Stroop色词测验在早期识别卒中后认知障碍中的作用研究

doi:10.12114/j.issn.1007-9572.2021.00.446

摘要/Abstract

摘要： 背景　卒中后认知障碍（PSCI）作为急性脑梗死并发症之一，严重影响患者生活质量，增加患者家庭及社会经济负担。目前用于评估急性脑梗死患者认知功能的量表存在耗时长、灵敏度有限、患者配合差等问题，因此需要探索操作更方便快捷、灵敏度更高的评估工具。目的　探究Stroop色词测验在早期识别PSCI中的作用。方法　选取2019年10月—2020年6月于成都市第三人民医院神经内科住院治疗的急性脑梗死患者174例为研究对象，依据北京版蒙特利尔认知评估量表（MoCA）总分将患者分为认知障碍组（PSCI组）、非认知障碍组（NPSCI组）。采用Stroop色词测验评估两组患者执行功能，比较两组患者的执行功能，并进一步分析Stroop色词测验指标与MoCA总分及其各认知域评分的相关性。绘制Stroop色词测验指标诊断急性脑梗死患者发生PSCI的受试者工作特征（ROC）曲线。结果　依据MoCA评估结果，PSCI组130例，平均MoCA总分为（18.2±4.2）分；NPSCI组44例，平均MoCA总分为（25.3±2.2）分；急性脑梗死患者PSCI发生率为74.7%（130/174）。PSCI组患者年龄大于NPSCI组（P<0.05）。PSCI组患者卡片A、B、C耗时和Stroop色词测验干扰量（SIE）耗时、SIE正确数、正确数递减率、卡片A耗时/正确数、卡片B耗时/正确数、卡片C耗时/正确数高于NPSCI组，卡片B、C正确数低于NPSCI组（P<0.05）。卡片A耗时、卡片B耗时、卡片C耗时、SIE正确数、正确数递减率、卡片A耗时/正确数、卡片B耗时/正确数、卡片C耗时/正确数均与MoCA总分及视空间与执行功能、命名、注意力、语言、抽象思维、延迟回忆、定向力评分呈负相关（P<0.05），卡片B、C正确数与之呈正相关（P<0.05）；SIE耗时与MoCA总分、视空间与执行功能、语言、延迟回忆、定向力评分均呈负相关（P<0.05）。卡片C耗时、SIE正确数、正确数递减率、卡片C耗时/正确数诊断急性脑梗死患者发生PSCI的灵敏度分别为87.7%、76.2%、76.2%、76.9%，特异度分别为56.8%、77.3%、77.3%、72.7%，最佳截断值分别为95.89 s、1.5、3.02%、2.36；ROC曲线下面积（AUC）分别为0.750〔95%CI（0.663，0.836）〕、0.802〔95%CI（0.730，0.874）〕、0.796〔95%CI（0.721，0.872）〕、0.796〔95%CI（0.718，0.874）〕，且均P<0.01；约登指数分别为0.445、0.535、0.535、0.496。结论　急性脑梗死早期PSCI发生率较高，PSCI患者执行功能较差，多数Stroop色词测验指标与MoCA各认知域评分存在相关性。在急性脑梗死早期，利用Stroop色词测验诊断PSCI具有较高的灵敏度和特异度，有助于早期快速识别PSCI患者。

