ACE-Ⅲ量表和MOCA量表在老年认知障碍诊断中的应用价值研究

Study on the application value of ACE-Ⅲscale and MoCA scale in the diagnosis of cognitive impairment in the elderly

目的探究Addenbrooke认知评估量表Ⅲ(ACE-Ⅲ)量表与蒙特利尔认知评估量表(MoCA)在老年认知障碍诊断中的临床应用价值。方法选择2020年1月—2021年12月于南京医科大学附属老年医院就诊的老年认知障碍患者52例(设为观察组)和同期无认知障碍的老年体检健康者52名(设为对照组)为研究对象。2组均采取ACE-Ⅲ量表和MoCA量表评估,比较2组ACE-Ⅲ量表和MoCA量表评分结果,并分析ACE-Ⅲ量表和MoCA量表对老年认知障碍的诊断信度和诊断效能。结果观察组ACE-Ⅲ量表总分和注意力、记忆力、语言流利、语言、视空间能力评分均明显低于对照组(P<0.05);观察组MoCA量表总分和视空间与执行、命名、注意、语言、抽象、延迟回忆、定向评分均显著低于对照组(P<0.05);ACE-Ⅲ量表与MoCA量表间的组内ICC值为0.810,信度良好;ACE-Ⅲ量表和MoCA量表重测信度分别为0.8和0.7,其中ACE-Ⅲ量表内部一致性良好;ACE-Ⅲ量表中,总分、注意力、记忆力、语言流利、语言和视空间能力的Cronbach’α分别为0.834、0.81、0.84、0.83、0.80和0.82,说明ACE-Ⅲ量表内部一致性良好;ACE-Ⅲ量表和MoCA量表ROC曲线下面积分别为0.903和0.812;ACE-Ⅲ量表截点为82/83,其灵敏度、特异度和约登指数分别为0.96、0.82和0.75;MoCA量表截点为22/23,其灵敏度、特异度和约登指数分别为0.92、0.67和0.54。结论在对老年患者认知障碍临床诊断中,ACE-Ⅲ量表、MoCA量表均具良好的诊断效果,但ACE-Ⅲ量表诊断信度和诊断灵敏度可能优于MoCA。

Objective To study the clinical application value of Addenbrooke Cognitive Assessment ScaleⅢ(ACE-Ⅲ)and Montreal Cognitive Assessment Scale(MoCA)in the diagnosis of cognitive impairment in the elderly.Methods 52elderly patients with cognitive impairment who visited the Affiliated Geriatrics Hospital of Nanjing Medical University from January2020to December2021(observation group)and52healthy elderly persons without cognitive impairment during the same period(the control group)were selected as the research subjects. Both groups were evaluated by ACE-Ⅲscale and MoCA scale. The scores of ACE-Ⅲscale and MoCA scale were compared between the two groups,and the diagnostic reliability and diagnostic efficacy of ACE-Ⅲscale and MoCA scale for cognitive impairment in the elderly were analyzed. Results The total score of ACE-Ⅲscale and the scores of attention,memory,language fluency,language and visuospatial ability in the observation group were significantly lower than those in the control group(P< 0.05);the total score of MoCA and the scores of visual space and execution,naming,attention,language,abstraction,delayed recall and orientation in the observation group were significantly lower than those in the control group(P< 0.05). The intra-group ICC value between the ACE-Ⅲscale and the MoCA scale was0.810. The test-retest reliability of the ACE-Ⅲscale and MoCA scale were0.8and0.7,respectively,and the internal consistency of the ACE-Ⅲscale was good. In the ACE-Ⅲscale,the Cronbach’αvalues of total score,attention,memory,language fluency,language and visuospatial ability were0.834, 0.81,0.84, 0.83, 0.80and0.82,respectively,indicating that the internal consistency of ACE-Ⅲscale was good. The area under the ROC curve of the ACE-Ⅲscale and MoCA scale were0.903and0.812,respectively. The cut-off point of the ACE-Ⅲscale was82/83,and its sensitivity,specificity and Jordan index were0.96, 0.82and0.75,respectively;the cut-off point of the MoCA scale was22/23,and its sensitivity,specificity and Jordan index were0.92, 0.67and0.54,respectively. Conclusion In the clinical diagnosis of cognitive impairment in elderly patients,both ACE-Ⅲscale and MoCA scale have good diagnostic effects,but the diagnostic reliability and diagnostic sensitivity of ACE-Ⅲscale may be better than MoCA scale.