蒙特利尔认知评估量表在帕金森病认知功能损害筛查中的应用

目的探讨蒙特利尔认知评估量表(MoCA)和简易智能状态检查量表(MMSE)在帕金森病(PD)患者认知功能损害筛查中的应用。方法选取1 29例年龄≥60岁的PD患者,根据认知功能将其分为正常组(60例)、轻度认知功能障碍(MCI,37例)组和PD痴呆(PDD,32例)组,采用MoCA和MMSE对患者进行评估和分析。结果 3组MoCA得分差异有统计学意义(P<0.01)。与正常组比较,MCI组和PDD组患者在画立方体、复述、1 mm动物数、抽象能力、延迟回忆得分较低(P<0.01);与PDD组比较,正常组和MCI组患者在命名、数字广度和定向力得分较高(P<0.05)。此外,受试者ROC曲线结果显示,MMSE诊断MCI的曲线下面积为0.803;MoCA诊断MCI的曲线下面积为0.947。MMSE诊断PDD的曲线下面积为0.952;MoCA诊断PDD的曲线下面积为0.990。结论 MoCA可作为有效的PD患者认知功能损害的筛查工具,且随着PD患者病情的进展,MoCA得分逐渐降低。MoCA筛查MCI的最佳界值为≤23分,且MoCA在筛查PD患者MCI方面的敏感性较MMSE高。     

海南版简易智能状态检查量表和蒙特利尔认知评估量表界值划分的初步研究

目的初步探讨中文海南版(琼北闽语版)简易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分在本地人群认知筛查中的可行性及界值的划分。方法选取2019年1~9月海口市养老院和海南省人民医院门诊及住院的本地被试者217例,根据临床诊断分为正常组45例,轻度认知功能障碍(MCI)组54例,轻度痴呆组62例,中度以上痴呆组56例,同时进行MMSE及MoCA评分评估,进行两种量表评分相关性及界值。结果与正常组比较,MCI组、轻度痴呆组和中度以上痴呆组MMSE及MoCA评分明显降低,差异有统计学意义(P<0.05)。正常组、MCI组、轻度痴呆组和中度以上痴呆组MMSE评分明显高于MoCA评分(P<0.01)。Person相关分析显示,MMSE评分与MoCA评分呈正相关(r=0.940,P<0.01)。MCI组、轻度痴呆组和中度以上痴呆组ROC曲线界值为:MCI组MMSE评分低于27分,MoCA评分低于22分;轻度痴呆组MMSE评分低于23分,MoCA评分低于16分;中度以上痴呆组MMSE评分低于15分,MoCA评分低于11分。结论海南版(琼北闽语版)MMSE与MoCA评分有较好的一致性,联合应用对认知障碍及痴呆患者有较好的筛查应用价值。     

The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment

OBJECTIVES: To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. DESIGN: Validation study. SETTING: A community clinic and an academic center. PARTICIPANTS: Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC). MEASUREMENTS: The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. RESULTS: Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). CONCLUSION: MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.     

北京地区蒙特利尔认知量表的应用研究

目的研究蒙特利尔认知量表（MoCA）测试结果的分布特征,为制定适合我国国情的筛查分界值标准提供科学的依据。方法通过随机抽样,以北京市≥50岁215例正常人群和66例轻度认知功能障碍（MCI）人群为样本。总结其MoCA测试结果的百分位数值和均值的年龄、性别和受教育程度分布,比较MoCA和简易精神状态量表（MMSE）检测MCI的效度。按MoCA和MMSE建立多元线性回归方程,分析影响测试结果的因素。结果MoCA的分界值≥26分,年龄和受教育程度诸因素均对MoCA得分有显著影响（P〈0．001）。检测MCI的敏感度MoCA为92．4％,显著优于MMSE的24．2％。结论MoCA用于筛查MCI病例优于MMSE。调整的分界值标准有助于早期发现MCI和痴呆病人,减少漏诊。MoCA得分是判断认知功能是否正常的非特异性指标,不能取代临床诊断。     

