蒙特利尔认知评估量表在中国中老年人群筛查轻度认知功能障碍中的截断值的系统评价

Diagnostic value of montreal cognitive assessment for mild cognitive impairment in Chinese middle-aged adults:a meta-analysis

目的系统评价蒙特利尔认知评估量表(Mo CA)在中国中老年人群筛查轻度认知功能障碍中不同截断值的诊断价值。方法计算机检索PubMed、EMbase、Web of Science、The Cochrane Library(2016年5期)、OVID、CBM、CNKI、VIP和WanFang Data数据库,搜集MoCA量表中文版本在中国中老年人群中以Petersen标准诊断MCI的相关诊断性试验,检索时限均为从2005年4月9日到2015年12月31日。由两位评价者独立筛选文献、提取资料,并采用QUADAS-2工具评价纳入研究的方法学质量后,采用STATA14.0软件进行Meta分析。结果共纳入27个研究,共计5 755研究对象(平均年龄60~80岁),按Petersen标准其中1 997人被诊断为MCI。Meta分析结果显示:以合并后受试者工作特征曲线下面积最大且合并灵敏度、特异度都相对较高为标准,Mo CA量表在中老年人群中轻度认知障碍筛查的最佳诊断截值为25/26[Sen合并=0.96,95%CI(0.93,0.97);Spe合并=0.83,95%CI(0.75,0.89);DOR=107,95%CI(61,188)]。按照不同研究设计(横断面研究和病例对照研究)、不同研究对象来源(社区与医院)或仅纳入使用北京版MoCA量表的亚组分析结果均显示:25/26仍是MoCA量表筛选MCI的最佳截断值。结论在中国中老年人群筛查轻度认知功能障碍,MoCA量表25/26分为最佳截断值,其准确性和特异性均较好。

Objective To evaluate diagnostic accuracy of several relevant cut-off points of Montreal cognitive assessment （MoCA） for mild cognitive impairment （MCI） in Chinese middle-aged adults. Methods Databases including PubMed, EMbase, Web of Science, The Cochrane Library （Issue 5, 2016）, OVID, CBM, CNKI, VIP, WanFang Data were searched for diagnostic tests about MoCA for MCI from April 9~h 2005 to December 31~t 2015. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality by QUADAS-2 tool. Then, meta-analysis was performed by Stata 14.0 software. Results A total of 27 studies involving 5 755 participants were included with mean ages from 60 to 80 years old. Among them, 1 997 were diagnosed as MCI patients by Petersen criteria. Based on maximal area under the ROC curve as well as optimal pooled sensitivity and specificity, the optimal cutoff value of MoCA was 25/26, the pooled sensitivity was 0.96 with 95%CI 0.93 to 0.97, specificity was 0.83 with 95%CI 0.75 to 0.89, and DOR was 107 with 95%CI 61 to 188. The subgroup analysis with different research designs, different sources of study participants and different MoCA versions all indicated 25/26 as an optimal cut-off value. Conclusion The optimal cutoff value of MoCA in Chinese middle-aged adults for screening MCI by Petersen criteria was 25/26.