蒙特利尔认知量表中文版诊断老年轻度认知功能损害的应用研究

目的探讨蒙特利尔认知量表(Montreal cognitive assessment,MoCA)中文版诊断老年轻度认知功能损害(mildcognitive impairment,MCI)的效能。方法选取73例MCI患者为MCI组和51例认知功能正常者为对照组,对两组进行均衡性检验及MoCA中文版评估。结果 MCI组MoCA总分、视空间功能、命名、计算力、语言、抽象及延迟回忆项得分显著低于对照组(P<0.01);以26分作为分界值,MoCA中文版诊断MCI结果与Petersen诊断标准结果相比较,差异无统计学意义(P=0.289),诊断符合率为0.935、敏感度为0.918、特异度为0.961、阳性预测值为0.971、阴性预测值为0.961。结论 MoCA中文版适于MCI患者的早期筛查和初步诊断。     

蒙特利尔认知评估量表(中文版)在驻京军队离退休干部中界值划分的初步研究

目的初步探讨蒙特利尔认知评估表(Montreal cognitive assessment,MoCA)中文版筛查轻度认知损害(mild cognitive impairment,MCI)的可行性及界值的划分。方法选取军队驻京干休所的离退休干部169人为研究对象,根据临床诊断标准分为正常组(51名),MCI组(73名),痴呆组(45名),分别给予MoCA与简易智能精神状态量表(mini mental state exami-nation,MMSE)评估,进行两种量表得分相关性及MoCA得分截断值的初步探讨。结果 MoCA总分和MMSE总分相关性很好(r=0.846,P0.001);经过绘制受试者工作曲线(ROC曲线)确定MoCA得分值≥26为正常,其敏感性和特异性分别为1.000和0.986,19～25分为MCI,其敏感性和特异性分别为0.932和0.717。结论本研究人群MoCA得分与MMSE得分有很好的相关性,在该人群中可以使用MoCA量表筛查MCI患者,得分范围可设定为19～25分。     

蒙特利尔认知评估量表在老年轻度认知功能障碍筛查中的应用

目的探讨蒙特利尔认知评估量表（MoCA）在老年轻度认知功能障碍（MCI）患者筛查中的应用。方法选择老年MCI患者56例为MCI组和认知功能正常者50例为对照组,分别给予MoCA、简易精神状态检查量表（MMSE）评估,并分析评估结果。结果 MCI组和对照组MoCA总分明显低于MMSE总分（P〈0.01）。MoCA筛查MCI的敏感性为96.4%、特异性为84%;MMSE筛查MCI的敏感性为35.7%、特异性为100%。MoCA中除定向力项外,总分及其余各亚项的评分在MCI组和对照组间差异均有统计学意义（P〈0.01）。结论 MoCA为高敏感性的MCI筛查工具,能全面评估MCI患者的认知功能,筛查MCI的敏感性优于MMSE。     

无症状脑梗死后轻度认知功能障碍的影响因素及蒙特利尔认知评估量表的临床应用

目的 探讨无症状脑梗死(SBI)后轻度认知功能障碍(MCI)的发生情况及其影响因素,以及中文版蒙特利尔认知评估量表(MoCA)在MCI筛查中的应用价值.方法 选择精神状态简易速检表(MMSE)检测均在正常范围的69例SBI患者(SBI组)与52例非脑梗死患者(对照组),分别采用MoCA进行评分,并对评分结果进行比较.分析SBI患者的年龄、梗死灶数目、伴发疾病(原发性高血压、糖尿病及高脂血症)对MoCA评分的影响.结果 SBI组MoCA评分为(20.70±4.01)分,较对照组的(23.96±3.48)分显著降低(P＜0.01);SBI组MCI发生率[85.5%(59/69)]显著高于对照组[48.1%(25/52)](P＜0.01).SBI组中,年龄≥65岁,多发梗死灶,合并原发性高血压、糖尿病及高脂血症患者MoCA评分显著降低(P＜0.01或＜0.05).结论 SBI患者中MCI发生率高,并与年龄、梗死灶数目及合并原发性高血压、糖尿病及高脂血症有关.MoCA可在MMSE评分正常的患者中筛查出MCI.     