轻度认知障碍患者认知功能与事件相关电位N400的临床研究

目的探讨轻度认知障碍(mild cognitive impairment,MCI)患者的认知功能状况与N400表现。方法选择MCI患者20例(MCI组),健康体检者23例(对照组)。使用简易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)对所有受试者进行评定,并做N400检测,分析它们之间的相关性及对MCI的诊断价值。结果与对照组比较,除MoCA语言项外,MCI组MMSE、MoCA评分明显降低,差异有统计学意义(P<0.05,P<0.01);N400潜伏期延长,其中Fz、Pz匹配和非匹配刺激潜伏期,C3、C4非匹配刺激潜伏期,Pz、C4匹配刺激波幅的差异有统计学意义(P<0.05,P<0.01)。N400潜伏期与MMSE总分、MoCA总分呈负相关,N400波幅与MMSE总分、MoCA总分呈正相关(P<0.05,P<0.01)。结论 MCI患者存在N400的异常及认知功能的损害,N400对MCI的诊断具有辅助价值。     

蒙特利尔认知评估量表筛查轻度认知功能障碍分界值的研究

目的研究蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)在筛查轻度认知功能障碍(MCI)中的应用价值,初步探讨MoCA筛查MCI的最佳界值。方法分别采用简易智能状态检查量表(MMSE)及MoCA评估入组的男性患者153例,根据诊断标准分为对照组69例、MCI组60例、AD组24例。进行2种量表得分的相关性分析,并且计算MoCA筛查MCI患者的敏感性、特异性、Kappa值、约登指数等,并选取最佳分界值。结果与对照组比较,MCI组和AD组MMSE评分和MoCA评分明显降低(P<0.05)。MMSE评分与MoCA评分呈正相关(r=0.847,P<0.01);以26分为分界值,MoCA诊断MCI的敏感性为98.3%,特异性为85.5%,Kappa值=0.830;绘制ROC曲线得到MoCA筛查MCI的最佳分界值为25分,敏感性为93.3%,特异性为97.1%,Kappa值=0.906。结论本研究人群MMSE评分与MoCA评分有很好的相关性,并且与临床诊断一致性好,推荐25分为该类人群MCI的分界值。     

蒙特利尔认知评估量表用于轻度认知功能障碍患者评估的初步研究

目的探讨中文版蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)用于轻度认知功能障碍(mild cognitive impairment,MCI)评估的可行性。方法选择MCI患者128例(MCI组),另选同期健康体检者101例(对照组)。分别给予MoCA和简易智能状态检查量表(MMSE)评估,并分析评估结果。结果对照组和MCI组MoCA总分与MMSE总分呈正相关(r=0.352,P<0.05;r=0.765,P<0.01);MoCA评分明显低于MMSE评分(P<0.01)。与对照组比较,MCI组MoCA总分及各亚项得分明显降低(P<0.01)。MoCA筛查MCI敏感性为97.66%,特异性为95.05%,MMSE筛查MCI敏感性为32.03%,特异性为100%。结论 MCI患者及健康体检人群MoCA总分与MMSE总分相关;MoCA用于MCI筛查时敏感性优于MMSE。     

蒙特利尔认知评估量表用于帕金森病认知评估的可行性研究

目的探讨蒙特利尔认知评估量表(MoCA)中文北京版用于帕金森病(PD)认知评估的可行性。方法分别用MoCA和简易智能状态检查量表(MMSE)对78例PD患者进行认知功能评估,分析评估结果。结果 PD患者MoCA与MMSE评分分别为(23.7±3.8)分和(27.7±2.3)分,MoCA评分明显低于MMSE,差异有统计学意义(P0.05);Pearson相关分析显示,MoCA与MMSE总分显著相关(r=0.89,P0.05)。在MMSE评定认知功能正常的患者中有50.7%MoCA评定有认知障碍。19例MMSE评分为30分患者的平均MoCA评分为(27.1±1.63)分,其中18例MoCA评分30分。MoCA延迟回忆下降发生率明显高于MMSE记忆和回忆能力下降发生率。结论 MoCA与MMSE总分上有较好的相关性,MoCA用作PD认知筛查时敏感性高于MMSE,较MMSE更适合用于PD患者的认知障碍筛查。     

