国产日韩欧美一区二区三区三州_亚洲少妇熟女av_久久久久亚洲av国产精品_波多野结衣网站一区二区_亚洲欧美色片在线91_国产亚洲精品精品国产优播av_日本一区二区三区波多野结衣 _久久国产av不卡

?

卒中后認(rèn)知障礙評(píng)估工具篩查準(zhǔn)確性的Meta分析

2024-08-06 00:00:00馬玉霞楊依依魏曉琴陳燕茹秦江霞袁月陳雅婧吳銀瓶韓琳
中國(guó)全科醫(yī)學(xué) 2024年32期

【摘要】 背景 卒中后認(rèn)知障礙(PSCI)給患者及其家庭帶來(lái)沉重的負(fù)擔(dān),早期識(shí)別及干預(yù)有助于延緩PSCI的發(fā)生及進(jìn)展,因此,使用準(zhǔn)確的神經(jīng)心理評(píng)估工具對(duì)PSCI進(jìn)行篩查,對(duì)于患者的管理和治療至關(guān)重要。目的 采用Meta分析的方法評(píng)價(jià)PSCI篩查工具的篩查準(zhǔn)確性,為準(zhǔn)確篩查PSCI提供依據(jù)。方法 檢索數(shù)據(jù)庫(kù)中國(guó)知網(wǎng)、維普網(wǎng)、萬(wàn)方數(shù)據(jù)知識(shí)服務(wù)平臺(tái)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)服務(wù)系統(tǒng)、PubMed、Embase、Web of Science、Cochrane Library中有關(guān)PSCI篩查工具的診斷性試驗(yàn)研究,檢索日期為建庫(kù)至2022年12月。2位研究者各自篩選文獻(xiàn)、提取數(shù)據(jù)、評(píng)估偏倚風(fēng)險(xiǎn)。采用Stata 17.0軟件分析數(shù)據(jù)。結(jié)果 共納入57篇文獻(xiàn),包含12 113例患者,報(bào)告了7種PSCI篩查工具:美國(guó)國(guó)立神經(jīng)疾病和卒中研究院-加拿大卒中網(wǎng)5-min測(cè)驗(yàn)(NINDS-CSN 5-min測(cè)驗(yàn))、蒙特利爾認(rèn)知評(píng)估量表(MoCA)、簡(jiǎn)易精神狀況檢查量表(MMSE)、老年認(rèn)知功能減退知情者問(wèn)卷(IQCODE)、阿登布魯克認(rèn)知能力檢查-修訂版(ACE-R)、認(rèn)知功能電話問(wèn)卷修訂版(TICS-m)、5分鐘蒙特利爾評(píng)估(MoCA-5 min)。Meta分析結(jié)果顯示:MoCA篩查PSCI的合并靈敏度及特異度分別為0.84(95%CI=0.80~0.87)和0.74(95%CI=0.67~0.80),合并AUC為0.87(95%CI=0.84~0.90);MMSE篩查PSCI的合并靈敏度及特異度為0.73(95%CI=0.67~0.79)和0.76(95%CI=0.69~0.82),合并AUC為0.81(95%CI=0.77~0.84);IQCODE篩查PSCI的合并靈敏度及特異度為0.73(95%CI=0.48~0.89)和0.95(95%CI=0.75~0.99),合并AUC為0.91(95%CI=0.88~0.93);NINDS-CSN 5-min測(cè)驗(yàn)篩查PSCI的合并靈敏度及特異度為0.83(95%CI=0.78~0.87)、0.69(95%CI=0.60~0.76),合并AUC為0.85(95%CI=0.81~0.88);ACE-R篩查PSCI的合并靈敏度及特異度為0.90(95%CI=0.80~0.95)、0.61(95%CI=0.19~0.91),合并AUC為0.90(95%CI=

0.87~0.92);TICS-m篩查PSCI的合并靈敏度及特異度為0.84(95%CI=0.75~0.91)、0.67(95%CI=0.61~0.74),合并AUC為0.66(95%CI=0.60~0.71)。結(jié)論 IQCODE和ACE-R的合并AUC較高,且IQCODE具有較高的合并特異度,ACE-R具有較高的合并靈敏度,故IQCODE和ACE-R是較為準(zhǔn)確的PSCI篩查工具。因IQCODE和ACE-R納入文獻(xiàn)數(shù)量有限,以上結(jié)論仍需多中心、大樣本研究予以驗(yàn)證。

【關(guān)鍵詞】 卒中后認(rèn)知障礙;篩查工具;Meta分析;診斷性試驗(yàn)

【中圖分類號(hào)】 R 749.1 【文獻(xiàn)標(biāo)識(shí)碼】 A DOI:10.12114/j.issn.1007-9572.2023.0873

The Accuracy of Screening for Post-stroke Cognitive Impairment Assessment Tools:a Meta-analysis

MA Yuxia1,2,YANG Yiyi1,WEI Xiaoqin1,CHEN Yanru1,QIN Jiangxia1,YUAN Yue1,CHEN Yajing1,WU Yinping3,HAN Lin1,4*

1.Center for Evidence-based Nursing,School of Nursing,Lanzhou University,Lanzhou 730011,China

2.The First School of Clinical Medicine,Lanzhou University,Lanzhou 730000,China

3.Department of Medical Oncology,the Second Hospital of Lanzhou University,Lanzhou 730030,China

