MMSE与MoCA在维持性血液透析患者认知损害诊断中灵敏性的比较分析

Comparison of the sensitivity of mini-mental state examination(MMSE) and Montreal cognitive assessment(MoCA) for the diagnosis of cognitive impairment in maintenance hemodialysis patients

目的 比较简易精神状态检查量表（mini-mental state examination,MMSE）与蒙特利尔认知评估量表（montreal cognitive assessment,Mo CA）对维持性血液透析患者（maintenance hemodialysis patients,MHP）认知损害诊断的灵敏性,并分析其认知损害的特点。方法 2015年10月~2016年1月间对89例MHP进行MMSE和Mo CA的横断面测试,由神经科医生对这部分患者进行认知损害诊断,比较MMSE和Mo CA对MHP认知损害诊断的特异性和灵敏性。并进一步使用独立样本t检验比较认知损害诊断为阳性/阴性的患者在MMSE和Mo CA分量上的具体差异。结果 MMSE对认知损害筛查的敏感性为30.23%,特异性为100%;Mo CA对认知损害筛查的敏感性为97.67%,特异性为76.32%。认知损害诊断为阳性的患者在MMSE量表的注意力与计算力（t=-4.995,P=0.000）、复述能力（t=-2.284,P=0.021）、阅读能力（t=-2.322,P=0.023）、书写能力（t=-4.156,P〈0.001）以及结构能力（t=-3.921,P〈0.001）与诊断为阴性的患者相比有显著差异;在Mo CA的视空间与执行能力（t=-4.636,P〈0.001）、注意及计算能力（t=-5.654,P〈0.001）、言语能力（t=-9.214,P〈0.001）、抽象能力（t=-4.910,P〈0.001）以及延迟回忆能力（t=-2.306,P=0.024）上与诊断为阴性的患者相比都有显著差异。结论 Mo CA量表对MHP患者认知损害诊断的敏感性更高。认知损害诊断为阳性的患者在执行能力、注意能力、结构能力和抽象能力等具体认知执行能力都显著低于认知损害为阴性的患者。

Objective To compare the sensitivity of mini-mental state examination （MMSE）, and Montreal cognitive assessment （MoCA） for the diagnosis of cognitive impairment in maintenance hemodialysis （MHD） patients, and to explore the characteristics of cognitive impairment in MHD patients. Methods A total of 89 MHD paiients were examined with MMSE and MoCA between Oct. 2015 to Jan. 2016, and at the same time their cognitive impairment was assessed by neurologists. We then evaluated the specificity and sensitivity of MMSE and MoCA for the diagnosisof cognitive impairment in these patients. Results For the diagnosis of cognitive impairment, the sensitivity was 30.23% and the specificity was 100% by MMSE, and the sensitivity was 97.67% and the specificity was 76.32% by MoCA. The patients diagnosed with cognitive impairment had lower scores in attention and calculation （t=-4.995, P=0.000）, retelling ability （t=-2.284, P= 0.021）, reading ability （t=-2.322, P=0.023）, writing ability （t=-4.156,P〈0.001）, and construction （t=-3.921, P〈0.001） by MMSE, and had lower scores in visual-spatial and executive capacities （t=-4.636, P〈0.001）, attention and calculation （t=-5.654, P〈0.001）, language （t=-9.214, P〈0.001）, abstract ability （t=--4.910, P〈 0.001）, and delayed recall ability （t=-2.306, P=0.024） by MoCA, as compared those with the patients without cognitive impairment. Conclusions The sensitivity of MoCA was higher than that of MMSE for the diagnosis of cognitive impairment in MHD patients. The patients diagnosed with cognitive impairment had lower scores in some specific executive abilities such as executive capacity, attention,construction,and abstract ability.