中文版认知障碍简要测试量表与简易精神状态检查量表在脑卒中患者认知评估中的比较分析

Comparative analysis of brief assessment of impaired cognition (Chinese version) and mini mental state examination scales in cognitive assessment of stroke patients

摘要:

目的： 比较简易精神状态检查量表（mini mental state examination，MMSE）和中文版认知障碍简要测试量表（brief assessment of impaired cognition，BASIC）在脑卒中患者认知测评中的表现，为临床使用提供理论参考。 方法： 纳入常州市第一人民医院2020年5月至2021年1月97例卒中中心住院的脑卒中患者作为脑卒中组，另选择40例年龄、性别和受教育程度相匹配的健康体检个体作为对照组，由经培训的康复医师对所有受试对象进行MMSE和BASIC测评，比较分析两者的测评结果。 结果： ①与对照组相比，脑卒中组MMSE和BASIC得分明显下降，说明脑卒中后患者认知功能显著受损。②脑卒中组MMSE和BASIC总分呈明显正相关（r=0.662，P=0.000）。③直线相关提示年龄与MMSE（r=-0.324，P=0.001）和BASIC（r=-0.401，P=0.000）均呈负相关。教育年限则与MMSE（r=0.349，P=0.000）和BASIC（r=0.378，P=0.000）均呈正相关。多元线性回归提示MMSE结果不受年龄影响。④MMSE和BASIC无显著天花板和地板效应。⑤Kappa分析显示两量表在评估脑卒中患者认知功能障碍时一致性一般（Kappa=0.286，P=0.005）。⑥受试者工作曲线提示，MMSE和BASIC曲线下面积无明显差异，MMSE和BASIC的最佳截值分别为27.5和20.5。 结论： BASIC量表衰减效应低、操作耗时短，可作为脑卒中后认知功能障碍的早期快速筛查工具，但应用于老年高文化程度患者时需酌情分析结果。

Abstract:

Objective: To compare the performance of mini mental state examination (MMSE) and Chinese version of brief assessment of impaired cognition (BASIC) in the cognitive assessment of patients with stroke, so as to provide theoretical reference for clinical use. Methods: A total of 97 patients with stroke hospitalized in The First People's Hospital of Changzhou from May 2020 to January 2021 were selected as the stroke group, and another 40 healthy individuals matched with age, sex and education level were selected as the control group. All subjects were assessed by trained rehabilitation physicians for MMSE and BASIC, and the results were compared and analyzed. Results: ①Compared with the control group, the scores of MMSE and BASIC in the stroke group decreased significantly, indicating that the cognitive function of patients with stroke was significantly impaired. ②The results of MMSE and BASIC in the stroke group were positively correlated (r=0.662, P=0.000). ③Linear correlation suggested that age was negatively correlated with MMSE (r=-0.324, P=0.001) and BASIC (r=-0.401, P=0.000), while education years were positively correlated with MMSE (r=0.349, P=0.000) and BASIC (r=0.378, P=0.000). However, multiple linear regression showed that the results of MMSE were not affected by age.④MMSE and BASIC had no significant ceiling and floor effects.⑤Kappa analysis showed that the consistency of the two scales in screening for cognitive dysfunction in stroke patients was fair (Kappa=0.286, P=0.005). ⑥The receiver operating characteristic curve showed that there was no significant difference in the areas under the curve between MMSE and BASIC. The best cut-off values of MMSE and BASIC were 27.5 and 20.5, respectively. Conclusion: BASIC scale has low attenuation effect and short operation time, which can be used as an early rapid screening tool for cognitive dysfunction after stroke. However, it is necessary to further improve its assessment accuracy and pay attention to the selection of the assessment population.