CAJ | 학술논문

目的：探讨蒙特利尔认知评估量表（MoCA）在稳定期双相情感障碍（BPD）患者中应用的信、效度，并确定其筛查 BPD 患者认知功能障碍的临界值。方法选取2013年11月—2014年5月在长沙市中南大学湘雅二医院精神科病房住院的稳定期 BPD 患者125例为病例组及同期跟病例组性别、年龄、文化程度相匹配的医院职工及社会志愿者130例为对照组。对两组进行一般资料问卷调查及 MoCA 测试，量表信度检验采用一致性信度和重测信度；量表效度检验采用结构效度、已知组别效度及同时效度；采用受试者工作特征（ROC）曲线确定 MoCA 筛查 BPD 患者认知功能障碍的临界值。结果 MoCA 的 Cronbach＇s α系数为0.762，重测信度系数为0.824；验证性因子分析显示 MoCA结构合理，两组 MoCA 总分间差异有统计学意义〔（22.2±3.9）分比（25.4±2.3）分，P ＜0.01〕；MoCA 总分与发病年龄呈正相关，与病程、住院次数、总发作次数、抑郁发作次数、躁狂发作次数、混合发作次数、汉密尔顿抑郁量表（HAMD）得分呈负相关（P ＜0.05）；MoCA 筛查 BPD 患者认知功能障碍的临界值为24分，所对应的灵敏度为0.723，特异度为0.688，曲线下面积为0.759〔95％ CI（0.700，0.819）〕。结论 MoCA 在筛查 BPD 患者认知功能障碍中具有良好的信、效度，在临界值为24分时具有较高的灵敏度和特异度，可用于我国稳定期 BPD 患者认知功能的评估。
목적：탐토몽특리이인지평고량표（MoCA）재은정기쌍상정감장애（BPD）환자중응용적신、효도，병학정기사사 BPD 환자인지공능장애적림계치。방법선취2013년11월—2014년5월재장사시중남대학상아이의원정신과병방주원적은정기 BPD 환자125례위병례조급동기근병례조성별、년령、문화정도상필배적의원직공급사회지원자130례위대조조。대량조진행일반자료문권조사급 MoCA 측시，량표신도검험채용일치성신도화중측신도；량표효도검험채용결구효도、이지조별효도급동시효도；채용수시자공작특정（ROC）곡선학정 MoCA 사사 BPD 환자인지공능장애적림계치。결과 MoCA 적 Cronbach＇s α계수위0.762，중측신도계수위0.824；험증성인자분석현시 MoCA결구합리，량조 MoCA 총분간차이유통계학의의〔（22.2±3.9）분비（25.4±2.3）분，P ＜0.01〕；MoCA 총분여발병년령정정상관，여병정、주원차수、총발작차수、억욱발작차수、조광발작차수、혼합발작차수、한밀이돈억욱량표（HAMD）득분정부상관（P ＜0.05）；MoCA 사사 BPD 환자인지공능장애적림계치위24분，소대응적령민도위0.723，특이도위0.688，곡선하면적위0.759〔95％ CI（0.700，0.819）〕。결론 MoCA 재사사 BPD 환자인지공능장애중구유량호적신、효도，재림계치위24분시구유교고적령민도화특이도，가용우아국은정기 BPD 환자인지공능적평고。
Objective To explore reliability and validity of Montreal Cognitive Assessment(MoCA)in the screening of patients with euthymic bipolar disorder(BPD)at stable stage and to determine the critical value of the scale in the screening of cognitive disorder in BPD patients. Methods We enrolled 125 patients with BPD at stable stage who were admitted into the psychiatric ward of the Second Xiangya Hospital of Central South University from November 2013 to May 2014 as case group,and we enrolled 130 controls,including hospital employees and social volunteers,who had corresponding gender,age,educational degree as control group. General Questionnaire survey and MoCA test were conducted on the two groups. Consistent reliability and test - retest reliability were investigated in the reliability test;construct validity,known - group - validity and concurrent validity were investigated in the validity test. ROC curve was used to determine the critical value of MoCA in the screening of cognitive disorder in BPD patients. Results For MoCA,the Cronbach's α coefficient was 0. 762 and the retest reliability coefficient was 0. 824. Confirmatory factor analysis validated the structure of MoCA. The two groups were significantly different in the total score of MoCA〔(22. 2 ± 3. 9)vs. (25. 4 ± 2. 3),P < 0. 01〕;the total score of MoCA was positively correlated with the age of onset and was negatively correlated with the illness duration,times of hospitalization,total times of episode,times of depressive episode,times of manic episode,times of mixed episode and HAMD(P < 0. 05). The critical value of MoCA in the screening of cognitive disorder in BPD patients was 24,with a sensitivity of 0. 723,a specificity of 0. 688,and an area under ROC curve of 0. 759〔95% CI(0. 700,0. 819)〕. Conclusion MoCA has good reliability and validity in the screening of cognitive disorder in BPD patients. It has superior sensitivity and specificity when critical value is 24 points. MoCA can be applied in the assessment of cognitive function in patients with BPD at stable stage.