蒙特利尔量表对老年慢性阻塞性肺疾病患者认知功能的评估

目的分析慢性阻塞性肺疾病（COPD）患者认知功能的改变,并探讨蒙特利尔（MoCA）量表和简明智能精神状态检查量表（MMSE）在评估认知功能方面的差异。方法分别采用MoCA、MMSE量表评估41例COPD患者和47例对照者认知功能的改变,并对2组MoCA、MMSE量表测量结果的特异度、灵敏度及一致性进行分析,进一步比较2种量表评估COPD伴轻度认知功能障碍（MCI）患者认知能力的差异。结果 COPD组MoCA总评分、MMSE总评分分别为（19.2±8.1）分及（22.6±8.4）分,低于对照组的（23.5±4.8）分及（26.9±5.0）分,在COPD人群中,MoCA量表诊断MCI的灵敏度为100%,特异度为76.9%,Kappa值为0.769;MMSE量表诊断MCI的灵敏度为53.8%,特异度为100%,Kappa值为0.538,MoCA量表对MCI的诊断效力明显高于MMSE。结论COPD患者存在认知功能损害,表现在记忆、注意力、计算、定向、语言等多个领域的认知障碍,MoCA和MMSE联合应用有利于早期发现COPD患者的认知功能障碍,对于MCI患者,MoCA较MMSE量表更为灵敏。     

介入血运重建改善颈动脉次全闭塞伴轻卒中患者认知障碍的研究

目的研究颈内动脉次全闭塞伴有轻卒中患者认知障碍的特点,明确介入颈动脉血运重建对这类患者认知障碍的改善作用。 方法续贯纳入济宁市第一人民医院神经内科自2016年2月至2019年2月住院的一侧颈动脉次全闭塞伴有轻卒中患者,住院期间完成介入颈动脉血运重建手术,分别在术前和术后3个月接受MMSE评分和MoCA评分检查。 结果共纳入33例患者,所有患者住院期间成功接受了介入颈动脉血运重建。患者术前33例患者在接受MoCA评分时都提示认知功能下降（19.58±1.54）,而MMSE评分未发现有认知功能下降（26.88±0.74）。33例接受介入颈动脉血运重建患者术后3个月的MMSE和MoCA评分较术前均有提高,而且差异具有统计学意义（P<0.05）。 结论颈内动脉次全闭塞伴有轻卒中患者的认知障碍的特点是MoCA评分较MMSE评分更敏感,能够发现早期认知功能障碍。介入血运重建技术能够改善颈内动脉次全闭塞伴有轻卒中患者的认知功能障碍。     

Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive Assessment

Aim: The Montreal Cognitive Assessment (MoCA), developed by Dr Nasreddine (Nasreddine et al. 2005), is a brief cognitive screening tool for detecting older people with mild cognitive impairment (MCI). We examined the reliability and validity of the Japanese version of the MoCA (MoCA‐J) in older Japanese subjects. Methods: Subjects were recruited from the outpatient memory clinic of Tokyo Metropolitan Geriatric Hospital or community‐based medical health check‐ups in 2008. The MoCA‐J, the Mini‐Mental State Examination (MMSE), the revised version of Hasegawa's Dementia Scale (HDS‐R), Clinical Dementia Rating (CDR) scale, and routine neuropsychological batteries were conducted on 96 older subjects. Mild Alzheimer's disease (AD) was found in 30 subjects and MCI in 30, with 36 normal controls. Results: The Cronbach's alpha of MoCA‐J as an index of internal consistency was 0.74. The test–retest reliability of MoCA, using intraclass correlation coefficient between the scores at baseline survey and follow‐up survey 8 weeks later was 0.88 (P < 0.001). MoCA‐J score was highly correlated with MMSE (r = 0.83, P < 0.001), HDS‐R (r = 0.79, P < 0.001) and CDR (r = ?0.79, P < 0.001) scores. The areas under receiver–operator curves (AUC) for predicting MCI and AD groups by the MoCA‐J were 0.95 (95% confidence interval [CI] = 0.90–1.00) and 0.99 (95% CI = 0.00–1.00), respectively. The corresponding values for MMSE and HDS‐R were 0.85 (95% CI = 0.75–0.95) and 0.97 (95% CI = 0.00–1.00), and 0.86 (95% CI = 0.76–0.95) and 0.97 (95% CI = 0.00–1.00), respectively. Using a cut‐off point of 25/26, the MoCA‐J demonstrated a sensitivity of 93.0% and a specificity of 87.0% in screening MCI. Conclusion: The MoCA‐J could be a useful cognitive test for screening MCI, and could be recommended in a primary clinical setting and for geriatric health screening in the community. Geriatr Gerontol Int 2010; 10: 225–232.     