关键词: 脑梗死, 卒中后认知障碍, Stroop色词测验, 执行功能, 诊断

Abstract: Background　Post-stroke cognitive impairment（PSCI） is one of the complications of acute cerebral infarction，which seriously affects the quality of life and increases the burden on patients' families and social economy.Current available scales used to assess the cognitive function of stroke patients have problems such as longer time consuming，limited sensitivity，and poor cooperation of patients.So there is a need to explore a more convenient and sensitive assessment tool.Objective　We aimed to explore the applicability of Stroop color word test（SCWT） on PSCI in the early stage.Methods　174 patients with acute cerebral infarction who were hospitalized in the Department of Neurology of the Third People's Hospital of Chengdu from October 2019 to June 2020 were selected.The Beijing version of the Montreal Cognitive Assessment （MoCA） was used to screen cognitive impairment.The SCWT was used to assess the executive function of patients with and without cognitive impairment.The correlation of the indictors of SCWT with the scale and each cognitive domain score of the MoCA was analyzed.The ROC curve of the indictors of SCWT in predicting PSCI was plotted and analyzed.Results　One hundred and thirty cases were found with PSCI，accounting for 74.7%（130/174），with an average scale score of MoCA of （18.2±4.2） points，other 44 without PSCI had an average scale score of MoCA of （25.3±2.2） points.PSCI group had a greater average age （P<0.05）.PSCI group used more time to finish card A，B，and C，had greater completion time of SIE（the difference between completion time for card C and that for card B），more correct response number of SIE，higher decline rate of correct response number，higher ratio of completion time for card A，B，or C to correct response number and less correct response numbers of cards B and C on average（P<0.05）.The completion time for card A，B or C，correct response number of SIE，decline rate of correct response number，ratio of completion time for card A，B or C to correct response number were negatively correlated with the scale score of MoCA and its domain scores of visuospatial and executive functioning，animal naming，attention，language，abstraction，delayed recall，and orientation （P<0.05），while the correct response number of card B or C was positively correlated with them （P<0.05）.The completion time of SIE was negatively correlated with the scale score of MoCA and its domain scores of visuospatial and executive functioning，language，delayed recall，and orientation （P<0.05）.In predicting PSCI，the sensitivity and specificity of the completion time for card C were 87.7% and 56.8%，with an AUC of 0.750〔95%CI（0.663，0.836），P<0.01〕when the optimal cut-off value was determined as 95.89 s and Youden's index of 0.445.The sensitivity and specificity of correct response number of SIE were 76.2% and 77.3%，with an AUC of 0.802〔95%CI（0.730，0.874），P<0.01〕when the optimal cut-off value was determined as 1.5 and Youden's index of 0.535.The sensitivity and specificity of decline rate of correct response number were 76.2% and 77.3%，with an AUC of 0.796〔95%CI（0.721，0.872），P<0.01〕when the optimal cut-off value was determined as 3.02% and Youden's index of 0.535.The sensitivity and specificity of ratio of completion time for card C to correct response number were 76.9% and 72.7%，with an AUC of 0.796〔95%CI（0.718，0.874），P<0.01〕when the optimal cut-off value was determined as 2.36 and Youden's index of 0.496.Conclusion　Patients at an early stage of acute cerebral infarction had high prevalence of cognitive impairment.PSCI patients had poor executive function，and their evaluation results by most items of the SCWT had correlation with the cognitive domain scores of MoCA，indicating that SCWT may have high sensitivity and specificity in rapidly diagnosing PSCI in early stage of acute cerebral infarction.

Key words: Brain infarction, Post-stroke cognitive impariment, Stroop color word test, Executive function, Diagnosis

张君芳,姜帅,赵晓玲,等. Stroop色词测验在早期识别卒中后认知障碍中的作用研究[J]. 中国全科医学, 2021, 24(15): 1896-1902. DOI: 10.12114/j.issn.1007-9572.2021.00.446.
ZHANG Junfang,JIANG Shuai,ZHAO Xiaoling, et al. Early Detection of Post-stroke Cognitive Impairment by Stroop Color Word Test　[J]. Chinese General Practice, 2021, 24(15): 1896-1902. DOI: 10.12114/j.issn.1007-9572.2021.00.446.

