轻度认知损害与简易精神状态检查分项相关性分析及其中医防治研究
|
摘要
目的探讨上海中医药大学附属普陀临床医学院门诊及住院病人不同分型轻度认知功能损害(MCI)和不同体质MCI患者与简易精神状态检查(MMSE)量表分项的相关性。方法根据2004年轻度认知功能损害(MCI)国际工作组制订的诊断标准,选择163例MCI患者并进行aMCI(遗忘型)和naMCI(非遗忘型)分型,收集调查对象的一般资料、神经心理测试量表、临床表现和舌脉,根据王琦等制订的9种基本中医体质类型的分类及其诊断表述依据判断中医体质类型。结果纳入的163例MCI患者中,aMCI 126例,naMCI 37例。MMSE量表中注意力及计算力、回忆力与aMCI相关(P <0.05),时间定向力、注意力及计算力、书写/叙述能力与naMCI相关(P <0.05)。MCI平和质、气虚质、阳虚质、阴虚质、湿热质、血瘀质及气郁质患者MMSE量表中注意力及计算力的得分率最低,痰湿质患者记忆力得分率最低。结论注意力及计算力、回忆力是aMCI较易损害的认知领域;时间定向力、注意力及计算力、书写/叙述能力是naMCI较易损害的认知领域。平和质、气虚质、阳虚质、阴虚质、湿热质、血瘀质及气郁质患者认知损害领域集中在注意力及计算力,痰湿质患者集中在记忆力。研究有利于识别MCI早期认知功能变化,为MCI中医防治提供有益线索。
Objective To explore correlation between mild cognitive impairment(MCI) and subitem of MMSE on MCI patients from Putuo Hospital, Shanghai University of Traditional Chinese Medicine(inpatient and outpatient).Methods A clinical investigation was conducted in 163 respondents according to diagnostic criteria set by International Working Group on MCI in 2004. 163 MCI patients were classified in amnestic MCI(aMCI) and non-amnestic MCI(naMCI). General information, neuropsychological scales, clinical manifestation, tongue and pulse of the respondents were selected to put into the study, and TCM constitutions of MCI patients were judged based on Classification and Diagnostic Expression Basis on 9 Basic Types of TCM Constitution drawn up by WANG Qi. Results Totally 163 MCI patients were accepted into the study. 126 patients were ill with aMCI, and 37 patients were ill with naMCI.There were correlations between attention and computing ability, memory ability and aMCI(P < 0.05), while there were correlations between orientation to time, attention and computing ability, writing/narrative ability in MMSE and naMCI(P < 0.05). Scoring of attention and computing ability of MMSE in mildly constitution, qi deficiency constitution, yang deficiency constitution, yin deficiency constitution, damp-heat constitution, blood stasis constitution and qi stagnation constitution were lower. Scoring of memory ability of MMSE in phlegm-damp constitution was the lowest. Conclusion Attention and computing ability, memory ability are the cognitive fields to be easily impaired in aMCI. Orientation to time, attention and computing ability, writing/narrative ability are the cognitive fields to be easily impaired in naMCI. Attention and computing ability is liable to be impaired in mildly constitution, qi deficiency constitution, yang deficiency constitution, yin deficiency constitution, damp-heat constitution, blood stasis constitution and qi stagnation constitution. Memory ability is liable to be impaired in phlegm-damp constitution. Revealing the cognitive fields which are liable to be impaired in different type and different constitution of MCI is beneficial to recognize the change of cognitive function in early stage of MCI, which will plays a crucial role in MCI prevention.