4.Department of Nursing,Gansu Provincial Hospital,Lanzhou 730000,China

*Corresponding author:HAN Lin,Professor;E-mail:hanlin@lzu.edu.cn

【Abstract】 Background Post-stroke cognitive impairment(PSCI) brings a heavy burden to patients and their families. An early recognition and intervention can help delay the occurrence and development of PSCI. Therefore,the use of accurate neuropsychological assessment tools to screen for PSCI is essential for the management and treatment of PSCI. Objective To analyze the screening accuracy of assessment tools for PSCI by meta-analysis,thus providing references for an accurate screening of PSCI. Methods Diagnostic trials on screening tools of PSCI published from the establishment of the database to December 2022 were searched in CNKI,VIP,Wanfang Data,SinoMed,PubMed,Embase,Web of Science,Cochrane Library. Two researchers respectively screened literatures,extracted data,and assessed the risk of bias. Stata 17.0 software was used to analyze the data. Results A total of 57 articles were included,involving 7 assessment tools [the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network 5-Minute Battery(NINDS-CSN 5-Minutes),the Montreal Cognitive Assessment(MoCA),the Mini-Mental State Examination(MMSE),the Informant Questionnaire on Cognitive Decline in the Elderly(IQCODE),the Addenbrooke's Cognitive Examination-Revised(ACE-R),the Telephone Interview for Cognitive Status Modified(TICS-m)and the Montreal Cognitive Assessment 5-minute protocol(MoCA-5 min)] to screen 12 113 patients. Meta-analysis results showed that the combined sensitivity and specificity of MoCA in screening PSCI were 0.84(95%CI=0.80-0.87) and 0.74(95%CI=0.67-0.80),respectively,with a combined area under the curve(AUC) of 0.87(95%CI=0.84-0.90). The combined sensitivity and specificity of MMSE in screening PSCI were 0.73(95%CI=0.67-0.79)and 0.76(95%CI=0.69-0.82),respectively,with a combined AUC of 0.81(95%CI=0.77-0.84). The combined sensitivity and specificity of IQCODE in screening PSCI were 0.73(95%CI=0.48-0.89) and 0.95(95%CI=0.75-0.99),respectively,with a combined AUC of 0.91(95%CI=0.88-0.93). The combined sensitivity and specificity of the NINDS-CSN 5-min in screening PSCI were 0.83(95%CI=0.78-0.87) and 0.69(95%CI=0.60-0.76),respectively,with a combined AUC of 0.85(95%CI=0.81-0.88). The combined sensitivity and specificity of the ACE-R in screening PSCI were 0.90(95%CI=0.80-0.95) and 0.61(95%CI=0.19-0.91),respectively,with a combined AUC of 0.90(95%CI=0.87-0.92). The combined sensitivity and specificity of TICS-m in screening PSCI were 0.84(95%CI=0.75-0.91) and 0.67(95%CI=0.61-0.74),respectively,with a combined AUC of 0.66(95%CI=0.60-0.71). Conclusion The combined AUC of IQCODE and ACE-R is larger,and the former as a higher combined specificity and the latter has a higher combined sensitivity. Therefore,IQCODE and ACE-R are optimal assessment tools to accurately screen PSCI. Due to the limited number of literatures reporting the IQCODE and ACE-R in screening PSCI,our conclusions still need to be validated by multicenter and large-sample studies.

【Key words】 Post-stroke cognitive impairment;Screening tools;Meta-analysis;Diagnostic test

根據(jù)《中國(guó)卒中報(bào)告2020》,中國(guó)40歲及以上人群卒中年發(fā)病率為201/10萬(wàn)[1],死亡率為149.49/10萬(wàn)[2]。卒中會(huì)導(dǎo)致各種并發(fā)癥,而卒中后認(rèn)知障礙(post-stroke cognitive impairment,PSCI)是主要并發(fā)癥之一[3]。PSCI是一種臨床綜合征,其特征是在卒中事件后持續(xù)6個(gè)月的認(rèn)知障礙[4]。研究報(bào)道PSCI的發(fā)病率為24%~53.4%[5-6]。PSCI包括卒中后認(rèn)知障礙非癡呆和卒中后癡呆,有研究顯示卒中后認(rèn)知障礙非癡呆患者5年生存率約為75%,而卒中后癡呆患者5年生存率僅為39%[7]??梢?jiàn),PSCI對(duì)患者的生活質(zhì)量和生存時(shí)間造成重大影響,同時(shí)給家庭、社會(huì)帶來(lái)巨大負(fù)擔(dān)[8]。

神經(jīng)心理評(píng)估是篩查和診斷PSCI及觀察認(rèn)知障礙程度的重要工具[4]。目前臨床常用的神經(jīng)心理評(píng)估工具有美國(guó)國(guó)立神經(jīng)疾病和卒中研究院-加拿大卒中網(wǎng)5-min測(cè)驗(yàn)(NINDS-CSN 5-min測(cè)驗(yàn))、蒙特利爾認(rèn)知評(píng)估量表(MoCA)、簡(jiǎn)易精神狀況檢查量表(MMSE)、老年認(rèn)知功能減退知情者問(wèn)卷(IQCODE)、阿登布魯克認(rèn)知能力檢查-修訂版(ACE-R)、認(rèn)知功能電話問(wèn)卷修訂版(TICS-m)等[9]。而不同工具在篩查PSCI時(shí)的靈敏度、特異度、評(píng)估時(shí)間、評(píng)估內(nèi)容等方面差異較大,增加了實(shí)際應(yīng)用中選擇的難度。因此,本研究采取Meta分析的方法,對(duì)不同的PSCI篩查工具的篩查準(zhǔn)確性進(jìn)行比較,為選擇PSCI篩查工具提供有力的證據(jù)支持。

1 資料與方法

1.1 納入與排除標(biāo)準(zhǔn)

1.1.1 納入標(biāo)準(zhǔn):研究類型:診斷試驗(yàn)以英文或中文發(fā)表。研究對(duì)象:年齡≥18歲的卒中患者。PSCI診斷金標(biāo)準(zhǔn):經(jīng)臨床、影像學(xué)、神經(jīng)心理三方面評(píng)估確診為PSCI;MRI是PSCI影像學(xué)評(píng)估的金標(biāo)準(zhǔn),至少包括腦萎縮(位置、程度)、腦梗死(位置、大小、數(shù)量)、腦白質(zhì)病變(范圍)、腦出血(位置、大小、數(shù)量);神經(jīng)心理評(píng)估:可多種工具結(jié)合,以確定認(rèn)知障礙及程度,包括最少5個(gè)核心認(rèn)知領(lǐng)域:執(zhí)行功能、注意、記憶、語(yǔ)言和視空間功能[4]。診斷試驗(yàn):至少用一種工具篩查PSCI。結(jié)局指標(biāo)包括報(bào)告的真陽(yáng)性、假陽(yáng)性、真陰性、假陰性、靈敏度、特異度。

1.1.2 排除標(biāo)準(zhǔn):合并其他腦血管疾病所致認(rèn)知障礙的研究,如阿爾茨海默病等;不能提取相關(guān)數(shù)據(jù)的研究;重復(fù)發(fā)表的研究;綜述和會(huì)議摘要;文獻(xiàn)檢索時(shí)發(fā)現(xiàn)的包含同一種研究工具的研究少于2篇。

1.2 檢索策略

檢索數(shù)據(jù)庫(kù)中國(guó)知網(wǎng)、維普網(wǎng)、萬(wàn)方數(shù)據(jù)知識(shí)服務(wù)平臺(tái)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)服務(wù)系統(tǒng)、PubMed、Embase、Web of Science、Cochrane Library,檢索日期為建庫(kù)至2022年12月。檢索時(shí)使用主題詞和自由詞結(jié)合。中文檢索詞:中風(fēng)、腦卒中、腦出血、腦梗死、腦血栓、腦血管疾??;認(rèn)知障礙、神經(jīng)行為障礙、記憶障礙、認(rèn)知功能損害、血管性癡呆、精神衰退;評(píng)估工具、篩查工具、量表、評(píng)分、問(wèn)卷、評(píng)估方法、綜合評(píng)估。英文檢索詞:stroke,cerebrovascular accident,brain vascular,CVA,intracranial hemorrhage,cerebral thrombosis,cerebral embolism,brain ischemia,cerebrovascular disease,brain injury;cognitive dysfunction,cognitive impairment,cognitive decline,cognition disorder,vascular dementia,mental disorders,auditory perceptual disorders;tool,score,scoring,scale,questionnaire,instrument,assessment。

