MoCA-B和MMSE对首发急性脑卒中患者认知功能障碍筛查作用的比较
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摘要
目的比较蒙特利尔认知评估基础量表(Montreal cognitive assessment-basic, MoCA-B)和简易精神状态量表(mini-mental state examination, MMSE)对急性脑卒中患者认知功能障碍的筛查作用。方法纳入发病10 d内的急性脑卒中(包括新发脑梗死及脑出血)患者83例,应用MMSE及MoCA-B量表进行神经心理评估,比较MMSE及MoCA-B量表所划分出的正常组和异常组与专家的临床判断的一致性及各认知域的差异。结果①MMSE评测异常者32例(38.6%),正常者51例(61.4%)。MoCA-B评测异常者43例(48.2%),正常者40例(51.8%)。②MoCA-B与专家的诊断一致性为89.16%,以专家判断为校标,MMSE假阳性为2.41%,假阴性(漏诊率)为16.87%;MoCA-B的假阳性为4.82%,假阴性(漏诊率)为6.02%。③MMSE正常的51例患者中,有15例MoCA-B检测为异常(29.4%),他们在执行功能、语言流畅性、定向力、抽象、延迟回忆、视知觉、命名等分认知域均与正常组存在显著差异(P<0.05)。结论 MoCA-B量表在筛查急性卒中患者认知障碍方面可能比MMSE量表更敏感,更具优势。
Objective To compare Montreal cognitive assessment-basic(MoCA-B)and mini-mental state examination(MMSE)in screening cognitive dysfunction of acute stroke patients.Methods The cognitive function of patients(n=83)with acute stroke onset within 10 days(including new cerebral infarction and cerebral hemorrhage)were assessed using MMSE and MoCA-B.The classification of patients with cognitive impairment was compared between the two scales.The consistency of cognitive impairment and affected domains assessed by MMSE or MoCA with experts were evaluated.Results(1)There were 32 cases(38.6%)with abnormal MMSE score and 40 cases(51.8%)with abnormal MoCA-B score.(2)The the diagnostic consistency of MoCA-B with experts was 89.16%.The false positive of MMSE was 2.41%and the false negative(rate of missed diagnosis)was 16.87%.False positives of MoCA-B were 4.82%and false negatives(rate of missed diagnosis)were 6.02%.(3)Among the 51 patients with normal MMSE,15 had abnormal MoCA-B(29.4%)There were significant differences between these two score system in executive function,verbal fluency,directivity abstraction,delayed recall,visual perception,naming and other cognitive domains(P<0.05).Conclusion MoCA-B scale may be more sensitive and better than MMSE scale in screening for cognitive impairment in patients with acute stroke.
Objective To compare Montreal cognitive assessment-basic(MoCA-B)and mini-mental state examination(MMSE)in screening cognitive dysfunction of acute stroke patients.Methods The cognitive function of patients(n=83)with acute stroke onset within 10 days(including new cerebral infarction and cerebral hemorrhage)were assessed using MMSE and MoCA-B.The classification of patients with cognitive impairment was compared between the two scales.The consistency of cognitive impairment and affected domains assessed by MMSE or MoCA with experts were evaluated.Results(1)There were 32 cases(38.6%)with abnormal MMSE score and 40 cases(51.8%)with abnormal MoCA-B score.(2)The the diagnostic consistency of MoCA-B with experts was 89.16%.The false positive of MMSE was 2.41%and the false negative(rate of missed diagnosis)was 16.87%.False positives of MoCA-B were 4.82%and false negatives(rate of missed diagnosis)were 6.02%.(3)Among the 51 patients with normal MMSE,15 had abnormal MoCA-B(29.4%)There were significant differences between these two score system in executive function,verbal fluency,directivity abstraction,delayed recall,visual perception,naming and other cognitive domains(P<0.05).Conclusion MoCA-B scale may be more sensitive and better than MMSE scale in screening for cognitive impairment in patients with acute stroke.
引文
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[2]张力,赵永波.卒中后的认知损害[J].神经疾病与精神卫生,2003(04):324-326.
[3]杨洁,区腾飞,解龙昌,等.短暂性脑缺血发作及轻型卒中患者认知功能下降的随访研究[J].中国神经精神疾病杂志,2015,41(02):98-101.
[4]FU C,JIN X,CHEN B,et al.Comparison of the Mini-Mental State Examination and Montreal Cognitive Assessment executive subtests in detecting post-stroke cognitive impairment[J].Geriatr Gerontol Int,2017,17:2329-2335.
[5]ALAGIAKRISHNAN K,MAH D,DYCK JR,et al.Comparison of two commonly used clinical cognitive screening tests to diagnose mild cognitive impairment in heart failure with the golden standard European Consortium Criteria[J].Int J Cardiol,2016,9:558-562.
[6]SCHEFFELS JF,KR魧LING H,KALBE E,et al.Conversions of cognitive screenings:Mini-Mental State Examination vs.Montreal Cognitive Assessment vs.DemTect[J].Nervenarzt,2018,89(12):1371-1377.
[7]TURUNEN KEA,LAARI SPK,KAURANEN TV,et al.Domain-Specific Cognitive Recovery after First-Ever Stroke:A 2-Year Follow-Up[J].J Int Neuropsychol Soc,2018,24(2):117-127.
[8]PARUNYOU J,SOOKJAROEN T,ZIAD S,et al.The montreal cognitive assessment-basic(MoCA-B):A new mild cognitive impairment screening test for illiterate and low educated elderly[J].Alzheimer's&Dementia:The Journal of the Alzheimer's Association,2015,11(7):442-443.
[9]王征宇,张明园.中文版简易智能状态检查(MMSE)的应用[J].上海精神医学,1989,7(3):108-111.
[10]郭起浩,洪震.神经心理评估(第二版)[M].上海科技技术出版社,2016:72-79.