应用蒙特利尔认知评测量表筛查早期帕金森病合并的认知功能障碍

目的 比较蒙特利尔认知评测量表(MoCA)和简易精神状态量表(MMSE)对于早期帕金森病(PD)合并认知障碍的筛查能力.方法 对101例PD患者首先应用MMSE量表进行认知评测,根据患者教育程度对应的MMSE临界值筛选出评分在正常参考范围的PD患者;对这些PD患者继续应用MoCA量表评测,并以MoCA量表评分26分为临界值将受试者进行分组比较.应用Spearman分析研究PD患者MoCA量表评分的影响因素.结果 经MMSE量表评测正常的PD患者共96例,MMSE评分为27.17±2.69(18～30)分,MoCA评分为22.60±4.42(26～29)分;其中MoCA评测正常(≥26分)的24例(25%),评测异常(<26分)的72例(75%),MoCA评测异常组在视空间与执行能力、命名、注意、语言、抽象、延迟记忆等认知领域得分分别为(3.11±1.40)、(2.56±0.69)、(5.07±1.05)、(1.69±0.85)、(1.08±0.84)、(1.08±1.31)分]较MoCA评测正常组得分分别为:(4.75±0.61)、(2.92±0.28)、(5.88±0.45)、(2.46±0.66)、(1.92±0.28)、(3.50±0.78)分]低,差异均有统计学意义(P均<0.05).MoCA得分与性别、年龄、受教育年限、运动障碍分期(Hoehn-Yahr分级)、UPDRSⅢ评分、抑郁程度(HAMD评分)、出现幻觉显著相关(r值分别为-0.205、-0.209、0.263、-0.352、-0.225、-0.293、-0.218,P均<0.05).结论 MoCA在筛查早期PD合并认知障碍方面比MMSE更敏感.

Screening of cognitive impairment in early stage parkinson disease with Montreal cognitive assessment scale

Objective To compare the ability of Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) in screening cognitive impairment in early stage of Parkinscn disease (PD). Methods The cognitive function of 101 patients with Parkinson disease (Hohen-Yahr stage 1-3) was assessed with MMSE. Ninety-six patients defined as having a normal age- and education-adjusted MMSE score were assessed subsequently with MoCA. The 96 patients were divided into two groups according to cut-off points of 26 of MoCA. The performance of cognitive domain was compared between PD-MCI group (MoCA <26) and control group (MoCA≥26). Results Mean MMSE and MoCA scores (standard deviation) were 27.17 (2.69) and 22.60(4.42) , respectively. 75% of the patients with normal MMSE scores had cognitive impairment according to their MoCA score. The PD-MCI group had lower scores in numerous cognitive domains (visuospatial and executive abilities, naming, attention,language, ab-straction, delayed memory) compared with control group (PD-MCI group: 3.11±1.40,2.56±0.69,5.07±1.05, 1.69±0.85,1.08±0.84, 1.08±1.31 ;Control group:4.75±0.61,2.92±0.28,5.88±0.45,2.46±0.66, 1.92±0.28,3.50±0.78, P<0.05). Predictors of cognitive impairment on the MoCA using univariate analyses were gender, age, education, Hoehn-Yabr stage, Unified Parkinscn Disease Rating Scale, depression severity (HAMD) and hallucination (r was-0.205,-0.209,0.263,-0.352,-0.225,-0.293 and-0.218, respectively). Condusions The MoCA is a more sensitive screening than the MMSE for cognitive impairment in early stage of PD.