1.3 文獻(xiàn)篩選與資料提取

將檢索結(jié)果錄入EndNote X9軟件去重,并進(jìn)行文獻(xiàn)篩選。2名研究人員分別提取數(shù)據(jù)和交叉檢查。存在分歧時(shí)由第3位研究員協(xié)商。初步篩選標(biāo)題和摘要后,研究員閱讀全文二次篩選后,確定納入的文獻(xiàn)。提取納入文獻(xiàn)基本信息:如作者、年份、國(guó)家等;納入文獻(xiàn)基本特征:患者來(lái)源、樣本量、性別、年齡等;試驗(yàn)相關(guān)要素:篩查量表、參考標(biāo)準(zhǔn)等;結(jié)局指標(biāo)包括靈敏度、特異度、真陽(yáng)性、假陽(yáng)性、真陰性、假陰性等。

1.4 文獻(xiàn)偏倚風(fēng)險(xiǎn)評(píng)估

2位研究者各自使用Cochrane Collaboration推薦的QUADAS-2[10]進(jìn)行納入文獻(xiàn)的方法學(xué)質(zhì)量評(píng)估。若存在分歧,由第3位研究員協(xié)商。采用RevMan 5.4繪制偏倚風(fēng)險(xiǎn)評(píng)估圖。

1.5 統(tǒng)計(jì)學(xué)方法

采用Stata 17.0的“Midas”程序包進(jìn)行Meta分析。采用隨機(jī)效應(yīng)模型進(jìn)行雙變量診斷分析,置信區(qū)間為95%,分析合并靈敏度、合并特異度、合并陽(yáng)性似然比、合并陰性似然比、合并診斷比值比、合并綜合受試者工作特征(SROC)曲線下面積(AUC)。I2表示異質(zhì)性程度,如P>0.1、I2<50%,則說(shuō)明納入研究異質(zhì)性低。若結(jié)果的異質(zhì)性較大,對(duì)有足夠研究數(shù)量的篩查工具采用單變量Meta回歸探索異質(zhì)性來(lái)源[11]。采用Z檢驗(yàn)比較合并靈敏度、特異度,以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

2.1 文獻(xiàn)篩選結(jié)果

通過(guò)對(duì)數(shù)據(jù)庫(kù)初步篩選,共獲得20 456篇文獻(xiàn)。EndNote X9去重后剩余18 251篇。在閱讀標(biāo)題、摘要后,不符合納入標(biāo)準(zhǔn)的論文被排除,剩余597篇。閱讀全文、按照排除標(biāo)準(zhǔn)進(jìn)一步排除后,最終納入文獻(xiàn)57篇[12-68],見(jiàn)圖1。

2.2 納入文獻(xiàn)的基本特征及偏倚風(fēng)險(xiǎn)

納入文獻(xiàn)的基本特征見(jiàn)表1。納入57篇研究[12-68]中共涉及7種篩查工具,共12 113例。其中37篇研究[12-13,15-22,24-28,30-34,36-37,40-48,50,52-54,56,59]使用MoCA進(jìn)行PSCI的篩查,26篇研究[14-15,19,23-24,27,30,34,37,40-41,43,45,48,50-54,56,58-59,61-63,68]使用MMSE進(jìn)行PSCI的篩查,7篇研究[55,57,60-61,64,66-67]使用IQCODE進(jìn)行PSCI篩查,6篇研究[18,29,35-36,47,49]使用NINDS-CSN 5-min測(cè)驗(yàn)進(jìn)行PSCI的篩查,4篇研究[28,39,47,64]使用TICS-m進(jìn)行PSCI的篩查,4篇研究[14,30,50-51]使用ACE-R進(jìn)行PSCI的篩查,2篇研究[18,38]使用

5 min蒙特利爾評(píng)估(MoCA-5 min)進(jìn)行PSCI的篩查。

QUADAS-2結(jié)果表明:31項(xiàng)研究[14,17,19,24-25,27,30-32,34-39,41,44,46,48,50-52,55,57-59,61-63,65-66]運(yùn)用了盲法,28項(xiàng)研究[15-16,21-22,25-26,28-30,32-34,36,38,44,46-47,49-50,57-58,60-61,63-64,66-68]納入連續(xù)病例,51項(xiàng)研究[12,14-23,25-36,38-52,54-62,65-68]避免病例對(duì)照,42項(xiàng)研究[14-15,17-18,20-27,29-30,32,34-35,37-38,41-43,45,47-50,52-57,59-61,63,65-68]事先設(shè)定了各篩查量表的閾值,所有研究描述了失訪情況,偏倚風(fēng)險(xiǎn)整體較低,臨床適用性整體較高。納入文獻(xiàn)的偏倚風(fēng)險(xiǎn)評(píng)估結(jié)果見(jiàn)圖2。

2.3 Meta分析結(jié)果

本研究通過(guò)隨機(jī)效應(yīng)模型對(duì)有足夠研究數(shù)量(n≥4)的6個(gè)篩查工具進(jìn)行Meta分析,并對(duì)6個(gè)篩查工具的準(zhǔn)確性進(jìn)行匯總(表2)。

2.3.1 靈敏度:ACE-R的合并靈敏度為0.90(95%CI=0.80~0.95),MoCA的合并靈敏度為0.84(95%CI=0.80~0.87),TICS-m的合并靈敏度為0.84(95%CI=0.75~0.91),NINDS-CSN 5-min測(cè)驗(yàn)的合并靈敏度為0.83(95%CI=0.78~0.87),IQCODE的合并靈敏度為0.73(95%CI=0.48~0.89),MMSE的合并靈敏度為0.73(95%CI=0.67~0.79)。

2.3.2 特異度:IQCODE的合并特異度為0.95(95%CI=0.75~0.99),MMSE的合并特異度為0.76(95%CI=0.69~0.82),MoCA的合并特異度為0.74(95%CI=0.67~0.80),NINDS-CSN 5-min測(cè)驗(yàn)的合并特異度為0.69(95%CI=0.60~0.76),TICS-m的合并特異度為0.67(95%CI=0.61~0.74),ACE-R的合并特異度為0.61(95%CI=0.19~0.91)。

2.3.3 合并靈敏度及合并特異度比較:ACE-R與MMSE合并靈敏度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=

