蒙特利尔认知评估量表识别首次卒中后轻度血管性认知障碍的作用  

Value of Montreal cognitive assessment in identifying patients with mild vascular cognitive impairment after first stroke

作　　者：王延平[1] 徐桂兰[1] 杨少青[1] 刘湘敏[1] 邓小莹[1] 

机构地区：[1]广州医学院第二附属医院神经内科,广州510260

出　　处：《中华神经医学杂志》2010年第5期503-507,共5页Chinese Journal of Neuromedicine

摘　　要：目的 探讨蒙特利尔认知评估量表（MoCA）识别首次卒中后轻度血管性认知障碍（mVCI-FS）的作用,并与简易智能精神状态量表（MMSE）比较. 方法 选取mVCI-FS患者60例.首次卒中后非血管性认知障碍（nVCI-FS）25例,于发病后（12＋1）周由不知情的神经科医师进行MoCA及MMSE评估. 结果 MoCA总平均分为（19.78±4.573）分,MMSE为（25.48±3.148）分,偏相关分析间.r=9,P=0.000.MoCA除计算力和言语流畅性外,其余各项在mVCI-FS和nVCI-FS间差异均有统计学意义（P〈0.05）;MMSE的即刻记忆、计算力、命名和阅读理解在2组间差异无统计学意义（P〉0.05）.应用ROC曲线和Youden指数最大值初步确定MoCA识别mVCI-FS与nVCI-FS的最佳分界值为21分.以21分为分界值.MoCA筛查mVCI-FS的敏感度和特异度分别为84.6%和76.0%,明显优于MMSE（敏感度59.6%和特异度57.7%）,差异有统计学意义（P〈0.05）. 结论 初步确定MoCA识别mVCI-FS与nVCI-FS的最佳分界值为21分.MoCA筛查mVCI-FS的敏感度和特异度均高,是一种有效的mVCI.FS筛查量表;MMSE对mVCI.FS的敏感度低,识别mVCI-FS的作用有限.Objective To determine the value of Montreal cognitive assessment （MoCA） in identifying the patients with mild vascular cognitive impairment after first stroke （mVCI-FS）, and compare it＇s results with those of mini-mental state examination （MMSE）. Methods MoCA and MMSE were performed on 60 patients with mVCI-FS and 25 with non mild vascular cognitive impairment after first stroke （nVCI-FS） by neurologists 12±1 w after the onset. Results Total mean scores of MoCA was 19.78±4.57 and that of MMSE was 25.48±3.14 with the partial correlation reaching r=0.779 and P=0.000. Significant differences in each sub-items of MoCA were found between mVCI-FS group and nVCI-FS group, except calculation and verbal fluency （P〈0.05）; no significant difference in immediate memory, calculation, naming and reading comprehension of MMSE was noted between the 2 groups （P〉0.05）. The initial optimal cut-off-point of MoCA was 21 in identifying mVCI-FS from nVCI-FS according to the ROC curve analyses as well as the largest youden＇s index. With the cut-off-point of 21,MoCA Can provided a sensitivity of 84.6% and a specificity of 76.0%,respectively,for screening mVCI-FS, which was much better than MMSE （sensitivity 59.6% and specificity 57.7%）Conclusions The initial optimal cut-off-point of MoCA is 21 in identifying mVCI-FS from nVCI-FS.MoCA, having high sensitivity and specificity in screening mVCI-FS, is a valid screening scale in screening mVCI-FS; however, MMSE, showing poor sensitivity in screening mVCI-FS, cannot be a reliable instrument in screening mVCI-FS.

关 键 词：蒙特利尔认知评估量表 简易智能精神状态量表 轻度血管性认知障碍 

分 类 号：R749.13[医药卫生—神经病学与精神病学]