MOCA量表在西安市軍隊(duì)干休所離退休干部輕度認(rèn)知功能障礙診斷中的應(yīng)用及修訂
發(fā)布時(shí)間：2018-12-13 04:42
【摘要】：隨著人口的老齡化，老年性癡呆(阿爾茨海默病Alzheimer’s disease,AD)的發(fā)生率日益增高。而輕度認(rèn)知功能障礙(Mild cognitive impairment,MCI)的老年人是老年性癡呆的早期表現(xiàn)[1]。能夠極早篩查并干預(yù)對(duì)AD的發(fā)生具有重要的臨床價(jià)值。蒙特利爾認(rèn)知評(píng)估(Montreal cognitive assessment,MOCA)量表[2]對(duì)快速篩查MCI患者，具有較高的靈敏度(Sensitivity,Se)和特異度(Specificity,Sp)[3-7]，被國(guó)際上廣泛應(yīng)用。2006年來(lái)我國(guó)學(xué)者應(yīng)用MOCA量表對(duì)中國(guó)老年人研究表明，MOCA量表檢驗(yàn)篩查輕度認(rèn)知功能障礙患者優(yōu)于簡(jiǎn)易智能精神狀態(tài)檢查(Mini—mentalstate examination，MMSE)量表，但由于東西方文化背景不同及生活習(xí)慣的差異，該量表對(duì)國(guó)人應(yīng)用時(shí)存在插圖陌生、詞語(yǔ)生僻、理解困難、受試者不易接受等問(wèn)題，具體操作中存在爭(zhēng)議和難度，影響測(cè)試結(jié)果，需要進(jìn)一步修訂[8-15]。 本研究應(yīng)用MOCA量表對(duì)西安軍隊(duì)干休所離退休干部進(jìn)行輕度認(rèn)知功能障礙的檢驗(yàn)篩查，同時(shí)對(duì)相關(guān)危險(xiǎn)因素進(jìn)行流行病學(xué)調(diào)查和分析。并針對(duì)MOCA量表在國(guó)人中應(yīng)用時(shí)存在的不足，結(jié)合國(guó)人的文化背景、生活習(xí)慣及中國(guó)老年人的生活經(jīng)歷等進(jìn)行適合中國(guó)老年人的修訂，并對(duì)修訂的MOCA量表進(jìn)行了信效度的檢測(cè)。 研究目的 1．應(yīng)用MOCA量表對(duì)西安軍隊(duì)干休所離退休干部進(jìn)行輕度認(rèn)知功能障礙的流行病學(xué)調(diào)查，分析相關(guān)危險(xiǎn)因素。 2．針對(duì)MOCA原量表在中國(guó)人群實(shí)際應(yīng)用中存在的不足，對(duì)其進(jìn)行修訂并對(duì)修訂后的MOCA量表進(jìn)行信度和效度檢驗(yàn)并分析。 研究方法 隨機(jī)、整群抽樣選取西安市9所軍隊(duì)干休所304名離退休干部同時(shí)進(jìn)行個(gè)人信息、患病情況、用藥情況、MOCA原量表、修訂后的MOCA量表(196名)及相關(guān)神經(jīng)精神量表調(diào)查，并對(duì)修訂后的MOCA量表1個(gè)月后隨機(jī)抽樣選取30名離退休干部進(jìn)行重測(cè)。 研究結(jié)果 1．西安軍隊(duì)干休所離退休干部輕度認(rèn)知功能障礙發(fā)生率為64.8%。 2．80歲以上輕度認(rèn)知功能障礙(Mild cognitive impairment, MCI)的發(fā)生率(67.56%)高于70歲組(47.62%)，二者有顯著性差異(P0.05)；教育年限小于6年者M(jìn)CI的發(fā)生率(72%)高于7～12年及12年以上者，二者有顯著性差異(P0.05)；不參加體育鍛煉者M(jìn)CI的發(fā)生率(80.95%)高于經(jīng)常參加體育鍛煉者(60.58%)，二者有顯著性差異(P0.01)；有腦卒中者M(jìn)CI的發(fā)生率(73.33%)高于無(wú)腦卒中者(57.64%)，，二者有顯著性差異(P0.05)。 3．MOCA量表得分與MMSE量表得分相關(guān)分析顯示，MOCA量表得分與MMSE量表得分顯著相關(guān)，r=0.81。MOCA量表得分與日�；顒�(dòng)能力量表、抑郁自評(píng)量表得分呈負(fù)相關(guān)。 4．修訂后的MOCA量表內(nèi)部一致性克朗巴赫α系數(shù)(Cronbach’s alpha)為0.862；Spearman-brown分半信度系數(shù)為0.862，兩分半子量表得分的相關(guān)系數(shù)為0.669。1個(gè)月后隨機(jī)抽樣選取30名離退休干部進(jìn)行重測(cè)，重測(cè)信度為0.831。具有較好的一致性信度和重測(cè)信度。 5．修訂后的MOCA量表與原表各緯度(測(cè)試項(xiàng)目)進(jìn)行相關(guān)性分析結(jié)果顯示，各緯度(測(cè)試項(xiàng)目)間具有顯著性相關(guān)，相關(guān)系數(shù)為0.501～0.942(P0.05)；修訂的MOCA量表各因子(測(cè)試項(xiàng)目得分)與總分呈顯著相關(guān)，相關(guān)系數(shù)在0.392～0.832之間。 6．修訂后的MOCA量表與原MOCA量表總分具有相關(guān)性，相關(guān)系數(shù)為0.878(P0.01)。 7．修訂后的MOCA量表具有較好的反應(yīng)度：不同年齡間量表總分以及視空間、語(yǔ)言、延遲記憶、注意和抽象得分的差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；不同性別量表總分以及視空間執(zhí)行功能、延遲記憶能力得分差異有統(tǒng)計(jì)學(xué)意義(P0.05)；不同受教育時(shí)間間量表總分以及視空間執(zhí)行功能、語(yǔ)言、注意、時(shí)空間定向能力得分差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 8．截?cái)帱c(diǎn)取28分時(shí)，修訂后的MOCA量表ROC曲線下面積最大，為0.859（0.809～0.910）。 結(jié)論 1．西安市軍隊(duì)干休所離退休干部輕度認(rèn)知功能障礙(MCI)發(fā)生率較高。 2．高齡、受教育年限低、不參加體育鍛煉、有腦卒中者M(jìn)CI的發(fā)生率高。 3．按照符合中國(guó)老年人的文化背景和生活習(xí)慣的指標(biāo)進(jìn)行修訂的MOCA量表，更易于操作、更適用于我國(guó)老年人群輕度認(rèn)知功能障礙的篩查和診斷。 4．修訂后的MOCA量表具有較好的信度、效度和反應(yīng)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
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R749.16
本文編號(hào)：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
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R749.16
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