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“洛文斯坦職能治療認知評估”第二版於輕度血管性認知缺損的中風病人之適用性：初探研究
Clinical Utility of the Loewenstein Occupational Therapy Cognitive Assessment-Second Edition in Stroke Patients with Mild Vascular Cognitive Impairment. A Preliminary Study
摘要
本研究旨在檢驗洛文斯坦職能治療認知評估第二版(Loewenstein Occupational Therapy Cognitive Assessment, LOTCA-Ⅱ)是否適用於輕度血管性認知缺損的中風病人。研究對象取自南部某醫學中心及一家區域醫院復健科的中風病人21名與正常人31名。輕度血管性認知缺損是指「簡短式智能評估」(Mini-Mental State Examination, MMSE)總分介於20-26分，且未被診斷為失智症。每位病人都個別接受LOTCA-Ⅱ與MMSE，而正常人只施測LOTCA-Ⅱ。研究結果顯示，80.8%的LOTCA-Ⅱ題項呈現顯著的天花板效應。所有題目中，只有思考操作分量表的邏輯問題呈現顯著的地板效應，LOTCA-Ⅱ總分並無顯著的天花板與地板效應。中風組在LOTCA-Ⅱ的視覺動作組織和思考操作分量表的得分顯著低於正常組。雖然中風組在LOTCA-Ⅱ各分量表的平均z分數皆落在正常組平均數至－2個標準差之間，仍有20-48%的病人在思考操作、定向感、視覺動作組織和視知覺分量表的得分以及總分屬於顯著損傷範圍（低於控制組平均數2個標準差）。LOTCA-Ⅱ分量表的整體正確區辨率不高，只達75%。LOTCA-II與MMSE總分有高度相關，與中風後至接受測驗的天數有中度相關。由以上初步的研究結果顯示，LOTCA-Ⅱ不適用於篩選輕度血管性認知缺損的中風病人，但可使用視覺動作組織與思考操作分量表來評估這類病人的高層次認知功能表現。
並列摘要
The aim of this study was to determine the clinical utility of the Loewenstein Occupational Therapy Cognitive Assessment-Second Edition (LOTCA-Ⅱ) in a stroke sample with mild vascular cognitive impairment (mVCI). Twenty-one stroke patients from a medical center and a regional hospital located in southern Taiwan, as well as 31 age- and education-matched healthy controls participated in the study. Mild VCI was defined based on a total score ranging between 20 and 26 on the Mini-Mental State Examination (MMSE), without concomitant dementia. LOTCA-Ⅱ and MMSE were administered individually to each patient, whereas normal controls were tested on the LOTCA-Ⅱ. The results showed that substantial ceiling effects existed in 80.8% of the LOTCA-Ⅱ items. Among the LOTCA-Ⅱ items, only logic questions item of the thinking operations subtest achieved a substantial floor effect. LOTCA-Ⅱ total scores exhibited neither ceiling nor floor effects. Relative to normal controls, stroke patients performed more poorly on visuomotor organization and thinking operations subtests. For stroke patients, none of the mean z scores for each of the LOTCA-Ⅱ subtests fell within the impaired range (2 standard deviations below the control mean). However, a high percentage (20%-48%) of patients scored in the designated impaired range on the thinking operations, orientation, visuomotor organization, and visual perception subtests as well as total score. The LOTCA-Ⅱ subtests discriminated patients from controls with an overall accurate classification rate of 75%. Finally, LOTCA-Ⅱ total score correlated highly with MMSE total score, and moderately with time between stroke onset and assessment. Taken together, these preliminary findings suggested that the LOTCA-II is not suitable for screening mVCI in stroke patients; however, the visuomotor organization and thinking operations subtests can be used to evaluate higher cognitive abilities in this group of patients.