参考文献

［1］QU Y，ZHUO L，LI N，et al．Prevalence of post-stroke cognitive impairment in China：a community-based，cross-sectional study［J］．PLoS One，2015，10（4）：e0122864．DOI：10.1371/journal.pone.0122864.
［2］GENG S，LIU N，MENG P，et al．Midterm blood pressure variability is associated with poststroke cognitive impairment：a prospective cohort study［J］．Front Neurol，2017，8：365．DOI：10.3389/fneur.2017.00365.
［3］DIVYA K P，MENON R N，VARMA R P，et al．Post-stroke cognitive impairment——a cross-sectional comparison study between mild cognitive impairment of vascular and non-vascular etiology［J］．J Neurol Sci，2017，372：356-362．DOI：10.1016/j.jns.2016.10.031.
［4］LAAKSO H M，HIETANEN M，MELKAS S，et al．Executive function subdomains are associated with post-stroke functional outcome and permanent institutionalization［J］．Eur J Neurol，2019，26（3）：546-552．DOI：10.1111/ene.13854.
［5］CHEN K，HUANG L，LIN B，et al．The number of items on each stroop test card is unrelated to its sensitivity［J］．Neuropsychobiology，2019，77（1）：38-44．DOI：10.1159/000493553.
［6］郭起浩，洪震，吕传真，等．Stroop色词测验在早期识别阿尔茨海默病中的作用［J］．中华神经医学杂志，2005，4（7）：701-704．DOI：10.3760/cma.j.issn.1671-8925.2005.07.017.
GUO Q H，HONG Z，LYU C Z，et al．Application of Stroop color-word test on Chinese elderly patients with mild cognitive impairment and mild Alzheimer's dementia［J］．Chin J Neuromedicine，2005，4（7）：701-704．DOI：10.3760/cma.j.issn.1671-8925.2005.07.017.
［7］中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014［J］．中华神经科杂志，2015，48（4）：246-257．DOI：10.3760/cma.j.issn.1006-7876.2015.04.002.
［8］中国医师协会神经内科分会认知障碍专业委员会，《中国血管性认知障碍诊治指南》编写组.2019年中国血管性认知障碍诊治指南［J］．中华医学杂志，2019，99（35）：2737-2744．DOI：10.3760/cma.j.issn.0376-2491.2019.35.005.
［9］POVROZNIK J M，OZGA J E，VONDER HAAR C，et al．Executive （dys）function after stroke：special considerations for behavioral pharmacology［J］．Behav Pharmacol，2018，29（7）：638-653．DOI：10.1097/fbp.0000000000000432.
［10］SUDO F K，AMADO P，ALVES G S，et al．A continuum of executive function deficits in early subcortical vascular cognitive impairment：a systematic review and meta-analysis［J］．Dement Neuropsychol，2017，11（4）：371-380．DOI：10.1590/1980-57642016dn11-040006.
［11］OZGA J E，POVROZNIK J M，ENGLER-CHIURAZZI E B，et al．Executive （dys）function after traumatic brain injury：special considerations for behavioral pharmacology［J］．Behav Pharmacol，2018，29（7）：617-637．DOI：10.1097/fbp.0000000000000430.
［12］BLAIR C.Educating executive function［J］．WIREs Cogn Sci，2017，8（1/2）：e1403．DOI：10.1002/wcs.1403.
［13］MIYAKE A，FRIEDMAN N P.The nature and organization of individual differences in executive functions：four general conclusions［J］．Curr Dir Psychol Sci，2012，21（1）：8-14．DOI：10.1177/0963721411429458.
［14］VINCENT C，HALL P A.Executive function in adults with type 2 diabetes：a meta-analytic review［J］．Psychosom Med，2015，77（6）：631-642．DOI：10.1097/psy.0000000000000103.
［15］DOLCOS F，MILLER B，KRAGEL P，et al．Regional brain differences in the effect of distraction during the delay interval of a working memory task［J］．Brain Res，2007，1152：171-181．DOI：10.1016/j.brainres.2007.03.059.
［16］BELLA R，FERRI R，LANZA G，et al．TMS follow-up study in patients with vascular cognitive impairment-no dementia［J］．Neurosci Lett，2013，534：155-159．DOI：10.1016/j.neulet.2012.12.017.
［17］涂秋云，丁斌蓉，杨霞，等．缺血性脑血管病患者Stroop测验病例对照研究［J］．中华老年医学杂志，2011，30（11）：934-937．DOI：10.3760/cma.j.issn.0254-9026.2011.11.012.
