MoCA量表对创伤后应激障碍患者认知功能损伤的临床研究

目的 探讨MoCA量表在创伤后应激障碍（PTSD）患者认知功能损伤中的应用。 方法 纳入PTSD患者28例、经历创伤事件未发生PTSD患者28例和心理健康测评者28例，共3组。均行PTSD自评量表（PCL - C）和认知功能评定量表（MoCA）评估。结果 PCL - C总分与再体验、回避麻木与警觉性增高分项得分PTSD组＞非PTSD组＞对照组（F = 164.790，F = 98.570，F = 124.879，F = 138.570，P＜0.05）；PTSD组和对照组在MoCA总分和各个分项上的差异具有统计学意义（P＜0.05）；除了语言表达能力（2组无统计学差异,F = 7.572，P＞0.05），PTSD组和非PTSD组在MoCA总分和各个分项上的差异具有统计学意义（P＜0.05）；非PTSD组和对照组在语言表达和注意力上的得分差异具有统计学意义（F = 7.572，F = 38.626，P＜0.05）；在空间与执行能力、命名能力、抽象、延时回忆、定向力和MoCA总分的差异无统计学意义（P = 0.074，P = 0.256，P = 0.316，P = 0.274，P = 0.063，P = 0.052）；行Spearman相关分析显示，PTSD组PCL - C总分及3个症状群均和MoCA总分和7个认知小分项呈显著负相关（P＜0.01）；行多元线性回归分析显示，R2 = 0.968，F = 240.135，表明再体验、麻木回避和警觉性增高联合起来对PTSD患者的认知功能损伤的影响是显著的，在对单个预测变量的回归系数B进行t检验时发现，只有预测变量警觉性增高的P = 0.275＞0.05，说明警觉性增高对PTSD患者认知功能损伤的影响是不显著的，而再体验和麻木回避对PTSD患者认知功能损伤的影响是显著的。结论 PTSD患者存在认知功能损伤，且随着PTSD症状加重，认知功能的损伤越明显；其中再体验和麻木回避这两大症状群对认知功能的损伤有显著的影响。

Clinical study of cognitive impairment in patients with post-traumatic stress disorder by MoCA scale

Objective The aim of this study was to explore the application of MoCA scale in evaluating cognitive impairment of patients with posttraumatic stress disorder (PTSD). Methods 28 patients with PTSD were assigned as PTSD group, 28 people who experienced traumatic events without developing PTSD were assigned as non-PTSD group, and 28 people who planned to take a mental health test were used as control group. All the people completed the assessment of PCL-C and MoCA. Results PCL-C total score and re-experience, numbness and avoidance, increased alertness score were arranged in PTSD group, the non-PTSD group and the control group from small to large (F=164.790，F=98.570, F=124.879, F=138.570, P<0.05). The difference between the PTSD group and the control group was statistically significant in the total score of MoCA and in each sub-items. In addition to language expression ability (no difference between the two groups, F=7.572, P>0.05), the difference between the group of PTSD group and non-PTSD group was statistically significant in the total score of MoCA and in each sub-items(P<0.05). The difference in verbal expression and attention score between non-PTSD group and control group was statistically significant(F=7.572, F=38.626, P<0.05), there was no statistically significant difference between spatial and executive ability, naming ability, abstract, time-lapse recall, orientation force and MoCA total score(P=0.074, P=0.256, P=0.316, P=0.274, P=0.063, P=0.052). According to the Spearman correlation analysis, the PCL-C total score and 3 symptom groups of the PTSD group were significantly negatively correlated with the total score of MoCA and 7 cognitive sub-items (P<0.01). According to the multiple linear regression analysis, R2=0.968 and F=240.135 indicated that the influence of united reexperience, numbness and avoidance，increased alertness on cognitive impairment of the patients with PTSD was significant. Using inspection for B, the regression coefficient of a single prediction variable, we found that only the P value of prediction variables increased alertness was 0.275>0.05, showing that the influence of increased alertness on cognitive impairment of the patients with PTSD was not significant, and the influence of reexperience, numbness and avoidance on cognitive impairment of the patients with PTSD was significant. Conclusion There was cognitive impairment in patients with PTSD. And with the aggravation of PTSD symptoms, the impairment of cognitive function is more obvious. The re-experience and numbness and avoidance had a significant effect on cognitive impairment of the patients with PTSD.