脑白质高信号对帕金森病运动症状和认知损害的影响

目的探讨脑白质高信号(WMH)对帕金森病(PD)运动症状和认知损害的影响。方法回顾性纳入315例PD患者,根据Fazekas量表评分分为轻度WMH组191例,中度WMH组74例,重度WMH组50例。收集脑血管病相关危险因素,Hoehn-Yahr(H-Y)分级、世界运动障碍协会统一帕金森病评定量表第三部分(MDS-UPDRSⅢ)总分及震颤、强直、运动迟缓、步态姿势异常评分评估运动症状,用简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估认知功能,用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估情绪,用3T MRI及Fazekas量表评估WMH程度,用Spearman相关和多元线性回归分析。结果 3组年龄、起病年龄、病程、MMSE和MoCA评分比较,有统计学差异(P<0.05,P<0.01)。3组H-Y分级、MDS-UPDRSⅢ总分、震颤、强直、运动迟缓、步态姿势异常、HAMA、HAMD评分及体位性低血压比例比较,无统计学差异(P>0.05)。多元线性回归分析校正年龄、病程、起病年龄、MoCA、同型半胱氨酸、缺血性脑卒中、高血压、吸烟、性别、体质量指数和心脏病等因素后,WMH与MMSE仍显著相关(β=-0.183,95%CI:-0.134^-0.007,P=0.029)。脑室旁WMH(r=-0.246,P=0.000;r=-0.235,P=0.000)和深部WMH(r=-0.192,P=0.001;r=-0.187,P=0.001)与MMSE和MoCA呈显著负相关。WMH与PD运动症状不相关(P>0.05)。结论 WMH对PD认知损害影响明显,临床需警惕PD伴发WMH,脑血管病二级预防可能对PD患者认知减退有潜在预防作用。     

Montreal Cognitive Assessment Arabic version: Reliability and validity prevalence of mild cognitive impairment among elderly attending geriatric clubs in Cairo

Aim:   Mild cognitive impairment (MCI) is a clinical label which includes elderly subjects with memory impairment and with no significant daily functional disability. MCI is an important target for Alzheimer's dementia prevention studies. Data on the prevalence and incidence of MCI varies greatly according to cultural difference. The first aim of this study was to assess the reliability and validity of Montreal Cognitive Assessment (MoCA) Arabic version in MCI detection. The second was to determine the prevalence of MCI among apparently healthy elderly people attending geriatric clubs in Cairo.
Methods:   In stage I reliability & validity of MoCA Arabic version were assessed in reference to Cambridge Cognitive Examination (CAMCOG). In stage II prevalence of MCI was estimated using Arabic MoCA among apparently healthy elderly attending geriatric clubs. These geriatric clubs were randomly selected from different regions in Cairo governorate.
Results:   Test–retest reliability data of the Arabic MoCA were collected approximately 35.0 ± 17.6 days apart. The mean change in Arabic MoCA scores from the first to second evaluation was 0.9 ± 2.5 points, and correlation between the two evaluations was high (correlation coefficient = 0.92, P  < 0.001). The internal consistency of the Arabic MoCA was good, yielding a Cronbach's α on the standardized items of 0.83. In diagnosing mild cognitive impairment, the Arabic MoCA showed 92.3% sensitivity and 85.7% specificity. The prevalence of MCI among elderly subjects attending geriatric clubs in Cairo is 34.2% and 44.3% of healthy men and women, respectively.
Conclusion:   Older age, female sex and less education are the independent risk factors for MCI among apparently healthy elderly subjects attending geriatric clubs in Cairo.     

