| Abstract | Cilj istraživanja: Blagi kognitivni poremećaj (MCI) je patologija sa sve većom pojavnosti u
općoj i u populaciji naše države. Iako je široko rasprostranjen te postoje dijagnostički testovi
adekvatni za pravovremeno prepoznavanje, terapijske su metode još uvijek nedovoljno
istražene. Cilj našeg istraživanja bio je prikazati prevalenciju blagog kognitivnog poremećaja
u šestomjesečnom razdoblju na prigodnom uzorku pacijenata te oslikati stanje prosječnog
bolesnika sa blagim kognitivnim poremećajem.
Ispitanici i metode: Retrospektivno su analizirani podaci iz povijesti bolesti 173 bolesnika
koji su prošli neuropsihologijsku evaluaciju sa sumnjom na blagi kognitivni poremećaj na
Klinic za neurologiju u KBC Split. Prikupljeni demografski podaci uključivali su dob
bolesnika u trenutku ispitivanja, spol, broj godina formalnog obrazovanja i dominantnu ruku.
Podaci neuropsihologijske obrade uključivali su rezultate 3 testa - Montrealske kognitivne
procjene (MoCA test), Mini Mental Status Examination (MMSE test) i Adenbrookeovu
kognitivnu procjenu, revidiranu verziju testa (ACE-R). ACE-R rezultati raščlanjeni su, kao u
klasičnoj interpretaciji, na rezultate više kognitivnih domena od interesa. Domene su
uključivale: pažnju i orijentaciju, jezik, fluentnost, vizuo-prostornu percepciju i pamćenje.
Rezultati: U uzorku 173 ispitanika upućena sa sumnjom na blagi kognitivni poremećaj
muškaraca je bilo 46.2%, a žena 53.8%. Blagi kognitivni poremećaj je pomoću Montrealske
kognitivne procjene (MoCA testa) u ukupnom uzorku otkriven u 71 (41%) pacijenata. U
skupini pacijenata sa pronađenim deficitom 54.9% su bili muškarci. MMSE test je u istom
uzorku pacijenata deficit kognicije dokazan u 16.7% pacijenata. U daljnjoj dijagnostici, na
ACE-R testu, ukupan rezultat u medijanu je iznosio 89 bodova (Q1-Q3: 80-93; min-max:
30-100). Pozitivan probirni rezultat, manji od 83 boda, ostvarilo je 49 (28.3%) pacijenata. U
kategoriji pamćenja ACE-R testa korištena je odsječna točka od 17 bodova za diferenciranje
amnestičkog od ne-amnestičkog blagog kognitivnog poremećaja. Od ukupnog uzorka, 30
ispitanika (17,3%) ostvarilo je manje od 17 bodova. Također, od 30 navedenih, ni jedan od
ispitanika nije ostvario minimalan normalan broj bodova (>83 boda) na ukupnom bodovanju
ACE-R testa, a čak 22 (73.3%) ispitanika ostvarilo je manje od 22 boda na MoCA testu.
Abnormalne rezultate MoCA testa i domene pamćenja na ACE-R testu imalo je ukupno 33
(19%) ispitanika, što čini 46% u skupine sa rezultatima MoCA testa ispod 26. Abnormalne
rezultate MoCA testa, a normalne rezultate u domeni pamćenja na ACE-R testu imalo je 38
(22 %) pacijenata, što čini 54% skupine sa rezultatima MoCA testa manjima od 26.
Fluentnost je najčešća domena kognitivnog deficita, u ne-amnestičkom blagom kognitivnom
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poremećaju kao dio poremećaja u jednoj domeni, a i kao dio poremećaja u više domena. Od
ukupnog uzorka ispitanika njih 118 (68,2%) ima deficit u domeni fluentnosti. Također,
najčešća domena sa deficitom pridružena pamćenju u amnestičkom blagom kognitivnom
poremećaju je fluentnost. 33 ispitanika (94,1%) sa amnestičkim blagim kognitivnim
poremećajem ima deficit u domeni fluentnosti.