-4.580,P<0.05);ACE-R與MoCA合并靈敏度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=-2.092,P<0.05);ACE-R與IQCODE合并靈敏度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=5.005,P<0.05);ACE-R與TICS-m合并靈敏度比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=1.244,P>0.05);ACE-R與NINDS-CSN 5-min合并靈敏度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=5.875,P<0.05)。

ACE-R與MMSE合并特異度比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=-0.803,P>0.05);ACE-R與MoCA合并特異度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=-2.574,P<0.05);ACE-R與IQCODE合并特異度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=2.082,P<0.05);ACE-R與TICS-m合并特異度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=2.787,P<0.05);ACE-R與NINDS-CSN 5-min合并特異度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=2.609,P<0.05)。

IQCODE與MMSE合并靈敏度比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=-1.673,P>0.05);IQCODE與MoCA合并靈敏度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=-5.980,P<0.05);IQCODE與TICS-m合并靈敏度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=-2.523,P<0.05);IQCODE與NINDS-CSN 5-min合并靈敏度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=-4.232,P<0.05)。

IQCODE與MMSE合并特異度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=4.606,P<0.05);IQCODE與MoCA合并特異度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=7.690,P<0.05);IQCODE與TICS-m合并特異度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=5.863,P<0.05);IQCODE與NINDS-CSN 5-min合并特異度比較,差異有統(tǒng)計(jì)學(xué)意義(Z=6.874,P<0.05)。

2.3.4 SROC曲線:Meta分析結(jié)果表明,6個(gè)PSCI篩查工具AUC均>0.80。其中,IQCODE的合并AUC為0.91(95%CI=0.88~0.93),ACE-R的合并AUC為0.90(95%CI=0.87~0.92),MoCA的合并AUC為0.87(95%CI=0.84~0.90),TICS-m的合并AUC為0.66(95%CI=0.60~0.71),NINDS-CSN 5-min測(cè)驗(yàn)的合并AUC為0.85(95%CI=0.81~0.88),MMSE的合并AUC為0.81(95%CI=0.77~0.84)。

2.4 Meta回歸

對(duì)MoCA進(jìn)行Meta回歸分析,探究異質(zhì)性來(lái)源。結(jié)果顯示,樣本量、評(píng)估時(shí)間、是否前瞻性研究、研究地點(diǎn)、是否盲法可影響合并靈敏度的異質(zhì)性;樣本量、研究地點(diǎn)、是否盲法是合并特異度的異質(zhì)性來(lái)源(圖3)。

對(duì)MMSE進(jìn)行Meta回歸分析,探究異質(zhì)性來(lái)源。結(jié)果顯示,研究地點(diǎn)和是否盲法可影響合并靈敏度的異質(zhì)性;研究地點(diǎn)和是否盲法是合并特異度的異質(zhì)性來(lái)源(圖4)。

2.5 其他篩查工具

MoCA 5-min納入研究數(shù)量較少(n=2),且樣本量較小,可參考價(jià)值有限。

3 討論

PSCI是卒中后常見(jiàn)并發(fā)癥,對(duì)卒中患者進(jìn)行認(rèn)知評(píng)估尤為重要[4]。本系統(tǒng)評(píng)價(jià)著眼于PSCI篩查工具的篩查準(zhǔn)確性,Meta分析結(jié)果顯示,IQCODE和ACE-R的AUC高于MMSE和MoCA,提示對(duì)PSCI的篩查準(zhǔn)確性較好。與其他篩查試驗(yàn)相比,IQCODE還具有較高的合并特異度:0.95(95%CI=0.75~0.99),ACE-R具有較高的合并靈敏度:0.90(95%CI=0.80~0.95),且MMSE的靈敏度、特異度、ROC曲線的AUC點(diǎn)估計(jì)值均較低,MoCA特異度低于MMSE。但因IQCODE和ACE-R納入文章數(shù)量有限,仍需進(jìn)一步驗(yàn)證。

3.1 MoCA

MoCA包括記憶、視空間功能、執(zhí)行功能、注意、語(yǔ)言、時(shí)間和地點(diǎn)取向等認(rèn)知領(lǐng)域,評(píng)估時(shí)間15 min。若患者受教育年限<12年,MoCA評(píng)分需加1分。JAYWANT等[25]及GODEFROY等[56]發(fā)現(xiàn)其篩查PSCI的AUC為0.88,但PENDLEBURY等[47]及王慕秋等[54]發(fā)現(xiàn)其AUC僅為0.75~0.78,提示其篩查準(zhǔn)確性不高。還有研究顯示MoCA篩查PSCI的特異度較低(0.79)[69],WONG等[70]認(rèn)為這與卒中患者的受教育程度低和病情不穩(wěn)定或各研究截?cái)嘀禈?biāo)準(zhǔn)不統(tǒng)一有關(guān),需進(jìn)一步驗(yàn)證。

3.2 MMSE

MMSE包括30個(gè)條目,提供有關(guān)定向、注意力、學(xué)習(xí)、計(jì)算、延遲回憶和結(jié)構(gòu)的信息。評(píng)分依據(jù)為未受教育者>17分,小學(xué)>20分,中學(xué)及以上>24分者為認(rèn)知正常。有研究證實(shí)了MMSE作為卒中患者認(rèn)知功能篩查工具的可行性和有效性[71-72]。但有學(xué)者指出MMSE不能區(qū)分局灶性和彌漫性腦損傷,且對(duì)右側(cè)腦損傷不敏感[62,73]。結(jié)合本Meta分析結(jié)果,MMSE對(duì)PCSI的篩查價(jià)值有待進(jìn)一步研究。

3.3 IQCODE

IQCODE包含26個(gè)項(xiàng)目,通過(guò)詢問(wèn)了解患者情況的主要照護(hù)者來(lái)完成,評(píng)價(jià)過(guò)去10年中的記憶和其他認(rèn)知能力的變化。因IQCODE的評(píng)估是由研究者向患者的主要照護(hù)者提問(wèn),不需要卒中患者的參與,可防止患者年齡、教育程度、抑郁等癥狀對(duì)結(jié)果的影響。包紹智等[55]發(fā)現(xiàn),IQCODE適合初步篩查腔隙性卒中患者的認(rèn)知功能損害,具有較高的靈敏度(0.82)。但有學(xué)者發(fā)現(xiàn)IQCODE識(shí)別卒中后癡呆缺乏特異性[74],可能的原因是該問(wèn)卷易受患者主要照顧者的主觀期望和對(duì)患者病情熟悉程度等因素的影響。