MoCA指数对老年人群轻度认知障碍诊断效力的研究

目的探讨蒙特利尔认知评估量表（Montreal cognitive assessment,MoCA）认知域指数得分（cognitive domain index score,CDIS）对老年人群轻度认知障碍（mild cognitive impairment,MCI）的诊断效力。 方法选择2009年5月至2015年7月在江苏省老年医学研究所就诊的老年人152例,其中认知正常者94例（正常对照组）,轻度认知障碍者58例（MCI组;混合型35例,遗忘型23例）。按照CDIS的评分方法计算MoCA记忆指数（MoCA MIS）、执行力指数（MoCA EIS）、视空间能力指数（MoCA VIS）、语言能力指数（MoCA LIS）、注意力指数（MoCA AIS）、定向力指数（MoCA OISA）,比较两组对象的MoCA总分及各个指数评分,并绘制ROC曲线,通过计算ROC曲线下面积的方法观察不同指数量表方法对MCI诊断的敏感性、特异性的差异。两组间计量资料的比较采用独立样本t检验,计数资料的边角采用χ²检验;采用ROC曲线下面积观察不同指数量表对MCI诊断的敏感性及特异性。 结果正常组MoCA总分、视空间、命名、注意、计算、语言、抽象、延迟记忆、定向及MoCA MIS、MoCA EIS、MoCA VIS、MoCA LIS、MoCA AIS、MoCA OISA评分分别为27.0±1.9、4.4±0.9、3.0±0.2、2.9±0.3、2.8±0.5、2.1±0.8、1.8±0.4、4.0±0.9、5.9±0.4、13.5±2.0、12.1±1.1、6.6±0.7、5.0±0.8、15.4±1.9、5.9±0.4,MCI组分别为22.2±3.1、3.5±1.3、2.8±0.5、2.7±0.6、2.7±0.6、1.8±0.7、1.7±0.6、1.3±0.3、5.4±0.9、7.8±3.4、10.9±1.7、5.9±1.1、4.6±0.9、13.5±2.8、5.4±0.9,混合型MCI者分别为20.8±2.8、2.8±1.0、2.7±0.5、2.5±0.6、2.6±0.7、1.7±0.8、1.6±0.7、1.2±1.2、5.2±1.0、7.7±3.2、10.0±1.4、5.4±1.1、4.5±1.0、12.4±2.8、5.2±1.0。MCI组与正常对照组间除计算、语言项评分差异无统计学意义外,MoCA总分、各分项评分、各指数的差异均有统计学意义（t=10.709、4.508、2.639、3.256、1.991、13.845、3.380、11.626、5.002、4.299、2.962、4.500、3.380,P<0.05或0.01）;混合型MCI患者与正常对照组比较,MoCA总分、各分项评分、各指数的差异均有统计学意义（t=12.263、8.291、2.303、3.548、2.132、2.357、2.066、12.336、3.668、10.104、8.309、5.753、3.133、5.898、3.668,P<0.05或0.01）。MoCA MIS对MCI的诊断效力与MoCA总分相当,AUC的差异无统计学意义（P>0.05）,其余各个指数的AUC均明显小于MoCA总分/MoCA MIS。MoCA总分在25分时,灵敏度达88.3%,特异度达到84.5%;MoCA MIS取11分为界值时,灵敏度达到91.5%,特异度达89.7%,均略高于MoCA总分。 结论MoCA指数可以很好的反映患者相关认知域受损情况,对临床有很好的指示作用。     

Albumin, Apolipoprotein E-ɛ4 and Cognitive Decline in Community-Dwelling Chinese Older Adults