蒙特利尔认知评估量表的验证性因素分析

目的 从不同角度评估蒙特利尔认知评估量表(MoCA),并对其结构进行验证性因素分析.方法 对103例进行MoCA和简易智能量表(MMSE)测试,并分对照组29例,轻度认知功能障碍(MCI)组42例,阿尔兹海默病(AD)组32例.比较MoCA与MMSE在诊断筛查MCI敏感性的差异、MoCA总分与MMSE总分相关性、MoCA量表内部一致性,并对MoCA量表结构进行验证性因素分析.结果 MoCA区分MCI、AD的敏感性分别为81.0％、100％,MMSE分别为20.0％、93.8％,MoCA诊断MCI敏感性较MMSE高,与MMSE高度相关(r=0.911,P＜0.001),且内部一致性极好(郎巴赫α系数为0.954),验证性因素分析显示MoCA结构合理.结论 MoCA量表具有实用性强、可靠和量表结构合理等特性.     

有椎动脉优势的轻度认知障碍患者MoCA量表特征研究

目的研究存在椎动脉优势(vertebral artery dominance,VAD)的轻度认知障碍(mild cognitive impairment,MCI)患者的蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)结果的特点。方法在2013年10月—2016年2月医院查体者中,依照2010年MCI的诊断指南,结合MoCA筛选出MCI患者共89例,再根据MRA/CTA图像进行有否VAD的判定,分为有VAD组(A组)43例和无VAD组(B组)46例,采用t检验分析2组间MoCA得分的差异,P0.05为差异有统计学意义。结果 A组的MoCA平均得分为(22.34±2.83)分,低于B组的(23.01±1.95)分,但对比差异无统计学意义(P0.05)。A组视空间与执行功能平均得分为(2.42±1.22)分,而B组为(3.01±0.87)分,两者对比差异有统计学意义(P0.05)。其他单项认知领域两组得分对比差异均无统计学意义(均P0.05)。结论与无VAD的MCI患者对比,有VAD的MCI患者有更明显的视空间技能与执行功能的减退。     

中国四省55岁及以上人群身体活动时间与认知功能状况的关系

目的分析不同强度身体活动时间与认知功能之间的关系。方法以2018—2019年"神经系统疾病专病社区队列研究"基线调查数据为依托,采用多阶段分层整群随机抽样的方法在河北、浙江、陕西及湖南省选取5571名有完整人口学信息、身体活动以及认知功能资料的55岁及以上人群作为研究对象。采用问卷调查法收集研究对象基础信息和身体活动(physical activity,PA)等数据。通过蒙特利尔认知评估量表(the Montreal cognitive assessment,MoCA)评分方法评估认知功能,计算每周低强度(light physical activity,LPA)和中高强度身体活动(moderate-to-vigorous physical activity,MVPA)时间。采用多因素Logistic回归和多元线性回归,分别分析不同强度PA时间与轻度认知功能障碍(mild cognitive impairment,MCI)的患病风险,以及与MoCA总分的关系。结果2018年中国四省5571名55岁及以上人群身体活动时间以中位数(P25,P75)表示,非MCI组每周LPA时间为7.0(0.0,16.3)小时,每周MVPA时间为7.3(0.0,14.0)小时;MCI组每周LPA时间为9.3(0.0,17.5)小时,每周MVPA时间为7.0(0.0,11.7)小时。Logistic回归分析显示,与MVPA时间为0小时的人群相比,每周MVPA时间达到3.6~7.0小时的人群MCI患病风险相对危险度为0.63(95%CI 0.49~0.82,P<0.05)。与LPA时间为0小时的人群相比,每周LPA时间达到3.6~7.0小时人群MCI患病风险相对危险度为1.26(95%CI 0.94~1.67,P>0.05)。多元线性回归分析显示,与每周MVPA时间为0小时的人群相比,随着MVPA时间增加,MoCA总分增加。与每周LPA时间为0小时的人群相比,每周LPA时间小于10.5小时的人群MoCA总分随着每周LPA时间增加而增加。每周LPA时间达到10.5~21.0小时的人群,MoCA总分随着每周LPA时间增加而减少。结论中国四省55岁及以上人群MVPA时间的增加与MCI患病率下降和认知功能检查得分增加有关。LPA时间在适宜范围内,与MCI患病率下降和认知功能检查得分增加有关。     