3.4 ACE-R

ACE-R比MMSE涵蓋更多個(gè)認(rèn)知篩查領(lǐng)域,尤其增加了執(zhí)行功能的測(cè)量,并提供了5個(gè)分量表的常模數(shù)據(jù),可分析認(rèn)知障礙模式。有研究表明ACR-R對(duì)卒中后1年內(nèi)的認(rèn)知障礙篩查具有良好的靈敏度[14,50]。MORRIS等[51]發(fā)現(xiàn),ACE-R特異性存在爭(zhēng)議,可能與ACE-R定向、注意和記憶部分占比較大和納入人群文化差異有關(guān)。ACE-R在理想截?cái)嘀捣矫嬉泊嬖跔?zhēng)議[75],因此,可在我國(guó)臨床背景下進(jìn)一步驗(yàn)證ACE-R對(duì)PSCI的最佳閾值及受教育程度等對(duì)ACE-R篩查準(zhǔn)確性的影響。

3.5 本研究的局限性

(1)本次納入研究限于中、英文,可能存在選擇偏倚;(2)部分篩查工具納入的研究較少,今后可進(jìn)一步探究其篩查準(zhǔn)確性;(3)納入研究的截?cái)嘀挡槐M相同,可能導(dǎo)致研究間存在異質(zhì)性,今后可探討各量表使用不同截?cái)嘀禃r(shí)篩查PSCI的準(zhǔn)確性;(4)受少數(shù)納入研究限制,結(jié)果可能存在偏倚。產(chǎn)生偏倚風(fēng)險(xiǎn)的主要原因是:在最后的分析中未包含所有患者、未報(bào)告判讀待評(píng)價(jià)試驗(yàn)結(jié)果時(shí)是否在不知曉金標(biāo)準(zhǔn)結(jié)果的情況下進(jìn)行、未報(bào)告是否預(yù)先設(shè)定了閾值、未報(bào)告金標(biāo)準(zhǔn)結(jié)果判讀是否使用了盲法。因此,在今后的診斷性試驗(yàn)設(shè)計(jì)中,應(yīng)注意盡量避免病例對(duì)照設(shè)計(jì)、結(jié)果分析時(shí)盡量納入所有患者、盲法的合理使用和事先設(shè)定量表閾值。

4 小結(jié)

本研究結(jié)果顯示,IQCODE和ACE-R的合并AUC較高,且與其他篩查試驗(yàn)相比,IQCODE還具有較高的合并特異度,ACE-R具有較高的合并靈敏度,故IQCODE和ACE-R是較為準(zhǔn)確的PSCI篩查工具。另外,MMSE、MoCA的AUC均低于IQCODE和ACE-R,提示其PSCI篩查準(zhǔn)確性低于IQCODE和ACE-R。但受納入研究工具數(shù)量與質(zhì)量的限制,在未來(lái)的研究中可以開展IQCODE、ACE-R、MMSE、MoCA對(duì)PSCI篩查準(zhǔn)確性的比較研究,進(jìn)一步證實(shí)PSCI篩查的最優(yōu)工具。

作者貢獻(xiàn):馬玉霞、楊依依、陳燕茹進(jìn)行文章的構(gòu)思與設(shè)計(jì);馬玉霞、楊依依、魏曉琴進(jìn)行數(shù)據(jù)整理;楊依依、魏曉琴進(jìn)行文獻(xiàn)檢索、篩查和統(tǒng)計(jì)學(xué)處理;楊依依、魏曉琴、秦江霞、袁月、陳雅婧進(jìn)行結(jié)果的分析與解釋,論文的修訂;馬玉霞、楊依依負(fù)責(zé)撰寫論文;吳銀萍、韓琳負(fù)責(zé)文章的質(zhì)量控制及審核;馬玉霞、韓琳對(duì)文章整體負(fù)責(zé)、行政或技術(shù)材料的支持。

本文無(wú)利益沖突。

參考文獻(xiàn)

王隴德,彭斌,張鴻祺,等. 《中國(guó)腦卒中防治報(bào)告2020》概要[J]. 中國(guó)腦血管病雜志,2022,19(2):136-144.

WANG Y J,LI Z X,GU H Q,et al. China stroke statistics 2019:a report from the national center for healthcare quality management in neurological diseases,China national clinical research center for neurological diseases,the Chinese stroke association,national center for chronic and non-communicable disease control and prevention,Chinese center for disease control and prevention and institute for global neuroscience and stroke collaborations[J]. Stroke Vasc Neurol,2020,5(3):211-239. DOI:10.1136/svn-2020-000457.

汪凱,董強(qiáng),郁金泰,等. 卒中后認(rèn)知障礙管理專家共識(shí)2021[J]. 中國(guó)卒中雜志,2021,16(4):376-389.

MIJAJLOVI? M D,PAVLOVI? A,BRAININ M,et al. Post-stroke dementia - a comprehensive review[J]. BMC Med,2017,15(1):11. DOI:10.1186/s12916-017-0779-7.

DOUIRI A,RUDD A G,WOLFE C D A. Prevalence of poststroke cognitive impairment:South London Stroke Register 1995-2010[J]. Stroke,2013,44(1):138-145. DOI:10.1161/STROKEAHA.112.670844.

LO J W,CRAWFORD J D,DESMOND D W,et al. Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups[J]. Neurology,2019,93(24):e2257-2271. DOI:10.1212/WNL.0000000000008612.

中國(guó)卒中學(xué)會(huì),卒中后認(rèn)知障礙管理專家委員會(huì). 卒中后認(rèn)知障礙管理專家共識(shí)[J]. 中國(guó)卒中雜志,2017,12(6):519-531. DOI:10.3969/j.issn.1673-5765.2017.06.011.

GBD Causes of Death Collaborators. Global,regional,and national age-sex specific mortality for 264 causes of death,1980-2016:a systematic analysis for the Global Burden of Disease Study 2016[J]. Lancet,2017,390(10100):1151-1210. DOI:10.1016/S0140-6736(17)32152-9.

崔倩,李瑞玲,栗文娟,等. 《腦卒中后認(rèn)知障礙》指南解讀[J]. 護(hù)理研究,2022,36(22):3949-3952. DOI:10.12102/j.issn.1009-6493.2022.22.001.

REITSMA J B,MOONS K G,BOSSUYT P M,et al. Systematic reviews of studies quantifying the accuracy of diagnostic tests and markers[J]. Clin Chem,2012,58(11):1534-1545. DOI:10.1373/clinchem.2012.182568.

LIJMER J G,BOSSUYT P M M,HEISTERKAMP S H. Exploring sources of heterogeneity in systematic reviews of diagnostic tests[J]. Stat Med,2002,21(11):1525-1537. DOI:10.1002/sim.1185.

SALVADORI E,COVA I,MELE F,et al. Prediction of post-stroke cognitive impairment by Montreal Cognitive Assessment(MoCA)performances in acute stroke:comparison of three normative datasets[J]. Aging Clin Exp Res,2022,34(8):1855-1863. DOI:10.1007/s40520-022-02133-9.