OBJECTIVES: To examine the association between serum albumin and cognitive impairment and decline in community-living older adults.
DESIGNS: Population-based cohort study, followed up to 2 years; serum albumin, apolipoprotein E (APOE)-ɛ4, and cognitive impairment measured at baseline and cognitive decline (≥2-point drop in Mini-Mental State Examination (MMSE) score). Odds ratios were controlled for age, sex, education, medical comorbidity, hypertension, diabetes mellitus, cardiac disease, stroke, smoking, alcohol drinking, depression, APOE-ɛ4, nutritional status, body mass index, anemia, glomerular filtration rate, and baseline MMSE.
SETTINGS: Local area whole population.
PARTICIPANTS: One thousand six hundred sixty-four Chinese older adults aged 55 and older.
RESULTS: The mean age of the cohort was 66.0±7.3, 65% were women, mean serum albumin was 42.3±3.1 g/L, and mean MMSE score was 27.2±3.2. Lower albumin tertile was associated with greater risk of cognitive impairment in cross-sectional analysis (low, odds ratio (OR)=2.30, 95% confidence interval (CI)=1.31–4.03); medium, OR=1.59, 95% CI=0.88–2.88) versus high ( P for trend=.002); and with cognitive decline in longitudinal analyses: low, OR=1.73, 95% CI=1.18–2.55; medium, OR=1.32, 95% CI=0.89–1.95, vs high ( P for trend=.004). In cognitively unimpaired respondents at baseline (MMSE≥24), similar associations with cognitive decline were observed ( P for trends <.002). APOE-ɛ4 appeared to modify the association, due mainly to low rates of cognitive decline in subjects with the APOE-ɛ4 allele and high albumin.
CONCLUSION: Low albumin was an independent risk marker for cognitive decline in community-living older adults.     

Predictors of Mortality in Home-Dwelling Patients with Cardiovascular Disease Aged 75 and Older

OBJECTIVES: To compare the predictive value of biomarkers commonly measured in older patients with cardiovascular disease (CVD) with an indicator of cognitive function.
DESIGN: Prospective cohort study.
SETTING: Helsinki, Finland.
PARTICIPANTS: Three hundred ninety-eight home-dwelling older persons (261 women, mean age 80) with stable CVD and without a diagnosis of clinical dementia.
MEASUREMENTS: Simple laboratory and clinical measurements (including the Mini Mental State Examination (MMSE, maximum score 30 points) and New York Heart Association (NYHA) classification) were used to predict mortality. A MMSE score between 18 and 24 points was considered to indicate cognitive impairment.
RESULTS: At baseline, median MMSE score was 27 (interquartile range 25–28), with 59 individuals having a score below 24 points. During a mean follow-up of 6.0 years, 129 participants died. In the fully adjusted Cox proportional hazards model, low MMSE score was the strongest predictor of mortality, with a relative hazard of 2.38 (95% confidence interval=1.52–3.74; P <.001). Of the various clinical and laboratory variables, only creatinine, C-reactive protein, and history of congestive heart failure were significant independent predictors, whereas conventional risk factors were not.
CONCLUSION: Only a few clinical variables independently predicted 6-year mortality in older home-living patients with CVD. The strongest predictor was impaired cognitive function assessed using MMSE.     

Neurocognitive impairment in Chinese patients with obstructive sleep apnoea hypopnoea syndrome

Background and objective: Sleep‐disordered breathing is known to be associated with impairment in cognitive function. The aim of this study was to characterize neurocognitive impairment in a cohort of Chinese patients with varying severities of obstructive sleep apnoea hypopnoea syndrome (OSAHS), and to develop a sensitive instrument for routine screening of cognitive impairment. Methods: Eligible patients (n = 394) were categorized into a primary snoring group, and mild, moderate and severe OSAHS groups, based on assessment of AHI. The Montreal Cognitive Assessment (MoCA) and the Mini‐Mental State Examination (MMSE) questionnaires were administered to assess cognitive function, and the correlations between questionnaire scores and clinical and polysomnographic parameters were further evaluated by stepwise multivariate regression. Results: MoCA scores decreased progressively across the spectrum from primary snoring to severe OSAHS. Importantly, mild neurocognitive impairment as defined by a MoCA score <26 was more common in the moderate (38.6%) and severe (41.4%) OSAHS groups than in the mild OSAHS (25.0%) and primary snoring (15.2%) groups. In contrast, MMSE scores were largely normal and comparable among all four groups. Evaluation of MoCA subdomains further revealed selective reduction in memory/delayed recall, visuospatial and executive function, and attention span in the severe OSAHS group compared with the other groups. Stepwise multivariate regression analysis demonstrated that MoCA scores correlated significantly with lowest oxygen saturation (L‐SaO₂) and years of education. Conclusions: Neurocognitive impairment is common in patients with OSAHS. The MoCA is a brief and sensitive tool for the assessment of cognitive impairment in OSAHS patients, whose performance on the MMSE is in the normal range.     

