應用中文簡短式智能評估（MMSE-C）與盧-尼神經心理測驗組篩檢測驗（LNNB-S）於腦中風患者之篩檢比較

Comparing the Application of Assessment Tests on Patients with Cerebrovascular Accident: the Mini-Mental Status Examination-Chinese Test Versus the Luria-Nebraska Neuropsychological Battery-Screening Test

王鼎嘉(Ting‐Chia Wang) ； 吳玉欣(Yu‐Hsin Wu) ； 郭乃文(Nai‐Wen Guo) ； 黃茂雄(Mao‐Hsiung Huang) ； 蘇炯輝(Jyong‐Huei Su)

《台灣復健醫學雜誌》 44卷1期 (2016/03) Pp. 19-27

https://doi.org/10.6315/2016.44(1)03

摘要

目的：認知功能缺損為腦中風(stroke)疾患常伴隨之症狀，故臨床上應發展適用之篩檢測驗。中文簡短式智能評估(Mini-Mental Status Examination-Chinese, MMSE-C)與盧-尼神經心理測驗組篩檢測驗(Luria-Nebraska Neuropsychological Battery-Screening test, LNNB-S)為兩項廣泛被使用之神經認知功能缺損的篩檢測驗。國內過去較少有針對認知篩檢測驗適用性之研究，故本研究目的有二：1.比較MMSE-C與LNNB-S 於腦中風患者之檢測能力。2.比較MMSE-C 與LNNB-S 於四種腦區中風患者之檢測能力。方法：本研究為回溯性研究，病歷資料來自南部某醫學中心復健科自2005 至2014 年之腦中風患者，篩檢條件為確診僅具腦中風診斷且因臨床需求完成MMSE-C 與LNNB-S 之病患共158 人(男125 人、女33 人，平均年齡52.6 歲，平均教育年數10.5 年)。將所有病歷資料依腦部中風區域分為四組：左腦中風(32 人)、右腦中風(37 人)、雙側腦中風(46 人)、多處腦中風(43 人)，並以單因子變異數分析、共變數分析、卡方檢定分析之。結果：1.資料顯示20.3%於MMSE-C 與LNNB-S 均呈現陰性，或許源於其認知功能受腦中風影響不大。2. MMSE-C 檢出認知功能不足之比率為44.9%；LNNB-S 檢出77.9%。被MMSE-C 檢出陽性者，同時有95.8%可被LNNB-S 檢出；被LNNB-S 檢出陽性者，僅有55.3%同時被MMSE-C 檢出；於MMSE-C陰性者，在右腦中風組達64.9%為最高。3.四組於MMSE-C 得分皆低於正常組常模，其中左腦、雙側、多處腦中風等三組於MMSE-C 總分、地點定向、回憶、語言之表現皆顯著低於右腦中風組。4.四組於LNNB-S 受損分數皆遠高於正常組常模，左腦中風組於數字概念與高等認知兩個因素之受損分數顯著高於其他三組。結論：運用界斷分數時，MMSE-C 對於腦中風患者認知功能不足之檢出率較低，尤其對於右腦中風患者檢出比率最低，推測是因測驗內容大量涉及語文功能之故。MMSE-C 受到天花板效應之影響，對於腦中風患者而言整體偏易，故不宜單獨作為腦中風患者之篩檢測驗。建議臨床工作者在使用MMSE-C後，加做LNNB-S 以提高對於留有神經認知功能缺損之中風患者之評估力。但若臨床評估時間有限，建議直接做LNNB-S 取代MMSE-C。

關鍵字

簡短式智能評估(Mini-Mental Status Examination MMSE) ； 盧-尼神經心理測驗組篩檢測驗(Luria-Nebraska Neuropsychological Battery-Screening test, LNNB-S) ； 神經心理衡鑑(neuropsychological assessment) ； 腦中風(stroke)

並列摘要

Purposes: Patients with stroke often experience neurocognitive impairment; thus, an effective screening test should be developed. The Mini-Mental Status Examination-Chinese (MMSE-C) test and the Luria-Nebraska Neuropsychological Battery-Screening (LNNB-S) test are two commonly used tests for assessing cognitive impairment. In Taiwan, few studies have been conducted on the applicability of cognitive assessment tests. In the present study, we examined the assessment effectiveness of the MMSE-C and LNNB-S and compared them regarding their assessment effectiveness for impairment in various brain regions. Methods: This study was a retrospective study. Medical records from the 2005-2014 period for patients with stroke at the rehabilitation division at a medical center in Southern Taiwan were used. A total of 158 patients diagnosed with stroke and who had completed the MMSE-C and LNNB-S tests were enrolled in this study (125 men and 33 women; average age = 52.6 years; average education duration = 10.5 years). According to their impaired brain areas, the participants were divided into four groups: left-brain impairment (n = 32), right-brain impairment (n = 37), bilateral brain impairment (n = 43), and brain impairment in multiple areas (n = 43). One-way analysis of variance (ANOVA), analysis of covariance (ANCOVA), and a chi-square test were performed. Results: (1) For 20.3% of the patients, the results of the MMSE-C and LNNB-S tests were negative; the reason might be that stroke did not highly influence their cognitive function. (2) Respectively, 44.9% and 77.9% of the patients who received the MMSE-C and LNNB-S test exhibited cognitive impairment. In addition, 95.8% of the patients whose MMSE-C test results were positive also presented positive LNNB-S test results; however, only 55.3% of the patients whose LNNB-S test results were positive presented positive MMSE-C test results. Furthermore, 64.9% of the patients with right-brain impairment presented negative MMSE-C test results; this proportion was the highest among the four groups. (3) The MMSE-C scores of the four groups were lower than those of the control group; in addition, the MMSE-C scores, orientation, recall and language of the patients with left-brain impairment, bilateral brain impairment, or brain impairment in multiple areas were significantly inferior compared with those of the patients with right-brain impairment. (4) The LNNB-S impairment scores of the four groups were higher than those of the control group; the impairment scores of the patients with left-brain impairment on number concepts and higher cognitive function were significantly higher than those of the other three groups. Conclusion: When cutoff points were used to screen patients with stroke, the detection rate of the MMSE-C test was low particularly for patients with right-brain impairment. The reason may be that the test involves verbal function. Because of the ceiling effect, the MMSE-C test was not a challenge for patients with stroke; thus, the MMSE-C test should not be used alone to diagnose patients' condition for stroke. The cutoff point for the LNNB-S test can be used to test for abnormalities in patients with stroke. Therefore, we suggest that after using the MMSE-C test, medical professionals should use the LNNB-S test to enhance accuracy in the test for impaired neurocognitive function.

並列關鍵字

MMSE ； LNNB-S ； neuropsychological assessment ； stroke

參考文獻

余麗樺、郭乃文：盧-尼神經心理測驗組篩檢測驗在台灣地區適用性之探討。高雄醫學科學雜誌1998；14：779-90。

郭乃文、劉秀枝、王佩芳等：「簡短式智能評估」之中文施測與常模建立。復健醫學雜誌1988；16：52-59。

Desmond DW, Moroney JT, Sano M, et al. Recovery of cognitive function after stroke. Stroke 1996;27:1798-803.

Tatemichi TK, Desmond DW, Stern Y, et al. Cognitive impairment after stroke: frequency patterns and relationship to functional abilities. J Neurol Neurosurg Psychiatry 1994;57:202-7.

Spooner DM & Pachana NA. Ecological validity in neuropsychological assessment: a case for greater consideration in research with neurologically intact populations. Arch Clin Neuropsychol 2006;21:327-37.