家属参与个性化干预对轻度认知功能损害患者静脉输液安全的影响

目的探讨家属参与个性化护理干预对轻度认知功能损害患者静脉输液安全的影响。方法将2013年9月至12月在中心注射室进行静脉输液治疗的MCI患者39例为对照组,2014年1月至4月的MCI患者40例为观察组,对两组患者进行相同内容的护理干预,观察组患者家属参与护理干预的全过程。1个月后,比较两两组患者的蒙特利尔认知评估量表(MoCA)各认知域得分及总分、输液安全问题发生率及对输液过程满意度。结果干预后观察组MoCA各认知域得分及总分、输液安全问题发生率及对输液过程满意度均优于对照组,比较差异有统计学意义(P<0.05)。结论家属参与个性化护理干预不仅能改善MCI患者的认知功能,而且能有效减少患者输液安全问题的发生率,提高其对输液过程的满意度。     

MoCA量表对脑梗死患者认知功能障碍评估的临床研究

目的 探讨MoCA量表对脑梗死患者认知功能障碍评估的临床价值.方法 应用蒙特利尔认知评测量表(Montreal Cognitive Assessment,MoCA)对无症状脑梗死患者进行认知功能障碍评价,并对相关危险因素进行分析研究.结果 研究组患者的MoCA评分明显低于对照组,而且研究组中MCI发生率较对照组明显升高,且差异有统计学意义(t或x2=5.61、18.18,P均＜0.05).研究组患者的MoCA评分明显低于对照组,而且研究组中MCI发生率较对照组明显升高,且差异有统计学意义(t或x2=5.61、18.18,P均＜0.05).年龄≥65岁、多发梗死灶,合并高血压、糖尿病、高脂血症等因素是脑梗死患者发生认知功能障碍的危险因素.结论 MoCA量表可操作性强、测试简便快捷、敏感度高,MoCA可以作为对脑梗死患者进行认知功能障碍评估和筛查的良好工具,值得在临床推广使用.     

多状态Markov模型在社区老年人轻度认知损害转归分析中的应用

目的 利用多状态Markov模型对社区老年人轻度认知损害(MCI)转归进行研究.方法 通过MCI患者智商(IQ)变化反映随访人群认知功能的变化趋势,构建一个四状态模型,采用多状态Markov模型进行分析.结果 600例MCI患者中,男性174例(29.0%),女性426例(71.0%),年龄65～90岁,平均(69.7±6.6)岁.单因素分析显示,性别、年龄、文化程度、婚姻状况、吸烟、经济收入、脑溢血、高血压、高胆固醇、糖尿病、低密度脂蛋白胆固醇(LDL-C)水平、收缩压(SBP)、舒张压(DBP)等因素与认知功能有关.多因素分析显示,女性、高年龄、发生脑溢血及高SBP为认知稳定转化为认知重度恶化的危险因素(系数分别为0.762、0.366、0.885、0.069);高年龄是认知稳定转化为认知轻度恶化的危险因素(系数为0.038);高文化程度均为保护因素(系数分别为-0.219和-0.297).转移强度结果显示认知功能稳定进一步恶化(轻度+重度)的进度是好转的1.2倍;轻度恶化到认知功能稳定的进展强度是进一步发展成重度恶化的11.4倍多.结论 多状态Markov模型是处理纵向资料的有效工具.

