Samarasekera Shanika R, Helmstaedter Christoph, Reuber Markus
Department of Neurology, University Hospitals Coventry and Warwickshire, UK.
Department of Epileptology, University of Bonn, Germany.
Epilepsy Behav. 2015 Nov;52(Pt A):9-13. doi: 10.1016/j.yebeh.2015.08.013. Epub 2015 Sep 19.
This study aimed to assess the relationship between objective measures of cognition and subjective perception of cognitive functioning reported by patients with epilepsy and their caregivers.
One hundred patients with epilepsy attending hospital neurology outpatient clinics and their caregivers were enrolled in this study. The EpiTrack (version 1) brief cognitive screening tool was used to measure objective impairment, the ABNAS questionnaire (A-B Neuropsychological Assessment Schedule) to assess subjective cognitive performance, and a version of the ABNAS designed to be completed by caregivers (C-ABNAS) to document caregivers' views. Patient anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) and considered as covariates. Patients with an uncertain diagnosis of epilepsy or likely severe comorbid mood or anxiety disorders were excluded.
Data from 82 patients were analyzed after exclusion of patients with uncertain diagnoses or likely severe comorbid mood or anxiety disorders. Fifty-nine (72%) had a degree of objective cognitive impairment. Fifty (84.7%) of these 59 patients had 'high' ABNAS scores concordant with the objective assessment, and 43 (72.9%) had high C-ABNAS scores matching the abnormalities detected by objective screening. Of the 23 (28%) patients without objective cognitive impairment, seven (30.4%) had concordantly low ABNAS scores, and 10 (43.4%) had concordantly low C-ABNAS scores. Patient memory impairment was more often reported by patients themselves than by caregivers (p=0.011). Carers were significantly more likely to rate patients as having impaired motor coordination than patients themselves. A small part of the variance of the EpiTrack score was predicted by the C-ABNAS. Objective cognitive performance did not predict ABNAS or C-ABNAS scores.
Self-report or caregiver report questionnaires identify patients with epilepsy and objective cognitive impairment more accurately than patients with intact cognition. Those without objective evidence of cognitive impairment may, nevertheless, perceive themselves as having memory dysfunction; it is these patients, therefore, who most require both subjective and objective assessments of cognition, including carers' assessments, in order to establish the nature of their symptoms. None of these assessment measures can be used as a reliable proxy for another, each contributes individually to a comprehensive assessment of cognition, and all must be used in conjunction with measures of mood and anxiety.
本研究旨在评估癫痫患者及其照料者报告的认知功能客观测量指标与认知功能主观感受之间的关系。
本研究纳入了100名到医院神经科门诊就诊的癫痫患者及其照料者。使用EpiTrack（版本1）简易认知筛查工具测量客观损伤，使用ABNAS问卷（A - B神经心理评估量表）评估主观认知表现，并使用一个供照料者填写的ABNAS版本（C - ABNAS）来记录照料者的看法。使用医院焦虑抑郁量表（HADS）测量患者的焦虑和抑郁情况，并将其视为协变量。排除癫痫诊断不明确或可能患有严重共病性情绪或焦虑障碍的患者。
排除诊断不明确或可能患有严重共病性情绪或焦虑障碍的患者后，对82名患者的数据进行了分析。59名（72%）患者存在一定程度的客观认知损伤。这59名患者中有50名（84.7%）的ABNAS得分“高”，与客观评估结果一致，43名（72.9%）的C - ABNAS得分高，与客观筛查检测到的异常情况相符。在23名（28%）无客观认知损伤的患者中，7名（30.4%）的ABNAS得分相应较低，10名（43.4%）的C - ABNAS得分相应较低。患者本人报告记忆损伤的情况比照料者更常见（p = 0.011）。照料者将患者评定为运动协调受损的可能性显著高于患者本人。C - ABNAS预测了EpiTrack得分的一小部分方差。客观认知表现无法预测ABNAS或C - ABNAS得分。
自我报告或照料者报告问卷识别癫痫患者及存在客观认知损伤的患者比识别认知功能正常的患者更准确。然而，那些没有认知损伤客观证据的患者可能仍认为自己存在记忆功能障碍；因此，正是这些患者最需要进行认知的主观和客观评估，包括照料者的评估，以确定其症状的性质。这些评估措施都不能可靠地替代其他措施，每种措施都单独有助于对认知进行全面评估，并且所有措施都必须与情绪和焦虑测量结合使用。
