蒙特利尔认知评估量表在老年人轻度认知功能障碍筛查中的截断值分层研究  

Cut- off Value of Montreal Cognitive Assessment: A Layering Research in Screening of Elderly with Mild Cognitive Impairment in Changsha City

作　　者：张雪晴[1] 曾慧[2] 

机构地区：[1]湖南省常德市第一人民医院神经外科,415000 [2]中南大学护理学院

出　　处：《中国全科医学》2014年第26期3046-3051,共6页Chinese General Practice

基　　金：湖南省自然科学基金资助项目(11JJ5057)

摘　　要：目的探讨蒙特利尔认知评估量表(MoCA)在老年人轻度认知功能障碍(MCI)筛查中的截断值。方法采用多阶段随机整群抽样的方法,于2012年4—9月在长沙市汤家岭社区、蓉园社区、湖中社区、湖东社区选取1 764例老年人(年龄≥60岁)。采用简易精神状态量表(MMSE)、北京版MoCA(MoCA-BJ)、临床金标准(Petersen等制定的诊断标准作为判定MCI的金标准)对受试者进行MCI筛查。分析MoCA-BJ筛查不同文化程度老年人MCI的截断值及筛查价值。结果 MoCA-BJ筛查不同文化程度老年人MCI的截断值:受试者为文盲时,判断老年痴呆和MCI的截断值为17分,判断正常老年人和MCI的截断值为23分;受试者为小学文化程度时,判断老年痴呆和MCI的截断值为20分,判断正常老年人和MCI的截断值为24分;受试者为初中及以上文化程度时,判断老年痴呆和MCI的截断值为20分,判断正常老年人和MCI的截断值为25分。根据以上截断值采用MoCA-BJ筛查MCI的灵敏度为87.1%(250/287),特异度为94.2%(1 372/1 456),阳性预测值为74.9%(250/334),阴性预测值为78.1%(1 372/1 409),正确率为92.5%(1 622/1 743)。进行Kappa一致性检验显示,Kappa值为0.763,一致性较好。结论采用MocA-BJ根据不同文化程度人群的截断值对长沙市老年人进行MCI筛查具有良好的灵敏度和特异度,筛查结果与临床诊断结果具有较好的一致性,值得在社区筛查中推广应用。Objective To investigate the cutoff value of Montreal Cognitive Assessment（ MoCA） in screening of elderly with mild cognitive impairment（ MCI） in Changsha city. Methods The diagnostic criteria of Mini- Mental State Examination（ MMSE）,MoCA Beijing version（ MoCA- BJ）,Clinical Gold Standard were taken as the gold standards for MCI diagnoses,multi- stage random cluster sampling was used to perform a MCI screening in 1 764 elderly（ aged ≥60 years） in Communities Tangjialing,Rongyuan,Huzhong,Hudong from April to September 2012. The cutoff value of MoCA- BJ and its role in screening MCI in elderly at different educational levels were analyzed. Results The elderly receiving screening were divided into illiterate（ The cutoff value of MoCA- BJ was 17 points in judging senile dementia and MCI） and normal（ The cutoff value was23 points）. The cutoff value was 20 points in subjects with primary education,24 in normal ones. The cutoff value was 20 points in those with over primary education,25 in normal ones. Based on the above cutoff values,the sensitivity of MoCA- BJ was87. 1%（ 250 /287）,specificity was 94. 2%（ 1 372 /1 456）,positive predictive value was 74. 9%（ 250 /334）,negative was78. 1%（ 1 372 /1 409）,correct rate was 92. 5%（ 1 622 /1 743）. Kappa consistency test showed that Kappa value was 0. 763 with good consistency. Conclusion The cutoff values of MoCA- BJ based on educational level is of good sensitivity and specificity in elderly MCI screening. The screening results are well consistent with those of clinical diagnoses.

关 键 词：蒙特利尔量表 认知障碍 截断值 老年人 筛查 

分 类 号：R749.1[医药卫生—神经病学与精神病学]