目的 探讨不同画钟测验(CDT)评分系统、简易精神状态检查量表(MMSE)及蒙特利尔认知评估量表(MoCA)在煤矿地区老年人认知功能障碍筛查中的效能.方法 招募大同煤矿地区认知障碍老年患者85例,以及认知正常老年人95例,应用CDT-Lin、CDT-Royall、MMSE和MoCA对两组老年人认知功能进行量化评分,比较两组人群基本信息和各项认知评分,绘制各量表认知筛查受试者工作特征(ROC)曲线,比较各量表认知筛查的灵敏度和特异度.结果 两组人群在性别、年龄、受教育年限、体质指数、吸烟和饮酒情况、社会活动情况、体育锻炼情况、独居情况等均无统计学差异;认知障碍组CDT-Lin、CDT-Royall、MMSE和MoCA认知评分显著低于认知正常组.CDT-Lin、CDT-Royall、MMSE和MoCA认知筛查曲线下面积分别为60.1％、62.3％、80.5％和86.2％(P<0.05).MoCA认知筛查的灵敏度最高(98.8％),MMSE认知筛查的特异度最高(91.6％),与其他量表相比均存在统计学差异.与CDT-Royall相比,CDT-Lin评分系统认知筛查的灵敏度较高,但特异度较低(P<0.01).结论 将简单评分系统CDT与MMSE量表联合用于煤矿地区老年人早期认知筛查,并在认知障碍诊断中联合MoCA量表,以提高认知筛查和诊断的灵敏度、特异度和准确度.

Objective:To investigate the efficacy of the Mini-Mental State Scale (MMSE) versus the Montreal Cognitive Assessment Scale (MoCA) in screening cognitive impairment in patients with a lacunar cerebral infarction. Methods:138 eligible patients who received treatment in the Affiliated Hospital of Shanxi Datong University from January 2018 to October 2019 were recruited for this study. They received cognitive function evaluation by the MMSE and MoCA. These patients were grouped according to the median number of age or the median number of years of education. The sensitivity and consistency of the MMSE versus MoCA in screening cognitive impairment in patients with a lacunar cerebral infarction were analyzed using the χ2 test. The total cognitive scores of the MMSE and MoCA, and the scores of each cognitive domain such as memory, execution, visual space, attention, language, and orientation, were compared between groups using multiple linear regression analysis. Results:The sensitivity of MoCA in screening for cognitive impairment in low-age, high-age, low-year-education, and high-year-education groups and the whole population of patients with a lacunar cerebral infarction was 76.5%, 75.7%, 74.2%, 77.8%, 76.1%, respectively, which were significantly higher than those of MMSE (44.1%, 65.7%, 60.6%, 50.0%, 55.1%, χ2 = 12.17, 13.13, 9.33, 15.75, 23.86, all P < 0.01). The Kappa coefficients of low-age, high-age, low-year-education and high-year-education groups were 0.336, 0.391, 0.358, 0.389, and 0.373, respectively, all of which were less than 0.4 (all P < 0.01). These findings suggest that the consistency of the two scales in screening cognitive impairment is poor. The cognitive impairment detection rate by the MMSE was significantly higher in the high-age group than in the low-age group (65.7% vs. 44.1%, χ2 = 6.50, P < 0.05). The total cognitive scores of MMSE and MoCA and the scores of memory, execution, visual space, attention, language, and orientation in patients with a lacunar cerebral infarction were significantly lower in the high-age group or low-year-education group than in the low-age group ( tMMSE = 3.61, 2.49, 3.12, 4.26, 1.70, 3.69, 2.24, all P < 0.01; tMoCA = 3.83, 1.75, 3.28, 3.80, 2.21, 4.08, 2.52, all P < 0.05) or high-year-education group ( tMMSE = -2.87, -2.32, -0.85, -2.54, -0.73, -2.57, -2.96, all P < 0.01; tMoCA = -2.95, -1.12, -3.39, -1.54, -1.52, -3.09, -3.02, all P < 0.05). Conclusion:Combined application of MMSE and MoCA has a high clinical value in screening cognitive impairment in patients with a lacunar cerebral infarction. High-age patients with a lacunar cerebral infarction who receive low-year education have memory, execution, visual space, attention, language, and orientation impairments.

Objective:To investigate the characteristic of mild cognitive impairment (MCI) in the adults aged 48 years and over in a coal mine community, and to analyze its associated risk factors.Methods:From July to October 2019, a questionnaire survey for basic information was conducted among 180 middle-aged and elderly adults who met the inclusion criteria in the Datong coal mine community. The cognitive function was evaluated by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The effects of gender, age, years of education, sleep, living alone, physical exercise, social activities, smoking and drinking status, body mass index and chronic diseases on cognitive level were analyzed by single factor stratification and multiple linear regression.Results:There was no significant difference in the positive rate of MCI screened by MMSE and MoCA in the age groups of 48-<64, 64-<72 and 72-90 (original and corrected P>0.05); The positive rate of MCI in MoCA screening (64.4%, 66.7%, 60.9%) was significantly higher than that in MMSE (35.6%, 45.6%, 28.1%) (all P<0.05); MMSE was positively correlated with MoCA score ( r=0.762, P<0.001). With the increase of age, the scores of memory, execution and visual space detected by MoCA decreased significantly (all P<0.05), while the scores of attention, language and orientation did not change significantly (all P>0.05). Univariate stratification showed that the significant influencing factors of MMSE or MoCA scores were gender, age, years of education and sleep status (all P<0.05). Multiple linear regression analysis showed that gender ( βMMSE=-0.192; βMoCA=-0.140), years of education ( βMMSE=0.209; βMoCA=0.328) and sleep status( βMMSE=-0.162; βMoCA=-0.136) were risk factors affecting MMSE and MoCA scores ( P<0.05). Conclusions:More middle-aged and elderly adults with MCI might be observed in a coal mine community, and the main characteristics of MCI are impaired memory, executive function and visual space. To prevent and reduce the occurrence of dementia, early interventions of MCI should be carried out among the adults with female, old age, low years of education and poor sleep quality.