低血压对老年人认知功能的影响

目的探讨低血压对老年人认知功能的影响。方法选择因头晕、头昏、乏力就诊的患者141例,通过问诊了解既往血压>5年的老年低血压患者(低血压组)67例,老年正常血压者(正常血压组)74例,所有受试者行蒙特利尔认知评估量表(MoCA)和简易智能状态检查量表(MMSE)检测,以及头颅MRI和颈部血管超声检查。结果多因素logistic回归分析显示,低血压是认知功能障碍的危险因素(P=0.020)。与正常血压组比较,低血压组的MoCA、MMSE评分明显降低(P=0.000),MoCA的视空间与执行功能、注意、语言、抽象、延迟回忆评分明显降低,差异有统计学意义,MoCA和MMSE评分呈正相关(r=0.922,P<0.05)。与正常血压组比较,低血压组脑白质损害分级显著升高(P<0.01)。两组颈部血管超声比较差异无统计学意义(P>0.05)。结论低血压是认知功能障碍的危险因素,老年低血压患者认知功能较正常血压者下降。     

轻度认知障碍与非痴呆型血管性认知功能障碍患者屏气指数的研究

目的评价轻度认知障碍（McI）患者与非痴呆型血管性认知功能障碍（VICND）患者的屏气指数（BHI）与认知功能的关系。方法 150例受试者分为正常对照组、MCI组及VICND组,应用经颅多普勒（TCD）屏气试验计算BHI,并应用蒙特利尔认知评估量表（MoCA）进行认知功能评分,分析BHI与认知功能的关系。结果MCI组和VCIND组高血压、高血糖、高血脂的患病率均显著高于对照组（P〈0．05）,MCI组与VCIND组间比较无显著差异。MCI组和VCIND组BHI,分别为（0．90±0．16）％／s、（0．87±0．19）％／s,均明显低于对照组的（1．37±0．22）％／s。MoCA评分与BHI呈正相关（r=0．803,P〈0．01）结论高血压、糖尿病及高血脂可能与MCI患者及VCIND患者的认知功能下降有关,BHI与认知功能具有一定的相关性。     

Mild cognitive impairment: epidemiology and dementia risk in an elderly Italian population

OBJECTIVES: To investigate prevalence and incidence of mild cognitive impairment (MCI) and its risk of progression to dementia in an elderly Italian population.
DESIGN: Longitudinal.
SETTING: Population-based cohort aged 65 and older resident in an Italian municipality.
PARTICIPANTS: A total of 1,016 subjects underwent baseline evaluation in 1999/2000. In 2003/04, information about cognitive outcome was collected for 745 participants who were free of dementia at baseline.
MEASUREMENTS: MCI (classified as with or without impairment of the memory domain), dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) diagnosed according to current international criteria.
RESULTS: Overall prevalence of MCI was 7.7% (95% confidence interval (CI)=6.1–9.7 %) and was greater with older age and poor education. During 4 years of follow-up, 155 incident MCI cases were diagnosed, with an incidence rate of 76.8 (95% CI=66.8–88.4) per 1,000 person-years. Approximately half of prevalent and incident MCI cases had memory impairment. Compared with normal cognition, multivariable-adjusted risk for progression from MCI with memory impairment to dementia was 4.78 (95% CI=2.78–8.07) for any dementia, 5.92 (95% CI=3.20–10.91) for AD, and 1.61 (95% CI=0.37–7.00) for VaD. No association with dementia risk was found for MCI without memory impairment. Approximately one-third of MCI cases with memory impairment did not progress to dementia.
CONCLUSION: MCI occurs often in this elderly Italian cohort and is associated with greater risk of AD, but only when the impairment involves the memory domain. However, a substantial proportion of MCI cases with memory impairment do not progress to dementia.