RAMíREZ-MORENO J M,BARTOLOMé ALBERCA S,MU?OZ VEGA P,et al. Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack[J]. Neurologia,2022,37(1):38-44. DOI:10.1016/j.nrleng.2018.11.008.

CUSTODIO N,MONTESINOS R,ALVA-DIAZ C,et al. Diagnostic accuracy of brief cognitive screening tools to diagnose vascular cognitive impairment in Peru[J]. Int J Geriatr Psychiatry,2022,37(1). DOI:10.1002/gps.5531.

XU Y F,YI L R,LIN Y Y,et al. Screening for cognitive impairment after stroke:validation of the Chinese version of the quick mild cognitive impairment screen[J]. Front Neurol,2021,12:608188. DOI:10.3389/fneur.2021.608188.

MUNTHE-KAAS R,AAM S,SALTVEDT I,et al. Test accuracy of the Montreal cognitive assessment in screening for early poststroke neurocognitive disorder:the nor-COAST study[J]. Stroke,2021,52(1):317-320. DOI:10.1161/STROKEAHA.120.031030.

LIAO X L,ZUO L J,PAN Y S,et al. Screening for cognitive impairment with the Montreal cognitive assessment at six months after stroke and transient ischemic attack[J]. Neurol Res,2021,43(1):15-21. DOI:10.1080/01616412.2020.1819070.

FENG Y L,ZHANG J Q,ZHOU Y,et al. Concurrent validity of the short version of Montreal Cognitive Assessment(MoCA)for patients with stroke[J]. Sci Rep,2021,11(1):7204. DOI:10.1038/s41598-021-86615-2.

ZHU Y L,ZHAO S,F(xiàn)AN Z Q,et al. Evaluation of the mini-mental state examination and the Montreal cognitive assessment for predicting post-stroke cognitive impairment during the acute phase in Chinese minor stroke patients[J]. Front Aging Neurosci,2020,12:236. DOI:10.3389/fnagi.2020.00236.

ZAIDI K B,RICH J B,SUNDERLAND K M,et al. Methods for improving screening for vascular cognitive impairment using the Montreal cognitive assessment[J]. Can J Neurol Sci,2020,

47(6):756-763. DOI:10.1017/cjn.2020.121.

WEI J J,JIN X L,CHEN B X,et al. Comparative study of two short-form versions of the Montreal cognitive assessment for screening of post-stroke cognitive impairment in a Chinese population[J]. Clin Interv Aging,2020,15:907-914. DOI:10.2147/CIA.S248856.

POTOCNIK J,OVCAR STANTE K,RAKUSA M. The validity of the Montreal cognitive assessment(MoCA)for the screening of vascular cognitive impairment after ischemic stroke[J]. Acta Neurol Belg,2020,120(3):681-685. DOI:10.1007/s13760-020-01330-5.

李佳蕊,羅本燕. 不同量表對(duì)評(píng)價(jià)急性期卒中后認(rèn)知功能障礙的作用[J]. 阿爾茨海默病及相關(guān)病雜志,2020,3(2):108-112. DOI:10.3969/j.issn.2096-5516.2020.02.004.

金花,劉國(guó)利,姜彩霞,等. 不同量表對(duì)首發(fā)腦小血管閉塞性卒中患者早期認(rèn)知功能評(píng)價(jià)的比較[J]. 中國(guó)老年學(xué)雜志,2020,40(10):2029-2032. DOI:10.3969/j.issn.1005-9202.2020.10.005.

JAYWANT A,TOGLIA J,GUNNING F M,et al. The diagnostic accuracy of the Montreal Cognitive Assessment in inpatient stroke rehabilitation[J]. Neuropsychol Rehabil,2019,29(8):1163-1176. DOI:10.1080/09602011.2017.1372297.

CHAN E,GARRITSEN E,ALTENDORFF S,et al. Additional Queen Square(QS)screening items improve the test accuracy of the Montreal Cognitive Assessment(MoCA)after acute stroke[J]. J Neurol Sci,2019,407:116442. DOI:10.1016/j.jns.2019.116442.

粟珺,陳婷,陳李芳,等. MoCA-B和MMSE對(duì)首發(fā)急性腦卒中患者認(rèn)知功能障礙篩查作用的比較[J]. 中國(guó)神經(jīng)精神疾病雜志,2019,45(2):72-75. DOI:10.3969/j.issn.1002-0152.2019.02.002.

ZIETEMANN V,KOPCZAK A,MüLLER C,et al. Validation of the telephone interview of cognitive status and telephone Montreal cognitive assessment against detailed cognitive testing and clinical diagnosis of mild cognitive impairment after stroke[J]. Stroke,2017,48(11):2952-2957. DOI:10.1161/STROKEAHA.117.017519.

LIM J S,OH M S,LEE J H,et al. Prediction of post-stroke dementia using NINDS-CSN 5-minute neuropsychology protocol in acute stroke[J]. Int Psychogeriatr,2017,29(5):777-784. DOI:10.1017/S1041610216002520.

LEES R A,HENDRY BA K,BROOMFIELD N,et al. Cognitive assessment in stroke:feasibility and test properties using differing approaches to scoring of incomplete items[J]. Int J Geriatr Psychiatry,2017,32(10):1072-1078. DOI:10.1002/gps.4568.

CHAN E,ALTENDORFF S,HEALY C,et al. The test accuracy of the Montreal Cognitive Assessment(MoCA)by stroke lateralisation[J]. J Neurol Sci,2017,373:100-104. DOI:10.1016/j.jns.2016.12.028.

ZUO L J,DnyP0gY5CbNNZYYhmGwfruekflO1BF515PxV226ZClUo=ONG Y H,ZHU R Y,et al. Screening for cognitive impairment with the Montreal Cognitive Assessment in Chinese patients with acute mild stroke and transient ischaemic attack:a validation study[J]. BMJ Open,2016,6(7):e011310. DOI:10.1136/bmjopen-2016-011310.

SWARTZ R H,CAYLEY M L,LANCT?T K L,et al. Validating a pragmatic approach to cognitive screening in stroke prevention clinics using the Montreal cognitive assessment[J]. Stroke,2016,47(3):807-813. DOI:10.1161/STROKEAHA.115.011036.

SHEN Y J,WANG W A,HUANG F D,et al. The use of MMSE and MoCA in patients with acute ischemic stroke in clinical[J]. Int J Neurosci,2016,126(5):442-447. DOI:10.3109/00207454.2015.1031749.

LIN H F,CHERN C M,CHEN H M,et al. Validation of NINDS-VCI neuropsychology protocols for vascular cognitive impairment in Taiwan[J]. PLoS One,2016,11(6):e0156404. DOI:10.1371/journal.pone.0156404.

