摘要
目的:比较蒙特利尔认知评估量表(MoCA)和简易精神状态检查(MMSE)在筛查脑血管病患者中血管性认知障碍(VCI)及其最主要的亚型血管性痴呆(VaD)的能力。方法:对广东省中医院神经科门诊及住院治疗的127例脑血管病患者进行广泛的神经心理学测验,包括记忆力、执行能力、注意力、视空间、语言等五个方面的内容,并进行MoCA量表和MMSE量表的评价。根据广泛的神经心理学评价结果,采用可操作性的方法诊断认知受损,由临床医生结合认知受损的结果及相应的诊断标准进一步诊断非痴呆型血管性认知障碍(VCIND)和VaD,以此诊断结果作为相对的临床金标准,绘制受试者工作曲线(ROC),比较Mo-CA量表和MMSE量表在筛查脑血管病患者中VC(I包括VCIND和VaD)及VaD的能力。结果:127例受试者中诊断为认知受损的共101例,进一步诊断为VaD患者55例,VCIND患者46例,诊断为认知正常的患者26例。结论:MoCA量表、MMSE量表在筛查脑血管患者中VCI患者时曲线下面积(AUC)比较,MoCA(0.956±0.0177)>MMSE(0.920±0.0233),Z=2.339,P=0.019;而在筛查脑血管病患者中VaD患者时AUC比较,MoCA(0.945±0.0194)与MMSE(0.931±0.0248)无显著性差异,Z=1.453,P=0.146。MOCA量表在筛查脑血管病患者中VCI患者时优于MMSE量表,而两量表在筛查脑血管病患者中VaD患者时能力相似。
Objective： To compare the validity of Montreal cognitive assessment （MoCA） and mini-mental state examination （MMSE） in screening vascular cognitive impairment （VCI） and its main subtype vascular demantia （VaD） in cerebral vascular disease （CVD）. Method： One hundred and twenty-seven patients from both neurology clinic and ward of hospital of traditional Chinese medicine of Guangdong province with cerebral vascular disease （CVD） meeting studying criterion were in- cluded. All the subjects were administered a neuropsyehological tests battery, which included measurements in the following 5 cognitive domains： memory, executive abilities, attention, visuospatial, language, and were administered MoCA and MMSE as well. An operationalized criteria of cognitive deficits was used, results of every subjects＇ cognitive deficits and diagnostic criteria for vascular cognitive impairment--no dementia（VCIND） and VaD were combined as reference resources by neurology clinicians to diagnose VCIND and VaD. This diagnostic result was con- sidered as the relative clinical gold standard to draw receiver operating curve（ROC） and to compare the validity of MoCA and MMSE in screening VCI in CVD. Result： One hundred and one subjects met the criteria of cognitive deficits, and 55 of them were diagnosed as VaD, 46 of them were VCIND, the other 26 subjects were cognitive normal. The discriminant validity in detecting VCI from CVD was the MoCA superior to the MMSE （receiver operating characteristic area under the curve （AUC）： MoCA（0.956 ± 0.0177） 〉 MMSE（0.920± 0.0233）, Z=2.339, P=0.019）; The discriminant validity in detecting VaD from VCD was similar for the MoCA and the MMSE （receiver operating characteristic AUC MoCA（0.945 ± 0.0194）and MMSE （0.931 ±0.0248）, Z=1.453, P=0.146）. Conclusion： The MoCA possess adequate psychometric properties as a screening instrument in detecting VCI from CVD, and is superior to the MMSE, while they have the similar validity in detecting VaD from CVD.
出处
《中国康复医学杂志》
CAS
CSCD
北大核心
2012年第5期431-436,共6页
Chinese Journal of Rehabilitation Medicine
基金
中药新药临床评价技术平台研究.国家"十一五"计划科技重大专项(2008ZX09312-021)