Objective To explore correlation between mild cognitive impairment(MCI) and subitem of MMSE on MCI patients from Putuo Hospital, Shanghai University of Traditional Chinese Medicine(inpatient and outpatient).Methods A clinical investigation was conducted in 163 respondents according to diagnostic criteria set by International Working Group on MCI in 2004. 163 MCI patients were classified in amnestic MCI(aMCI) and non-amnestic MCI(naMCI). General information, neuropsychological scales, clinical manifestation, tongue and pulse of the respondents were selected to put into the study, and TCM constitutions of MCI patients were judged based on Classification and Diagnostic Expression Basis on 9 Basic Types of TCM Constitution drawn up by WANG Qi. Results Totally 163 MCI patients were accepted into the study. 126 patients were ill with aMCI, and 37 patients were ill with naMCI.There were correlations between attention and computing ability, memory ability and aMCI(P < 0.05), while there were correlations between orientation to time, attention and computing ability, writing/narrative ability in MMSE and naMCI(P < 0.05). Scoring of attention and computing ability of MMSE in mildly constitution, qi deficiency constitution, yang deficiency constitution, yin deficiency constitution, damp-heat constitution, blood stasis constitution and qi stagnation constitution were lower. Scoring of memory ability of MMSE in phlegm-damp constitution was the lowest. Conclusion Attention and computing ability, memory ability are the cognitive fields to be easily impaired in aMCI. Orientation to time, attention and computing ability, writing/narrative ability are the cognitive fields to be easily impaired in naMCI. Attention and computing ability is liable to be impaired in mildly constitution, qi deficiency constitution, yang deficiency constitution, yin deficiency constitution, damp-heat constitution, blood stasis constitution and qi stagnation constitution. Memory ability is liable to be impaired in phlegm-damp constitution. Revealing the cognitive fields which are liable to be impaired in different type and different constitution of MCI is beneficial to recognize the change of cognitive function in early stage of MCI, which will plays a crucial role in MCI prevention.
引文
[1]WINBLAD B,PALMER K,KIVIPELTO M,et al.Mild cognitive impairment-beyond controversies,towards a consensus:report of the International Working Group on Mild Cognitive Impairment[J].J Intern Med,2004,256(3):240-246.
[2]PETERSEN R C.Mild cognitive impairment:current research and clinical implications[J].Seminars in Neurology,2007,27(1):22-31.
[3]王琦.9种基本中医体质类型的分类及其诊断表述依据[J].北京中医药大学学报,2005,28(4):1-8.
[4]FOLSTEIN M F,FOLSTEIN S E,MCHUGH P R.“MiniMental State”:a practical method for grading the cognitive state of patients for the clinician[J].Journal of Psychiatric research,1975,12(3):189-198.
[5]KATZMAN R,ZHANG M Y,OUANG Y Q,et al.A Chinese version of the Mini-Mental State Examination;impact of illiteracy in a Shanghai dementia survey[J].J Clin Epidemiol,1988,41(10):971-978.
[6]王征宇,张明园.中文版简易智能状态检查(MMSE)的应用[J].上海精神医学,1989,7(3):108-111.
[7]LAWTON M P,BRODY E M.Assessment of older people:self-maintaining and instrumental activities of daily living[J].Gerontologist,1969,9(3):179-186.
[8]STEMMLER M,STEINWACBS,LEBFEL H,et al.Different methodological approaches for the construction of a therapy sensitive ADL scale for the assessment of Alzheimer patients[J].Spinnger Verlag Wien,1994:81-89.
[9]肖世富.神经心理测验和评定量表在阿尔茨海默病的应用及价值[J].中国现代神经疾病杂志,2005,5(3):137-140.
[10]PETERSEN R C,SMITH G E,WARING S C,et al.Mild cognitive impairment:clinical characterization and outcome[J].Arch Neurol,1999,56(3):303-308.
[11]PETERSEN R C,STEVENS J C,GANGULI M,et al.Practice parameter:early detection of dementia:mild cognitive impairment(an evidence-based review).Report of the Quality Standards Subcommittee of the American Academy of Neurology[J].Neurology,2001,56(9):1133-1142.
[12]KNOPMAN D S,JACK CR J R,WISTE H J,et al.Shortterm clinical outcomes for stages of NIA-AA preclinical Alzheimer disease[J].Neurology,2012,78(20):1576-1582.
[13]黄觉斌,张振馨,洪霞,等.自然人群中老年人轻度认知障碍的随访研究[J].中华神经科杂志,2004,37(2):105-108.
[14]WINBIAD B,PALMET K,KIVIPELTO M,et a1.Mild cognitive impairment-beyond controversies,towards a consensus:report of the International Working Group on Mild Cognitive Impairment[J].J Intern Med,2004,256(3):240-246.