Abstract：

Objective To introduce the Multi-state Markov model in studying the outcome prediction of mild cognitive impairment (MCI). Methods Based on the intelligence quotient (IQ)changes that reflecting the trends in cognitive function in the patients under follow-up program, we constructed a four states model and used Multi-state Markov model to analyze the patients. Results Among 600 MCI patients, there were 174(29.0%) males and 426(71.0%) females, with age range of 65-90 years-old (average 69.7±6.6). For univariate analysis, gender, age, education level, marital status, smoking, household income, cerebral hemorrhage, hypertension, high cholesterol, diabetes,LDL-C, SBP and DBP were found to be associated with cognitive function. For multivariate analysis,female, older age, cerebral hemorrhage and higher SBP were shown to be the risk factors for transition from the state of cognitive stability to the state of severe deterioration, and their coefficients were 0.762,0.366,0.885, and 0.069, respectively. Age (0.038) could influence the transition from the state of cognitive stability to slight deterioration. Higher education level was shown to be the protective factor for these transitions (-0.219 and-0.297). Transition intensity from the state of cognitive stability to the state of slight and severe deterioration was 1.2 times that of transition to the state of improving. Transition intensity from state of slight deterioration to cognitive stability was 11.4times that of transition to severe deterioration. Conclusion Multi-state Markov model was an effective tool in dealing with longitudinal data.     

The cognitive structure of the modified essay question

This paper analyses and discusses the extent to which the modified essay question (MEQ) in the Final MB Part II examination of the Queen's University, Belfast, assesses the three levels of cognitive ability described by Buckwalter et al. (1981) . The 1978 and 1980 Final MB MEQs are analysed and compared question by question using Bloom's taxonomy and Buckwalter's cognitive levels. Scores obtained for each question were factor analysed to determine any underlying relationships between the questions. The findings ( Table 1 ) indicate an uneven distribution of cognitive questions (Buckwalter's Levels I, II and III) in each MEQ and between the 1978 and 1980 MEQ papers. This reflects partly variation in the type of problems presented, and partly problems posed by having to mark large numbers of paper by hand against an objective marking schedule. The statistical analysis in Table 2 shows a consistent and strong correlation between scores in the MEQ Final MB papers and the Final Clinical examination. The factorial analysis shows that comprehension and evaluation questions do not, as perhaps expected, dominate the loading of any factor. The 1980 MEQ paper emerges as a testing of 'knowledge' paper compared with the 1978 paper, which tests much more analysis, synthesis and evaluation of knowledge. The appropriate balance between cognitive levels to be tested must be determined beforehand. The study shows however the potential of the MEQ to measure the entire span of Bloom and Buckwalter's levels.  

  Table 1.  Analysis of questions by taxonomy.     

14.

Methodological issues in the study of cognitive decline     

Morris MC  Evans DA  Hebert LE  Bienias JL 《American journal of epidemiology》1999,149(9):789-793

In recent years, epidemiologists have given increased attention to cognition, especially to the dementing illnesses that occur in old age. Central to this study is the measurement of change in cognition as opposed to cognition measured at a single point in time. This article addresses conceptual and methodological issues in the study of changes in cognitive function, including: 1) difficulties encountered with the use of single measurements of cognition and the importance of measuring changes in cognition; 2) sources of measurement variation and its potential effects; 3) the importance of careful modeling of age and education; 4) considerations in categorizing outcomes or combining the results of cognitive tests; and 5) the benefits of using multiple-outcome statistical models.     

15.

Computerised cognitive training programs improved the cognitive performance of healthy older adults on some cognitive tests including memory,speed of information processing and visuospatial skills          下载免费PDF全文

Dr Kate Laver  Caitlin Hamilton  Dr Annie McCluskey 《Australian Occupational Therapy Journal》2015,62(3):223-224

     

16.

How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care     

Jolien Janssen  Paula S. Koekkoek  Eric P. Moll van Charante  L. Jaap Kappelle  Geert Jan Biessels  Guy E. H. M. Rutten 《BMC family practice》2017,18(1):101

Background

Despite the wealth of research devoted to the performance of individual cognitive tests for diagnosing cognitive impairment (including mild cognitive impairment and dementia), it can be difficult for general practitioners to choose the most appropriate test for a patient with cognitive complaints in daily practice.In this paper we present a diagnostic algorithm for the evaluation of cognitive complaints in primary care. The rationale behind this algorithm is that the likelihood of cognitive impairment -which can be determined after history taking and an informant interview- should determine which cognitive test is most suitable.

