“洛文斯坦職能治療認知評估”第二版於輕度血管性認知缺損的中風病人之適用性：初探研究

The aim of this study was to determine the clinical utility of the Loewenstein Occupational Therapy Cognitive Assessment-Second Edition (LOTCA-Ⅱ) in a stroke sample with mild vascular cognitive impairment (mVCI). Twenty-one stroke patients from a medical center and a regional hospital located in southern Taiwan, as well as 31 age- and education-matched healthy controls participated in the study. Mild VCI was defined based on a total score ranging between 20 and 26 on the Mini-Mental State Examination (MMSE), without concomitant dementia. LOTCA-Ⅱ and MMSE were administered individually to each patient, whereas normal controls were tested on the LOTCA-Ⅱ. The results showed that substantial ceiling effects existed in 80.8% of the LOTCA-Ⅱ items. Among the LOTCA-Ⅱ items, only logic questions item of the thinking operations subtest achieved a substantial floor effect. LOTCA-Ⅱ total scores exhibited neither ceiling nor floor effects. Relative to normal controls, stroke patients performed more poorly on visuomotor organization and thinking operations subtests. For stroke patients, none of the mean z scores for each of the LOTCA-Ⅱ subtests fell within the impaired range (2 standard deviations below the control mean). However, a high percentage (20%-48%) of patients scored in the designated impaired range on the thinking operations, orientation, visuomotor organization, and visual perception subtests as well as total score. The LOTCA-Ⅱ subtests discriminated patients from controls with an overall accurate classification rate of 75%. Finally, LOTCA-Ⅱ total score correlated highly with MMSE total score, and moderately with time between stroke onset and assessment. Taken together, these preliminary findings suggested that the LOTCA-II is not suitable for screening mVCI in stroke patients; however, the visuomotor organization and thinking operations subtests can be used to evaluate higher cognitive abilities in this group of patients.