[15]ALISTAIR B,MICHAEL Z.Mild cognitive impairment in older people[J].Lancet,2002(360):1963-1965.
[16]陈美蓉,郭起浩,周燕,等.两种遗忘型轻度认知损害患者的随访比较[J].中华神经科杂志,2010,43(5):351-354.
[17]王琦.9种基本中医体质类型的分类及其诊断表述依据[J].北京中医药大学学报,2005,28(4):1-8.
[18]俞璐,夏明,冯青根,等.轻度认知功能损害的中医体质调查研究[J].辽宁中医,2017,44(5):1-5.
[19]张志斌,王永炎.试论中医“治未病”之概念及其科学内容[J].北京中医药大学学报,2007,30(7):440-444.
[2]PETERSEN R C.Mild cognitive impairment:current research and clinical implications[J].Seminars in Neurology,2007,27(1):22-31.
[3]王琦.9种基本中医体质类型的分类及其诊断表述依据[J].北京中医药大学学报,2005,28(4):1-8.
[4]FOLSTEIN M F,FOLSTEIN S E,MCHUGH P R.“MiniMental State”:a practical method for grading the cognitive state of patients for the clinician[J].Journal of Psychiatric research,1975,12(3):189-198.
[5]KATZMAN R,ZHANG M Y,OUANG Y Q,et al.A Chinese version of the Mini-Mental State Examination;impact of illiteracy in a Shanghai dementia survey[J].J Clin Epidemiol,1988,41(10):971-978.
[6]王征宇,张明园.中文版简易智能状态检查(MMSE)的应用[J].上海精神医学,1989,7(3):108-111.
[7]LAWTON M P,BRODY E M.Assessment of older people:self-maintaining and instrumental activities of daily living[J].Gerontologist,1969,9(3):179-186.
[8]STEMMLER M,STEINWACBS,LEBFEL H,et al.Different methodological approaches for the construction of a therapy sensitive ADL scale for the assessment of Alzheimer patients[J].Spinnger Verlag Wien,1994:81-89.
[9]肖世富.神经心理测验和评定量表在阿尔茨海默病的应用及价值[J].中国现代神经疾病杂志,2005,5(3):137-140.
[10]PETERSEN R C,SMITH G E,WARING S C,et al.Mild cognitive impairment:clinical characterization and outcome[J].Arch Neurol,1999,56(3):303-308.
[11]PETERSEN R C,STEVENS J C,GANGULI M,et al.Practice parameter:early detection of dementia:mild cognitive impairment(an evidence-based review).Report of the Quality Standards Subcommittee of the American Academy of Neurology[J].Neurology,2001,56(9):1133-1142.
[12]KNOPMAN D S,JACK CR J R,WISTE H J,et al.Shortterm clinical outcomes for stages of NIA-AA preclinical Alzheimer disease[J].Neurology,2012,78(20):1576-1582.
[13]黄觉斌,张振馨,洪霞,等.自然人群中老年人轻度认知障碍的随访研究[J].中华神经科杂志,2004,37(2):105-108.
[14]WINBIAD B,PALMET K,KIVIPELTO M,et a1.Mild cognitive impairment-beyond controversies,towards a consensus:report of the International Working Group on Mild Cognitive Impairment[J].J Intern Med,2004,256(3):240-246.
[15]ALISTAIR B,MICHAEL Z.Mild cognitive impairment in older people[J].Lancet,2002(360):1963-1965.
[16]陈美蓉,郭起浩,周燕,等.两种遗忘型轻度认知损害患者的随访比较[J].中华神经科杂志,2010,43(5):351-354.
[17]王琦.9种基本中医体质类型的分类及其诊断表述依据[J].北京中医药大学学报,2005,28(4):1-8.
[18]俞璐,夏明,冯青根,等.轻度认知功能损害的中医体质调查研究[J].辽宁中医,2017,44(5):1-5.
[19]张志斌,王永炎.试论中医“治未病”之概念及其科学内容[J].北京中医药大学学报,2007,30(7):440-444.