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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
引用本文:王延平,徐桂兰,杨少青,刘湘敏,邓小莹.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[J].中华神经医学杂志,2010,9(5).
作者姓名:王延平  徐桂兰  杨少青  刘湘敏  邓小莹
作者单位:广州医学院第二附属医院神经内科,广州,510260
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.

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

Value of Montreal cognitive assessment in identifying patients with mild vascular cognitive impairment after first stroke
WANG Yan-ping,XU Gui-lan,YANG Shao-qing,LIU Xiang-min,DENG Xiao-ying.Value of Montreal cognitive assessment in identifying patients with mild vascular cognitive impairment after first stroke[J].Chinese Journal of Neuromedicine,2010,9(5).
Authors:WANG Yan-ping  XU Gui-lan  YANG Shao-qing  LIU Xiang-min  DENG Xiao-ying
Abstract: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.
Keywords:Montreal cognitive assessment  Mini-mental state examination  Mild vascular cognitive impairment
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