简明精神状态检查和蒙特利尔认知评估量表筛查社区老年人中轻度认知功能障碍及痴呆的应用分析

The application of Mini-Mental State Examination and Montreal cognitive assessment for mild cognitive impairment and dementia in community survey

目的 比较MMSE和MoCA在社区老年人中MCI及痴呆筛查的准确度、敏感度和特异度等.方法 采用分层整群抽样方法,在广州地区抽取8个居（村）委会,对其所属年龄≥65岁老年人采用MMSE、MoCA、听觉词语学习测验等进行认知功能测评.采用临床痴呆评定量表评定认知功能损害程度,社会功能活动调查量表评定其生活功能状态.对完成测查的2 111例老年人参照Petersen及DSM-Ⅳ的诊断标准根据其认知功能受损程度分为对照组、MCI组、痴呆组.绘制受试者工作特征曲线及曲线下面积分析各量表诊断MCI或痴呆的准确度,及其相应的敏感度与特异度.结果 MMSE和MoCA筛查MCI或痴呆的曲线下面积范围0.72～0.99,曲线下面积与完全随机情况下获得的Az =0.5比较,差异均有统计学意义（Z=2.75,P＜0.01）;在MCI和痴呆筛查中,对不同文化程度人群MMSE较MoCA具有更大的曲线下面积,但两者比较差异无统计学意义;MCI筛查时,MMSE和MoCA在文盲、小学、中学文化及以上组的临界值及其相应的敏感度和特异度分别为21分（84％/64％）与15分（88％/54％）、26分（91％/70％）与20分（94％/68％） 、27分（93％/86％）与23分（93％/80％）;痴呆筛查时,MMSE和MoCA在文盲、小学、中学文化及以上组的临界值及其相应的敏感度和特异度分别为16分（98％/85％）与11分（98％/70％）、20分（100％/94％）与14分（100％/87％）、22分（100％/98％）与16分（100％/95％）.结论 MMSE和MoCA在MCI或痴呆筛查中均有较高的准确度、敏感度及特异度,但不同文化程度临界值不同.在MCI和痴呆的社区调查中,应分别采用MoCA及MMSE作为筛查工具.

Objective To compare the accuracy,sensitivity,specificity of the Mini-Mental State Examination （MMSE） and Montreal cognitive assessment （MoCA） in screening of mild cognitive impairment （MCI） and dementia in community survey.Methods This study was conducted among residents aged 65 years and above in the urban and rural areas selected by stratified sampling from 6 urban and 2 rural communities.The 2 111 cases who finished the Neuropsychological tests included MMSE,MoCA,and Clinical Dementia Rating scale（CDR） were divided into groups normal control,MCI,and dementia.The accuracy,sensitivity and specificity was compared by the area under the curve （AUC） of receiver-operating characteristic curve.The clinical diagnoses of MCI was made according to Petersen＇s criteria.Results The areas under curve were between 0.72 to 0.99 for MMSE and MoCA on discriminated MCI or dementia （Z =2.75,P ＜0.01） when compared with Az =0.5 by random.In elders with different education levels,MMSE showed no significanlty larger AUC than MoCA in MCI or dementia screening （P ＞ 0.05）.In MCI survey,the cutoff values and sensitivity/specificity of MMSE vs.MoCA in education levels of illiterate,primary,secondary and above were 21 （84 ％/64 ％） vs.15 （88 ％/54 ％）,26 （91％/70％） vs.20 （94 ％/68 ％）,27 （93％/86％） vs.23（93％/80％） respectively; but in dementia survey,the cutoff values and sensitivity/ specificity of MMSE vs.MoCA in education levels of illiterate,primary,secondary and above were 16 （98％/ 85％） vs.11 （98％/70％）,20（100％/94％） vs.14（100％/87％）,22（100％/98％） vs.16（100％/95％） respectively.Conclusions MMSE and MoCA are good cognitive assessment tools in the survey of MCI or dementia with high accuracy,sensitivity and specificity.But the cutoff value is different according to one＇s education level.MoCA may be more suitable for MCI survey but MMSE for dementia.