Zaključak: Rezultati našeg istraživanja pokazali su prisutnost blagog kognitivnog
poremećaja u prigodnoj skupini ispitanika starijih od 65 godina koji su bili upućeni na
neuropsihologijska testiranja na Klinici za neurologiju KBC Split, dominatno muškog spola
pri čemu se fluentnost dokazala kao najčešća domena iz spektra kognitivnog deficita. Blagi
kognitivni poremećaj je široko prisutan u populaciji Republike Hrvatske, te će se očekuje da
će sa starenjem stanovništva i razvojem novih dijagnostičkih metoda prevalencija povećavati.
Potrebni su daljnji napori u ovom polju kako bismo razvili adekvatne terapijske metode za
sve varijante ove bolesti te omogućili pojedincima koji pate od ove patologije da
funkcioniraju u društvu i kao jedinke što duže. |
| Abstract (english) | Objectives: Mild cognitive impairment (MCI) is a pathology with an increasing incidence in
the general population and in the population of our country. Although it is widespread and
there are diagnostic tests adequate for timely recognition, therapeutic methods are still
insufficiently researched. The goal of our research was to show the prevalence of mild
cognitive impairment in a six-month period on a convenient sample of patients and to
describe the condition of an average patient with mild cognitive impairment.
Patients and methods: Data from the medical history of 173 patients who underwent a
neuropsychological evaluation with suspected mild cognitive impairment at the Clinic for
Neurology at KBC Split were retrospectively analyzed. Demographic data collected included
the patient's age at the time of examination, gender, number of years of formal education, and
dominant hand. Neuropsychological processing data included the results of 3 tests - the
Montreal Cognitive Assessment (MoCA test), the Mini Mental Status Examination (MMSE
test) and the Addenbrooke's Cognitive Assessment, Revised Version (ACE-R) test. ACE-R
results are broken down, as in the classical interpretation, into results of several cognitive
domains of interest. Domains included: attention and orientation, language, fluency,
visuospatial perception and memory.
Results: In the sample of 173 subjects referred with suspicion of mild cognitive disorder,
46.2% were men, and 53.8% were women. Mild cognitive impairment was detected in 71
(41%) patients in the total sample using the Montreal Cognitive Assessment (MoCA test). In
the group of patients with a found deficit, 54.9% were men. In the same sample of patients,
the MMSE test showed a cognitive deficit in 16.7% of patients. In further diagnostics, on the
ACE-R test, the median total score was 89 points (Q1-Q3: 80-93; min-max: 30-100). A
positive screening result, less than 83 points, was achieved by 49 (28.3%) patients. In the
memory category of the ACE-R test, a cut-off point of 17 points was used to differentiate
amnestic from non-amnestic mild cognitive impairment. Out of the total sample, 30
respondents (17.3%) achieved less than 17 points. Also, out of the 30 mentioned, none of the
subjects achieved the minimum normal number of points (>83 points) on the total scoring of
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the ACE-R test, and even 22 (73.3%) subjects achieved less than 22 points on the MoCA test.
A total of 33 (19%) subjects had abnormal results of the MoCA test and the memory domain
of the ACE-R test, which makes up 46% of the group with MoCA test results below 26.
Abnormal results of the MoCA test and normal results in the memory domain of the ACE-R
test, 38 (22%) patients had it, which makes 54% of the group with MoCA test scores below
26. Fluency is the most common domain of cognitive deficit, in non-amnestic mild cognitive
disorder as part of a disorder in one domain, and as part of a disorder in more than one
domain. domain. Out of the total sample of respondents, 118 of them (68.2%) have a deficit
in the domain of fluency. Also, the most common domain with a deficit associated with
memory in amnestic mild cognitive impairment is fluency. 33 respondents (94.1%) with
amnestic mild cognitive disorder have a deficit in the domain of fluency.
Conclusion: The results of our research showed the presence of a mild cognitive disorder in
a suitable group of subjects over 65 years of age who were referred for neuropsychological
testing at the KBC Split Neurology Clinic, predominantly male, with fluency proving to be
the most common domain from the spectrum of cognitive deficits. Mild cognitive impairment
is widely present in the population of the Republic of Croatia, and it is expected that the
prevalence will increase with the aging of the population and the development of new
diagnostic methods. Further efforts are needed in this field in order to develop adequate
therapeutic methods for all variants of this disease and enable individuals suffering from this
pathology to function in society and as individuals for as long as possible |
