蒙特利尔评估表筛查皮层下非痴呆血管性认知障碍的可行性研究

Feasibility study of the Montreal cognitive assessment in detecting subcortcial vascular cognitive impairment-no dementia

目的探索蒙特利尔认知评估量表（MoCA）筛查皮层下非痴呆血管性认知障碍（VaCIND-S）汉族老年人的可行性。方法共入组75名汉族老年人，包括VaCIND—S患者40例，正常对照组35例，进行MoCA、简易精神状态量表（MMSE）等检查，研究VaCIND-S的神经心理学特征，使用ROC曲线分析其灵敏度和特异度。结果两组患者在年龄、性别、教育程度上差异均无显著性（P〉0．05），使用MoCA发现VaCIND—S患者在记忆功能、视空间、执行功能、注意力、语言功能、定向力得分[分别为（0．43±1．01）分，（2．21±1．19）分，（2．11±1．13）分，（4．66±1．48）分，（4．42±1．31）分，（4．86±1．12）分]均低于正常对照组得分[分别为（2．93±1．36）分，（3．29±1．06）分，（3．53±0．93）分，（5．94±0．24）分，（5．44±0．71）分，（5．80±0．48）分]，差异有显著性（P〈0．05）。MoCA在VaCIND．S的筛查中较MMSE灵敏，在截断值为23．5分时有较高的灵敏度和特异度，分别为0．971和0．789。结论MoCA是一个可靠的VaCIND-S筛选工具，且较MMSE敏感，尚需要进一步在大规模及不同种族人群中进行研究。

Objective To explore feasibility study of the Montreal cognitive assessment （MoCA） in detecting subcortcial vascular cognitive impairment-no dementia（VaCIND-S）. Methods Seventy-five Chinese Han were assessed by the MoCA and MMSE. 40 met criteria for VaCIND -S and 35 were considered cognitively normal. ROC curve analyses were performed to determine optimal sensitivity and specificity. Results No differences were found between groups on age, gender, education degrees. According to their MoCA scores, cognitive impairments in- cluding memory, visuospatial, executive function, attention, language, and orientation sub-scores in VaCIND-S （（0.43 ±1.01）,（2.21 ±1.19）,（2.11 ±1.13） ,（4.66 ± 1.48）,（4.42 ± 1.31）,（4.86 ±1.12）） significantly decreased compared with those in controls （ （2.93 ± 1.36）, （ 3.29 ± 1.06 ）, （ 3.53 ± 0.93 ）, （5.94 ± 0.24）, （5.44 ± 0.71 ）, （5.80 ± 0.48 ） ） （P 〈 0.05 ）. The MMSE scale was insensitive to cognitive impairment as compared with MoCA scale. Using cut-off score of 23.5 ,the MoCA exhibited excellent sensitivity （0.971） and specificity （0. 789）. Conclusion MoCA is a more sensitive instrument than the MMSE for the detection of VaCIND-S and warrants further investigation regarding its applicability in large and varying ethnic population.