DONG Y H,XU J,CHAN B P,et al. The Montreal Cognitive Assessment is superior to National Institute of Neurological Disease and Stroke-Canadian Stroke Network 5-minute protocol in predicting vascular cognitive impairment at 1 year[J]. BMC Neurol,2016,16:46. DOI:10.1186/s12883-016-0570-y.

雷軍. MoCA與MMSE在缺血性腦卒中患者認(rèn)知功能改變中的應(yīng)用價(jià)值[J]. 中國(guó)實(shí)用神經(jīng)疾病雜志,2016,19(8):26-29. DOI:10.3969/j.issn.1673-5110.2016.08.014.

CHEN X L,F(xiàn)AN X Y,ZHAO L L,et al. Telephone-based cognitive screening for stroke patients in China[J]. Int Psychogeriatr,2015,27(12):2079-2085. DOI:10.1017/S1041610215000551.

BACCARO A,SEGRE A,WANG Y P,et al. Validation of the Brazilian-Portuguese version of the Modified Telephone Interview for cognitive status among stroke patients[J]. Geriatr Gerontol Int,2015,15(9):1118-1126. DOI:10.1111/ggi.12409.

XU Q,CAO W W,MI J H,et al. Brief screening for mild cognitive impairment in subcortical ischemic vascular disease:a comparison study of the Montreal Cognitive Assessment with the Mini-Mental State Examination[J]. Eur Neurol,2014,71(3/4):106-114. DOI:10.1159/000353988.

DONG Y H,SLAVIN M J,CHAN B P,et al. Improving screening for vascular cognitive impairment at three to six months after mild ischemic stroke and transient ischemic attack[J]. Int Psychogeriatr,2014,26(5):787-793. DOI:10.1017/S1041610213002457.

CHAN E,KHAN S,OLIVER R,et al. Underestimation of cognitive impairments by the Montreal Cognitive Assessment(MoCA)in an acute stroke unit population[J]. J Neurol Sci,2014,343(1/2):176-179. DOI:10.1016/j.jns.2014.05.005.

袁正洲,李作孝,李經(jīng)倫,等. 長(zhǎng)沙版蒙特利爾認(rèn)知評(píng)估量表在血管性認(rèn)知功能障礙中應(yīng)用的初步研究[J]. 重慶醫(yī)學(xué),2014,43(2):132-135. DOI:10.3969/j.issn.1671-8348.2014.02.002.

WU Y B,WANG M Q,REN M S,et al. The effects of educational background on Montreal Cognitive Assessment screening for vascular cognitive impairment,no dementia,caused by ischemic stroke[J]. J Clin Neurosci,2013,20(10):1406-1410. DOI:10.1016/j.jocn.2012.11.019.

WONG G K,LAM S W,WONG A,et al. Comparison of Montreal cognitive assessment and mini-mental state examination in evaluating cognitive domain deficit following aneurysmal subarachnoid haemorrhage[J]. PLoS One,2013,8(4):e59946. DOI:10.1371/journal.pone.0059946.

TU Q Y,JIN H,DING B R,et al. Reliability,validity,and optimal cutoff score of the Montreal cognitive assessment(Changsha version)in ischemic cerebrovascular disease patients of Hunan Province,China[J]. Dement Geriatr Cogn Dis Extra,

2013,3(1):25-36. DOI:10.1159/000346845.

PENDLEBURY S T,WELCH S J V,CUTHBERTSON F C,et al. Telephone assessment of cognition after transient ischemic attack and stroke:modified telephone interview of cognitive status and telephone Montreal Cognitive Assessment versus face-to-face Montreal Cognitive Assessment and neuropsychological battery[J]. Stroke,2013,44(1):227-229. DOI:10.1161/STROKEAHA.112.673384.

CUMMING T B,CHURILOV L,LINDEN T,et al. Montreal Cognitive Assessment and Mini-Mental State Examination are both valid cognitive tools in stroke[J]. Acta Neurol Scand,2013,128(2):122-129. DOI:10.1111/ane.12084.

BOCTI C,LEGAULT V,LEBLANC N,et al. Vascular cognitive impairment:most useful subtests of the Montreal Cognitive Assessment in minor stroke and transient ischemic attack[J]. Dement Geriatr Cogn Disord,2013,36(3/4):154-162. DOI:10.1159/000351674.

PENDLEBURY S T,MARIZ J,BULL L,et al. MoCA,ACE-R,and MMSE versus the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Neuropsychological Battery after TIA and stroke[J]. Stroke,2012,43(2):464-469. DOI:10.1161/STROKEAHA.111.633586.

MORRIS K,HACKER V,LINCOLN N B. The validity of the Addenbrooke's Cognitive Examination-Revised(ACE-R)in acute stroke[J]. Disabil Rehabil,2012,34(3):189-195. DOI:10.3109/09638288.2011.591884.

DONG Y H,VENKETASUBRAMANIAN N,CHAN B P L,et al.

Brief screening tests during acute admission in patients with mild stroke are predictive of vascular cognitive impairment 3-6 months after stroke[J]. J Neurol Neurosurg Psychiatry,2012,83(6):580-585. DOI:10.1136/jnnp-2011-302070.

袁正洲,馬勛泰,王雪梅,等. 長(zhǎng)沙版蒙特利爾認(rèn)知評(píng)估量表在腔隙性腦梗死后認(rèn)知功能障礙篩查中的應(yīng)用[J]. 第三軍醫(yī)大學(xué)學(xué)報(bào),2012,34(19):2025-2027. DOI:10.16016/j.1000-5404.2012.19.025.

王慕秋,任明山. 蒙特利爾認(rèn)知評(píng)估量表在缺血性腦卒中人群中的應(yīng)用價(jià)值探討[J]. 中國(guó)臨床神經(jīng)科學(xué),2012,20(2):199-204. DOI:10.3969/j.issn.1008-0678.2012.02.014.

包紹智,顏志欽,陳光勇,等. IQCODE在篩查腔隙性腦梗死患者主觀認(rèn)知功能損害中的應(yīng)用[J]. 實(shí)用醫(yī)學(xué)雜志,2012,28(19):3321-3322. DOI:10.3969/j.issn.1006-5725.2012.19.067.

GODEFROY O,F(xiàn)ICKL A,ROUSSEL M,et al. Is the Montreal Cognitive Assessment superior to the Mini-Mental State Examination to detect poststroke cognitive impairment? A study with neuropsychological evaluation[J]. Stroke,2011,42(6):1712-1716. DOI:10.1161/STROKEAHA.110.606277.

WAGLE J,F(xiàn)ARNER L,F(xiàn)LEKK?Y K,et al. Cognitive impairment and the role of the ApoE epsilon4-allele after stroke—a 13 months follow-up study[J]. Int J Geriatr Psychiatry,

2010,25(8):833-842. DOI:10.1002/gps.2425.