Objective:To investigate the correlation between cognitive function and living ability of older adult patients living in a mining community.Methods:A total of 180 older adult patients living in a mining community who received treatment during July-October 2019 were included in this study. They were randomly divided into the low-age group (< 68 years old, n = 94) and the high-age group (≥ 68 years old, n = 86). Cognitive function and living ability were evaluated using the Mini-Mental State Examination (MMSE), The Montreal Cognitive Assessment (MoCA), and the Activity of Daily Living Scale (ADL). The relationship between cognitive function and living ability was investigated using hierarchical analysis and Pearson correlation analysis. Results:The proportions of older adult patients with abnormal cognitive function identified by the MMSE and MoCA were 39.4% and 66.0%, respectively in the low-age group, and they were 32.6% and 61.6%, respectively in the high-age group. The MoCA had a greater performance in identifying abnormal cognitive function in each group than the MMSE ( χ2 = 26.69, 10.18, both P < 0.001). There were no significant differences in proportions of older adult patients with abnormal cognitive function identified by the MMSE and MoCA between low-age and high-age groups ( χ2 = 0.90, 0.36, both P > 0.05). The proportion of older adult patients with abnormal living ability was not significantly different between low-age and high-age groups (4.3% vs. 10.5%, χ2 = 2.58, P > 0.05). Compared with patients negative for MMSE items, living ability and instrumental activity of daily living increased by 7.0% and 9.4% in low-age patients positive for MMSE items (both P < 0.05). Compared with patients negative for MoCA items, living ability increased by 3.5% in low-age patients positive for MoCA items ( P < 0.05). Correlation analysis revealed that total scores of MMSE and MoCA were significantly negatively correlated with ADL score ( r = -0.26, -0.27, both P < 0.001) and instrumental activity of daily living score ( r = -0.27, -0.27, P < 0.001). Conclusion:Cognitive function and living ability are correlated in older adult patients living in a mining community. We should pay attention to the screening results of cognitive disorder in older adult patients and improve their living ability by improving their cognitive function.

目的 研究煤矿社区老年人的执行功能状况及与认知功能的相关性,并分析执行功能的相关危险因素.方法 2019年7-8月抽样调查大同市煤矿社区180名老年人,应用简易精神状态检查量表(Mini-Mental State Examination,MMSE)和蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)分别对老年人执行功能和认知功能进行量化评分,并对数据进行分析.结果 MMSE和MoCA执行功能得分与对应的认知功能得分呈显著正相关(r=0.50、0.74,均P＜0.01),且认知功能异常组MMSE和MoCA执行功能得分(2.25±0.83、1.63±1.10)显著低于认知功能正常组(2.77±0.60、2.63±0.99)(均P＜0.01).女性组MMSE和MoCA执行功能得分(2.50±0.77、1.85±1.15)显著低于男性组(2.76±0.61、2.31±1.14)(均P＜0.05);MoCA执行功能得分在高年龄组(1.66±1.10)、低教育年限组(1.49±0.98)、素食组(1.63±1.10)、无社会活动组(1.73±1.22)均显著低于低及中年龄组(2.25±1.20、2.09±1.12)、中及高教育年限组(2.03±1.21、2.67±1.00)、均衡饮食及肉食组(2.17±1.17、2.22±1.11)、有社会活动组(2.12±1.12)(均P＜0.05).受教育年限是MMSE和MoCA执行功能最重要的影响因素(β=0.22、0.32,均P＜0.01).结论 大同市煤矿社区老年人执行功能可以较好反映认知功能,女性、高龄、低教育、素食、无社会活动是执行功能降低的危险因素,其中受教育年限对执行功能的影响最大,应针对危险因素制定干预措施,预防和延缓当地老年人执行功能的减退.

目的 比较简易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)在老人认知功能筛查中的作用.方法 选择某煤矿社区156名老人,分别进行MMSE和MoCA测评,按年龄或受教育年限分组后,比较各组MMSE和MoCA总分,分析2种量表筛查认知障碍的敏感度和一致性.结果 各组MoCA总分均显著低于MMSE总分(P<0.01),并呈正相关(P<0.01).随年龄增加和受教育年限降低,MMSE和MoCA总分均显著降低(P<0.01).各组中MoCA阳性筛查率显著高于MMSE(P<0.01),且一致性一般.结论 MMSE和MoCA量表可以不同程度评定老年人认知功能减退,且MoCA筛查敏感度优于MMSE,这将为老年人认知障碍的评定提供较为客观数据.

炭黑颗粒是生活和生产环境中普遍存在的重要细颗粒物污染源,与公众和职业人群的健康密切相关.炭黑由于其粒径小、质量轻而漂在空气中,易通过呼吸道进人人体,对呼吸系统、心血管系统、免疫系统和神经系统等造成损伤.本文主要关注炭黑颗粒对呼吸系统的影响,流行病学调查和毒理学实验显示,炭黑颗粒与哮喘、肺炎、肺纤维化和慢性阻塞性肺疾病等常见呼吸系统疾病的发病高度相关,但至今缺乏人群流行病学致肺癌的证据.在人群流行病学、动物实验及体外实验的毒理学数据基础上,本文就炭黑颗粒对呼吸系统的毒性效应机制进行综述,为其所致机体健康损害的预防和治疗提供参考依据.