RESUMO
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.
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Objective To quantify the expressions of tumor necrosis factor-α (TNF-α),caspase-8 and caspase-3 in lichen planus (LP) lesions,and to investigate their significance.Methods Skin samples were collected from the lesions of 20 patients with LP and normal skin of 20 healthy human controls.Immunohistochemistry was used to determine the expressions of TNF-αt,caspase-8 and caspase-3,and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) technique to evaluate the apoptosis in keratinocytes,in these samples.Results The expression levels (expressed in integrated optical density,IOD)of TNF-α,caspase-8 and caspase-3 were (12.58 ± 2.33) × 103,(11.69 ± 3.52) × 103 and (11.45 ± 2.82) × 103 respectively in LP lesions,significantly higher than those in the normal skin ((5.12 ± 1.78) × 103,(3.87 ± 3.36)× 103,(4.76 ± 1.93) × 103,t =11.38,7.19,8.76,respectively,all P ＜ 0.01).Elevated apoptosis index was noted in keratinocytes from LP lesions compared with those from normal skin (71.35 ± 7.93 vs.33.62 ± 8.75,t =14.29,P ＜ 0.01).In LP lesions,the expressions of both TNF-α and caspase-8 were positively correlated with the apoptosis index of keratinocytes (r =0.72,0.75,respectively,both P ＜ 0.01) and the expression of caspase-3 (r =0.68,0.73,respectively,both P ＜ 0.01).Conclusion The up-regulated expressions of TNF-α,caspase-8 and caspase-3 may participate in the apoptosis in keratinocytes in LP.