137.NASREDDINE ZIAD S,GAO J.Montreal Cognitive Assessment:a brief screening tool for mild cognitive impairment[J].Chinese Journal of Neurology,2012,45(2):135-137.
[9]侯庆石,周东,陈飞,等.MMSE和MoCA对脑肿瘤患者认知功能评估的应用比较[J].中国临床神经外科杂志,2013,18(6):356-358.HOU Q S,ZHOU D,CHEN F,et al.Evaluation of cognitive function in patients with brain tumors:mini-mental state examination verse Montreal Cognitive Assessment Scale[J].Chinese Journal of Clinical Neurosurgery,2013,18(6):356-358.
[10]杨树源,张建宁.神经外科学[M].2版.北京:人民卫生出版社,2015:464-465.YANG S Y,ZHANG J N.Neurosurgery[M].2nd Edition.Beijing:People′s Medical Publishing,2015:464-465.
[11]李奎成,唐丹,刘晓艳,等.国内Barthel指数和改良Barthel指数应用的回顾性研究[J].中国康复医学杂志,2009,24(8):737-740.LI K C,TANG D,LIU X Y,et al.Renew of the application of Barthel Index and Modified Barthel Index in Chinese mainland[J].Chinese Journal of Rehabilitation Medicine,2009,24(8):737-740.
[12]孙振晓,刘化学,焦林瑛,等.医院焦虑抑郁量表的信度及效度研究[J].中华临床医师杂志(电子版),2017,11(2):198-201.SUN Z X,LIU H X,JIAO L Y,et al.Reliability and validity of Hospital Anxiety And Depression Scale[J].Chin J Clinicians(E-lectronic Edition),2017,11(2):198-201.
[13]BOMMAKANTI K,SOMAYAJULA S,SUVARNA A,et al.Pre-operative and post-operative cognitive deficits in patients with supratentorial meningiomas[J].Clin Neurol Neurosurg,2016,143:150-158.
[14]张红波,穆林森,孙彦辉,等.脑肿瘤患者围手术期认知功能障碍的临床研究[J].中华神经外科杂志,2015,31(3):225-227.ZHANG H B,MU L S,SUN Y H,et al.The clinical research of perioperative neurocognitive dysfunction in brain tumor patient[J].Chin J Neurosurg,2015,31(3):225-227.
[15]SATOER D,VISCH-BRINK E,DIRVEN C,et al.Glioma surgery in eloquent areas:can we preserve cognition?[J].Acta Neurochir(Wien),2016,158(1):35-50.
[16]TAPHOORN M J,KLEIN M.Cognitive deficits in adult patients with brain tumours[J].Lancet Neurol,2004,3(3):159-168.
[17]VAN KESSEL E,BAUMFALK A E,VAN ZANDVOORT M,et al.Tumor-related neurocognitive dysfunction in patients with diffuse glioma:a systematic review of neurocognitive functioning prior to anti-tumor treatment[J].J Neurooncol,2017,134(1):9-18.
[18]钱海鹏,万经海,李学记,等.应用MMSE量表分析脑肿瘤患者认知功能的影响因素[J].中国医刊,2016,51(5):71-74.QIAN H P,WAN J H,LI X J,et al.Application of MMSE scale analysis the influence factors of cognitive function in patients with brain tumors[J].Chinese Journal of Medicine,2016,51(5):71-74.
[19]HENDRIX P,HANS E,GRIESSENAUER C J,et al.Neurocognitive function surrounding the resection of frontal WHO grade Imeningiomas:a prospective matched-control study[J].World Neurosurgery,2017,98:203-210.
[20]NOLL K R,WEINBERG J S,ZIU M,et al.Neurocognitive changes associated with surgical resection of left and right temporal lobe glioma[J].Neurosurgery,2015,77(5):777-785.
[21]MCALEER M F,BROWN P D.Neurocognitive function following therapy for low-grade gliomas[J].Semin Radiat Oncol,2015,25(3):210-218.
[22]VAN DER VOSSEN S,SCHEPERS V P,BERKELBACH VANDER SPRENKEL J W,et al.Cognitive and emotional problems in patients after cerebral meningioma surgery[J].J Rehabil Med,2014,46(5):430-437.