Methods

We distinguished three likelihoods of cognitive impairment: not likely, possible or likely. We selected cognitive tests based on pre-defined required test features for each of these three situations and a review of the literature. We incorporated the cognitive tests in a practical diagnostic algorithm.

Results

Based on the available literature, in patients with complaints but where cognitive impairment is considered to be unlikely the clock-drawing test can be used to rule out cognitive impairment. When cognitive impairment is possible the Montreal cognitive assessment can be used to rule out cognitive impairment or to make cognitive impairment more likely. When cognitive impairment is likely the Mini-Mental State Examination can be used to confirm the presence of cognitive impairment.

Conclusions

We propose a diagnostic algorithm to increase the efficiency of ruling out or diagnosing cognitive impairment in primary care. Further study is needed to validate and evaluate this stepwise diagnostic algorithm.

     

17.

老年人轻度认知功能障碍患病调查   总被引：9，自引：0，他引：9  

周东升  徐银儿  陈中鸣  胡珍玉  陈彦方 《中国公共卫生》2011,27(11)

目的 了解浙江省宁波市社区老年人轻度认知功能障碍(MCI)的流行病学特征.方法 采用随机整群分层分阶段抽样的方法对宁波市6个社区,年龄≥60岁的老年人进行现况调查及筛查,完成调查问卷及简易精神状况量表;临床诊断,对有明显记忆障碍者及简易精神状态量表(MMSE)分数低于界值者进一步进行临床检查,并由2名精神科医师进行最后诊断;同时进行总体衰退量表、Hachinski缺血指数量表、临床痴呆评定量表等评定.结果 调查1 227人,男性536人,女691人,MMSE阳性者131例,占10.68％,确诊为MCI者107例,患病率为8.72％;不同年龄段、文化程度、职业,居住及文化生活情况的老年人,其MCI患病率差异均有统计学意义(P＜0.05).结论 高龄、低文化水平、嗜烟、不喝酒或嗜酒、少吃鱼及海产品、单独居住以及少阅读等患MCI的危险性增加.     

18.

Plasma tocopherols and the risk of cognitive impairment     

Chow CK 《The American journal of clinical nutrition》2008,88(5):1447-8; author reply 1448

     

19.

Association of long-term adherence to the mind diet with cognitive function and cognitive decline in American women     

Agnes M. Berendsen  J. H. Kang  E. J. M. Feskens  C. P. G. M. de Groot  F. Grodstein  O. van de Rest 《The journal of nutrition, health & aging》2018,22(2):222-229

Objectives

There is increasing attention for dietary patterns as a potential strategy to prevent cognitive decline. We examined the association between adherence to a recently developed Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet with cognitive function and cognitive decline, taking into account the interaction between the apolipoprotein E ε4 genotype and the MIND diet.

Design

Population-based prospective cohort study.

Participants

A total of 16,058 older women aged 70 and over from the Nurses’ Health Study.

Measurements

Dietary intake was assessed five times between 1984 and 1998 with a 116-item Food Frequency Questionnaire. The MIND score includes ten brain-healthy foods and five unhealthy foods. Cognition was assessed four times by telephone from 1995 to 2001 (baseline) with the Telephone Interview for Cognitive Status (TICS) and by calculating composite scores of verbal memory and global cognition. Linear regression modelling and linear mixed modelling were used to examine the associations of adherence to the MIND diet with average cognitive function and cognitive change over six years, respectively.

Results

Greater long-term adherence to the MIND diet was associated with a better verbal memory score (multivariable-adjusted mean differences between extreme MIND quintiles=0.04 (95%CI 0.01-0.07), p-trend=0.006), but not with cognitive decline over 6 years in global cognition, verbal memory or TICS.

Conclusion

Long-term adherence to the MIND diet was moderately associated with better verbal memory in later life. Future studies should address this association within populations at greater risk of cognitive decline.