BOUR A,RASQUIN S,BOREAS A,et al. How predictive is the MMSE for cognitive performance after stroke?[J]. J Neurol,2010,257(4):630-637. DOI:10.1007/s00415-009-5387-9.

王延平,徐桂蘭,楊少青,等. 蒙特利爾認(rèn)知評(píng)估量表識(shí)別首次卒中后輕度血管性認(rèn)知障礙的作用[J]. 中華神經(jīng)醫(yī)學(xué)雜志,2010,9(5):503-507. DOI:10.3760/cma.j.issn.1671-8925.2010.05.016.

SERRANO S,DOMINGO J,RODRíGUEZ-GARCIA E,et al. Frequency of cognitive impairment without dementia in patients with stroke:a two-year follow-up study[J]. Stroke,2007,38(1):105-110. DOI:10.1161/01.STR.0000251804.13102.c0.

SRIKANTH V,THRIFT A G,F(xiàn)RYER J L,et al. The validity of brief screening cognitive instruments in the diagnosis of cognitive impairment and dementia after first-ever stroke[J]. Int Psychogeriatr,2006,18(2):295-305. DOI:10.1017/S1041610205002711.

FURE B,BRUUN WYLLER T,ENGEDAL K,et al. Cognitive impairments in acute lacunar stroke[J]. Acta Neurol Scand,2006,114(1):17-22. DOI:10.1111/j.1600-0404.2006.00603.x.

NYS G M,VAN ZANDVOORT M J,DE KORT P L,et al. Restrictions of the Mini-Mental State Examination in acute stroke[J]. Arch Clin Neuropsychol,2005,20(5):623-629. DOI:10.1016/j.acn.2005.04.001.

KLIMKOWICZ A,S?OWIK A,DZIEDZIC T,et al. Post-stroke dementia is associated with alpha(1)-antichymotrypsin polymorphism[J]. J Neurol Sci,2005,234(1/2):31-36. DOI:10.1016/j.jns.2005.02.012.

BARBER M,STOTT D J. Validity of the Telephone Interview for Cognitive Status(TICS)in post-stroke subjects[J]. Int J Geriatr Psychiatry,2004,19(1):75-79. DOI:10.1002/gps.1041.

TANG W K,CHAN S S,CHIU H F,et al. Can IQCODE detect poststroke dementia?[J]. Int J Geriatr Psychiatry,2003,18(8):706-710. DOI:10.1002/gps.908.

HéNON H,DURIEU I,GUEROUAOU D,et al. Poststroke dementia:incidence and relationship to prestroke cognitive decline[J]. Neurology,2001,57(7):1216-1222. DOI:10.1212/wnl.57.7.1216.

GRACE J,NADLER J D,WHITE D A,et al. Folstein vs modified Mini-Mental State Examination in geriatric stroke. Stability,validity,and screening utility[J]. Arch Neurol,1995,52(5):477-484. DOI:10.1001/archneur.1995.00540290067019.

GHAFAR M Z A A,MIPTAH H N,O'CAOIMH R. Cognitive screening instruments to identify vascular cognitive impairment:a systematic review[J]. Int J Geriatr Psychiatry,2019,34(8):1114-1127. DOI:10.1002/gps.5136.

WONG A,NYENHUIS D,BLACK S E,et al. Montreal Cognitive Assessment 5-minute protocol is a brief,valid,reliable,and feasible cognitive screen for telephone administration[J]. Stroke,2015,46(4):1059-1064. DOI:10.1161/STROKEAHA.114.007253.

APPELROS P. Characteristics of Mini-Mental State Examination 1 year after stroke[J]. Acta Neurol Scand,2005,112(2):88-92. DOI:10.1111/j.1600-0404.2005.00441.x.

AGRELL B,DEHLIN O. Mini mental state examination in geriatric stroke patients. Validity,differences between subgroups of patients,and relationships to somatic and mental variables[J]. Aging,2000,12(6):439-444. DOI:10.1007/BF03339874.

DICK J P,GUILOFF R J,STEWART A,et al. Mini-mental state examination in neurological patients[J]. J Neurol Neurosurg Psychiatry,1984,47(5):496-499. DOI:10.1136/jnnp.47.5.496.

HARRISON J K,STOTT D J,MCSHANE R,et al. Informant Questionnaire on Cognitive Decline in the Elderly(IQCODE)for the early diagnosis of dementia across a variety of healthcare settings[J]. Cochrane Database Syst Rev,2016,11(11):CD011333. DOI:10.1002/14651858.CD011333.pub2.

LARNER A J. Addenbrooke's Cognitive Examination-Revised(ACE-R)in day-to-day clinical practice[J]. Age Ageing,2007,36(6):685-686. DOI:10.1093/ageing/afm112.

(收稿日期:2024-03-16;修回日期:2024-05-19)

(本文編輯:賈萌萌)

基金項(xiàng)目:國(guó)家自然科學(xué)基金資助項(xiàng)目(72274087);甘肅省自然科學(xué)基金資助項(xiàng)目(22JR5RA218);甘肅省重點(diǎn)研發(fā)計(jì)劃(23YFFA0006);中華醫(yī)學(xué)會(huì)基金(20-374);蘭州大學(xué)護(hù)理學(xué)院科研基金(LZUSON202002);蘭州市城關(guān)區(qū)科技局項(xiàng)目(2022SHFZ0002);蘭州市衛(wèi)生科技項(xiàng)目(2021003)

引用本文:馬玉霞,楊依依,魏曉琴,等. 卒中后認(rèn)知障礙評(píng)估工具篩查準(zhǔn)確性的Meta分析[J]. 中國(guó)全科醫(yī)學(xué),2024,27(32):4066-4076. DOI:10.12114/j.issn.1007-9572.2023.0873. [www.chinagp.net]

MA Y X,YANG Y Y,WEI X Q,et al. The accuracy of screening for post-stroke cognitive impairment assessment tools:a meta-analysis[J]. Chinese General Practice,2024,27(32):4066-4076.

? Editorial Office of Chinese General Practice. This is an open access article under the CC BY-NC-ND 4.0 license.

垫江县| 肥西县| 高密市| 佛教| 靖西县| 米易县| 宾川县| 南部县| 徐汇区| 深水埗区| 田林县| 睢宁县| 汝城县| 张家港市| 深水埗区| 仪征市| 哈尔滨市| 海原县| 天台县| 平原县| 南宫市| 韶山市| 商洛市| 鹤庆县| 平遥县| 库车县| 阿图什市| 依兰县| 贵南县| 南部县| 怀远县| 兴山县| 休宁县| 乡城县| 新密市| 馆陶县| 锦州市| 卫辉市| 钟祥市| 晋江市| 淮安市|