TU Q Y，DING B R，YANG X，et al．A case-control study on the indexes of Stroop color-word test in the patients with ischemic cerebrovascular disease［J］．Chin J Geriatr，2011，30（11）：934-937．DOI：10.3760/cma.j.issn.0254-9026.2011.11.012.
［18］HILAL S，BAAIJ L G A，DE GROOT M，et al．Prevalence and clinical relevance of diffusion-weighted imaging lesions：The Rotterdam study［J］．Neurology，2019，93（11）：e1058-1067．DOI：10.1212/WNL.0000000000008090.
［19］DE BRUIJN M A A M，SYNHAEVE N E，VAN RIJSBERGEN M W A，et al．Long-term cognitive outcome of ischaemic stroke in young adults［J］．Cerebrovasc Dis Basel Switz，2014，37（5）：376-381．DOI：10.1159/000362592.
［20］VAN ROOIJ F G，PLAIZIER N O，VERMEER S E，et al．Executive function declines in the first 6 months after a transient ischemic attack or transient neurological attack［J］．Stroke，2017，48（12）：3323-3328．DOI：10.1161/strokeaha.117.018298.
［21］POSNER M I，ROTHBART M K，VOELKER P.Developing brain networks of attention［J］．Curr Opin Pediatr，2016，28（6）：720-724．DOI：10.1097/mop.0000000000000413.
［22］ARDILA A，BERNAL B，ROSSELLI M.Executive functions brain system：an activation likelihood estimation meta-analytic study［J］．Arch Clin Neuropsychol，2018，33（4）：379-405．DOI：10.1093/arclin/acx066.
［23］MAHONE M C，TRAVIS F，GEVIRTZ R，et al．fMRI during transcendental meditation practice［J］．Brain Cogn，2018，123：30-33．DOI：10.1016/j.bandc.2018.02.011.
［24］SAKURAI R，ISHII K，YASUNAGA M，et al．The neural substrate of gait and executive function relationship in elderly women：a PET study［J］．Geriatr Gerontol Int，2017，17（11）：1873-1880．DOI：10.1111/ggi.12982.
［25］SEO S W，AHN J，YOON U，et al．Cortical thinning in vascular mild cognitive impairment and vascular dementia of subcortical type［J］．J Neuroimaging，2010，20（1）：37-45．DOI：10.1111/j.1552-6569.2008.00293.x.
［26］KIM C，KROGER J K，CALHOUN V D，et al．The role of the frontopolar cortex in manipulation of integrated information in working memory［J］．Neurosci Lett，2015，595：25-29．DOI：10.1016/j.neulet.2015.03.044.
［27］PRADO J，CARP J，WEISSMAN D H.Variations of response time in a selective attention task are linked to variations of functional connectivity in the attentional network［J］．Neuroimage，2011，54（1）：541-549．DOI：10.1016/j.neuroimage.2010.08.022.
［28］TROYER A K，LEACH L，STRAUSS E.Aging and response inhibition：normative data for the Victoria Stroop Test［J］．Neuropsychol Dev Cogn B Aging Neuropsychol Cogn，2006，13（1）：20-35．DOI：10.1080/138255890968187.
［29］OVERTON M，PIHLSG?RD M，ELMST?HL S.Prevalence and incidence of mild cognitive impairment across subtypes，age，and sex［J］．Dement Geriatr Cogn Disord，2019，47（4/5/6）：219-232．DOI：10.1159/000499763.
［30］BOHLKEN J，JACOB L，KOSTEV K.Progression of mild cognitive impairment to dementia in German specialist practices［J］．Dementia，2019，18（1）：380-390．DOI：10.1177/1471301216673919.
［31］CSIPO T，LIPECZ A，FULOP G A，et al．Age-related decline in peripheral vascular health predicts cognitive impairment［J］．Geroscience，2019，41（2）：125-136．DOI：10.1007/s11357-019-00063-5.
［32］KALARIA R N，AKINYEMI R，IHARA M.Stroke injury，cognitive impairment and vascular dementia［J］．Biochim et Biophys Acta，2016，1862（5）：915-925．DOI：10.1016/j.bbadis.2016.01.015.
［33］CHEN X，DUAN L，HAN Y，et al．Predictors for vascular cognitive impairment in stroke patients［J］．BMC Neurol，2016，16：115．DOI：10.1186/s12883-016-0638-8.

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