     

Methodological issues in the study of cognitive decline

In recent years, epidemiologists have given increased attention to cognition, especially to the dementing illnesses that occur in old age. Central to this study is the measurement of change in cognition as opposed to cognition measured at a single point in time. This article addresses conceptual and methodological issues in the study of changes in cognitive function, including: 1) difficulties encountered with the use of single measurements of cognition and the importance of measuring changes in cognition; 2) sources of measurement variation and its potential effects; 3) the importance of careful modeling of age and education; 4) considerations in categorizing outcomes or combining the results of cognitive tests; and 5) the benefits of using multiple-outcome statistical models.     

How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care

Background

Despite the wealth of research devoted to the performance of individual cognitive tests for diagnosing cognitive impairment (including mild cognitive impairment and dementia), it can be difficult for general practitioners to choose the most appropriate test for a patient with cognitive complaints in daily practice.In this paper we present a diagnostic algorithm for the evaluation of cognitive complaints in primary care. The rationale behind this algorithm is that the likelihood of cognitive impairment -which can be determined after history taking and an informant interview- should determine which cognitive test is most suitable.

Methods

We distinguished three likelihoods of cognitive impairment: not likely, possible or likely. We selected cognitive tests based on pre-defined required test features for each of these three situations and a review of the literature. We incorporated the cognitive tests in a practical diagnostic algorithm.

Results

Based on the available literature, in patients with complaints but where cognitive impairment is considered to be unlikely the clock-drawing test can be used to rule out cognitive impairment. When cognitive impairment is possible the Montreal cognitive assessment can be used to rule out cognitive impairment or to make cognitive impairment more likely. When cognitive impairment is likely the Mini-Mental State Examination can be used to confirm the presence of cognitive impairment.

Conclusions

We propose a diagnostic algorithm to increase the efficiency of ruling out or diagnosing cognitive impairment in primary care. Further study is needed to validate and evaluate this stepwise diagnostic algorithm.

     

老年人轻度认知功能障碍患病调查

目的 了解浙江省宁波市社区老年人轻度认知功能障碍(MCI)的流行病学特征.方法 采用随机整群分层分阶段抽样的方法对宁波市6个社区,年龄≥60岁的老年人进行现况调查及筛查,完成调查问卷及简易精神状况量表;临床诊断,对有明显记忆障碍者及简易精神状态量表(MMSE)分数低于界值者进一步进行临床检查,并由2名精神科医师进行最后诊断;同时进行总体衰退量表、Hachinski缺血指数量表、临床痴呆评定量表等评定.结果 调查1 227人,男性536人,女691人,MMSE阳性者131例,占10.68％,确诊为MCI者107例,患病率为8.72％;不同年龄段、文化程度、职业,居住及文化生活情况的老年人,其MCI患病率差异均有统计学意义(P＜0.05).结论 高龄、低文化水平、嗜烟、不喝酒或嗜酒、少吃鱼及海产品、单独居住以及少阅读等患MCI的危险性增加.     

Association of long-term adherence to the mind diet with cognitive function and cognitive decline in American women

Objectives

There is increasing attention for dietary patterns as a potential strategy to prevent cognitive decline. We examined the association between adherence to a recently developed Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet with cognitive function and cognitive decline, taking into account the interaction between the apolipoprotein E ε4 genotype and the MIND diet.

Design

Population-based prospective cohort study.

Participants

A total of 16,058 older women aged 70 and over from the Nurses’ Health Study.

Measurements

Dietary intake was assessed five times between 1984 and 1998 with a 116-item Food Frequency Questionnaire. The MIND score includes ten brain-healthy foods and five unhealthy foods. Cognition was assessed four times by telephone from 1995 to 2001 (baseline) with the Telephone Interview for Cognitive Status (TICS) and by calculating composite scores of verbal memory and global cognition. Linear regression modelling and linear mixed modelling were used to examine the associations of adherence to the MIND diet with average cognitive function and cognitive change over six years, respectively.

Results

Greater long-term adherence to the MIND diet was associated with a better verbal memory score (multivariable-adjusted mean differences between extreme MIND quintiles=0.04 (95%CI 0.01-0.07), p-trend=0.006), but not with cognitive decline over 6 years in global cognition, verbal memory or TICS.

Conclusion

Long-term adherence to the MIND diet was moderately associated with better verbal memory in later life. Future studies should address this association within populations at greater risk of cognitive decline.