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张彦红,梁伟雄,朱 磊,尤劲松.蒙特利尔认知评估量表与简易精神状态量表用于筛查血管性认知障碍的比较[J].中国康复医学杂志,2012,27(5):431~436
蒙特利尔认知评估量表与简易精神状态量表用于筛查血管性认知障碍的比较    点此下载全文
张彦红  梁伟雄  朱 磊  尤劲松
广州市第一人民医院,广州,100068
基金项目:中药新药临床评价技术平台研究.国家“十一五”计划科技重大专项(2008ZX09312—021)
DOI:
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摘要:
      摘要 目的:比较蒙特利尔认知评估量表(MoCA)和简易精神状态检查(MMSE)在筛查脑血管病患者中血管性认知障碍(VCI)及其最主要的亚型血管性痴呆(VaD)的能力。 方法:对广东省中医院神经科门诊及住院治疗的127例脑血管病患者进行广泛的神经心理学测验,包括记忆力、执行能力、注意力、视空间、语言等五个方面的内容,并进行MoCA量表和MMSE量表的评价。根据广泛的神经心理学评价结果,采用可操作性的方法诊断认知受损,由临床医生结合认知受损的结果及相应的诊断标准进一步诊断非痴呆型血管性认知障碍(VCIND)和VaD,以此诊断结果作为相对的临床金标准,绘制受试者工作曲线(ROC),比较MoCA量表和MMSE量表在筛查脑血管病患者中VCI(包括VCIND和VaD)及VaD的能力。 结果:127例受试者中诊断为认知受损的共101例,进一步诊断为VaD患者55例,VCIND患者46例,诊断为认知正常的患者26例。MoCA量表、MMSE量表在筛查脑血管患者中VCI患者时曲线下面积(AUC)比较,MoCA(0.956±0.0177)>MMSE(0.920±0.0233),Z=2.339,P=0.019;而在筛查脑血管病患者中VaD患者时AUC比较,MoCA(0.945±0.0194)与MMSE(0.931±0.0248)无显著性差异,Z=1.453,P=0.146。 结论:MOCA量表在筛查脑血管病患者中VCI患者时优于MMSE量表,而两量表在筛查脑血管病患者中VaD患者时能力相似。
关键词:血管性认知障碍  血管性痴呆  非痴呆型血管性认知障碍  蒙特利尔认知评估表  简易精神状态量表  神经心理学评估
Comparison of validity of Montreal cognitive assessment and mini-mental state examination in screening vascular cognitive impairment in cerebral vascular disease    Download Fulltext
Guangzhou First Municipal People’s Hospital, Guangzhou, 510180
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Abstract:
      Abstract Objective: To compare the validity of Montreal cognitive assessment (MoCA) and mini-mental state examination (MMSE) in screening vascular cognitive impairment (VCI) and its main subtype vascular demantia (VaD) in cerebral vascular disease (CVD). Method: One hundred and twenty-seven patients from both neurology clinic and ward of hospital of traditional Chinese medicine of Guangdong province with cerebral vascular disease (CVD) meeting studying criterion were included. All the subjects were administered a neuropsychological tests battery, which included measurements in the following 5 cognitive domains: memory, executive abilities, attention, visuospatial, language, and were administered MoCA and MMSE as well. An operationalized criteria of cognitive deficits was used, results of every subjects' cognitive deficits and diagnostic criteria for vascular cognitive impairment-no dementia(VCIND) and VaD were combined as reference resources by neurology clinicians to diagnose VCIND and VaD. This diagnostic result was considered as the relative clinical gold standard to draw receiver operating curve(ROC) and to compare the validity of MoCA and MMSE in screening VCI in CVD. Result: One hundred and one subjects met the criteria of cognitive deficits, and 55 of them were diagnosed as VaD, 46 of them were VCIND, the other 26 subjects were cognitive normal. The discriminant validity in detecting VCI from CVD was the MoCA superior to the MMSE (receiver operating characteristic area under the curve(AUC): MoCA(0.956±0.0177)>MMSE(0.920±0.0233), Z=2.339, P=0.019); The discriminant validity in detecting VaD from VCD was similar for the MoCA and the MMSE (receiver operating characteristic AUC MoCA(0.945±0.0194)and MMSE (0.931±0.0248), Z=1.453, P=0.146). Conclusion: The MoCA possess adequate psychometric properties as a screening instrument in detecting VCI from CVD, and is superior to the MMSE, while they have the similar validity in detecting VaD from CVD.
Keywords:vascular cognitive impairment  vascular dementia  vascular cognitive impairment-no dementia  Montreal cognitive assessment  mini-mental state examination  neuropsychological test
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