中文版卒中认知评估量表在非失语脑卒中患者中的信效度和临床应用

关键词：卒中患者认知评估量表  认知评估  信效度  临床应用  卒中后认知障碍

Keywords:cognitive assessment scale for stroke patients  cognitive assessment  reliability and validity  clinical application  post-stroke cognitive impairment

摘要：

      摘要 目的：在对卒中认知评估量表（CASP）进行翻译和信效度验证的基础上，探讨该量表在卒中后认知障碍（PSCI）中的临床应用价值，以期完善卒中患者的认知评估体系。 方法：将原始版本CASP翻译成中文版，分别使用简易精神状态量表（MMSE）、蒙特利尔认知评估量表（MoCA）和中文版卒中认知评估量表（C-CASP）对82例脑卒中患者进行评估。采用Cronbach's α系数、组内相关系数（ICC）进行信度分析，采用结构效度和效标效度进行效度分析，采用独立样本t检验对脑卒中患者的认知功能、病灶性质和损伤部位进行分层分析。 结果：Cronbach's α=0.792，评估者间信度ICC 0.999和0.998，重测信度ICC 0.985和0.982。提取出1个因子，方差累计贡献率52.89%。C-CASP与MMSE、MoCA、ADL的相关系数为0.867、0.848、0.597。C-CASP的曲线下面积（AUC）为0.938，最佳截断值32分，敏感度94.5%，特异度77.8%。认知受损组的C-CASP总分和各条目得分显著低于认知非受损组（P<0.05）；右半球损伤组的C-CASP“二分线段”得分显著低于左半球损伤组（P<0.05）；缺血性卒中组的C-CASP“命名”和“理解能力”条目得分显著低于出血性卒中组（P<0.05）。 结论：C-CASP是一种可靠有效的脑卒中后认知功能障碍筛查工具，该量表检测的认知阈较宽泛，比MMSE更适用于卒中患者的认知功能评估。

Abstract:

      Abstract Objective： To explore the clinical application value of the cognitive assessment scale for stroke patients （CASP） in post-stroke cognitive impairment （PSCI） based on the translation and reliability and validity testing of the original CASP in order to improve the cognitive assessment system for stroke patients. Method： The original version of CASP was translated into Chinese， and a total of 82 stroke patients were assessed using the Mini-Mental State Examination (MMSE)，the Montreal Cognitive Assessment (MoCA) and the Chinese version of CASP (C-CASP). Reliability analysis was conducted using Cronbach's α coefficient and inter-group correlation coefficient （ICC）. Structure validity and criterion validity were analyzed to assess the validity. The stroke patients were stratified according to cognitive function， lesion location and injury nature using independent sample t-tests. Result： The reliability analysis showed the Cronbach's α coefficient was 0.792，and the inter-rater reliability ICC was 0.999 and 0.998， while the ICC was 0.985 and 0.982 for retest reliability. The structure validity analysis extracted one factor with a cumulative contribution rate of 52.89%. The correlation coefficients of C-CASP with MMSE， MoCA and ADL were 0.867， 0.848 and 0.597. The area under the curve(AUC) for C-CASP was 0.938， with an optimal cutoff score of 32， sensitivity of 94.5%， and specificity of 77.8%. The total scores and item scores of C-CASP in the patients with cognitive impairment were significantly lower than those in the patients with non-cognitive impairment（P<0.05）. The item scores of the “bisection of a horizontal line” in C-CASP were significantly lower in the patients with right hemisphere lesions compared to the patients with left hemisphere lesions（P<0.05）. Additionally， the patients with ischemic stroke scored significantly lower than the patients with hemorrhagic stroke on the items of “naming” and “comprehension” in C-CASP （P<0.05）. Conclusions： C-CASP is a reliable and valid screening tool for assessing cognitive function in stroke patients. C-CASP has a broader cognitive threshold， which is more suitable than MMSE for the assessment of cognitive function in stroke patients.