血管性痴呆患者发病前后精神状态检查量表评分变化及其预测因子的分析

目的调查血管性痴呆（VD）患者发病前后认知功能状况的改变及其预测因子。方法选择2004年＂北京市老龄化多维纵向研究＂中完成4年随访的1797名受试者,其中新发VD共27例,选择其中658名年龄、文化程度与其相匹配的认知功能正常的老年人作为对照组。采用简易精神状态检查（MMSE）量表进行检查,并与2000年的检查结果比较。采用Logistic多元逐步回归分析寻找MMSE量表中的预测因子。结果①VD组发病前的MMSE总分、阅读、构图、书写、时间定向、地点定向、延时记忆、计算亚项的评分均低于对照组;VD组发病后,除识记亚项之外,MMSE总分及各项评分均低于对照组,差异有统计学意义,均P〈0.05。②两组2004年与2000年的MMSE评分差值比较显示,VD组在构图、时间定向、地点定向、计算、注意及总分项目上减少分数均高于对照组,差异有统计学意义,均P〈0.05。③Logistic多元回归分析,MMSE评分中,计算亚项为VD发生的独立预测因子（OR=1.47,95%CI：1.16～1.86）。结论 VD患者发病前已存在非痴呆性认知功能障碍。其认知功能的下降程度随时间进展。早期MMSE评分中,计算亚项评分的下降是VD发生的独立预测因子。

Cognitive function changes in patients with vascular dementia before and after symptom onset and analysis of its cognitive predictor

Objective To study the changes of cognitive function and the onset predictors in patients with vascular dementia(VD).Methods A total of 1797 participants whom completed 4-year follow-up study were selected from Multidimensional longitudinal Study of Aging in Beijing 2004,in which 27 were newly developed VD,and 658 educational level marched normal old people were used as a normal control group.The mini-mental state examination(MMSE) was used for examination,and the results were compared with the data at 2000.Logistic multivariate stepwise regression analysis was used to find the preditive factors.Results ①The total score of the MMSE and the scores of reading,composition,writing,time orientation,place orientation,delayed memory,and sub-item calculation in the VD group before onset were lower than those in the normal control group.In addition to the memorizing sub-item,the total score of the MMSE after onset in the VD group was lower than that in the normal control group.There was significant difference(P<0.05).②The comparison of the MMSE score differences between the 2 groups before and after onset showed that the reduced scores of composition,time orientation,place orientation,calculation,attention and total score in the VD group were higher than those in the normal control group.There were significant differences(P<0.05).③Multiple logistic regression analysis indicated that the calculation of the sub-items in the MMSE scores was the independent predictor for the occurrence of VD(OR 1.47,95% CI 1.16-1.86,P<0.01).Conclusion The patients with VD have already had preclinical cognitive deficits.Calculation of the decreased sub-items in early MMSE scores is the independent cognitive predictor for the occurrence of VD.