蒙特利尔认知评估量表在血管性认知功能障碍初步应用的研究

目的 研究蒙特利尔认知评估量表（MoCA）在血管性认知功能障碍（VCI）中的初步应用，探讨适合我国国情的VCI筛查分界值。方法 选择VCI病例组50例，对照组60例，分别用MoCA和简易精神状态量表(MMSE)评定2组认知功能，比较MoCA和MMSE检测VCI的效度，并分别将病例组和对照组进行年龄、性别、教育程度、工作性质的分层分析。结果 受教育程度、工作性质均对MoCA得分有显著影响。受教育程度为初中以上者MoCA的筛查分界值≥25分，此时筛查VCI灵敏度为83.3%，高于MMSE 46.7%；初中以下者MoCA的分界值≥22分，筛查VCI灵敏度为85%，高于MMSE 50%。结论 MoCA用于筛查VCI优于MMSE。应用MoCA有助于早期发现VCI患者，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。

Preliminary application of Montreal cognitive assessment in vascular cognitive impairment

 Objective     To study the application of Montreal cognitive assessment (MoCA) in vascular cognitive impairment (VCI), and make a benchmark for a cutoff score. Methods   60 healthy elderly controls and 50 patients meeting the clinical criteria for VCI were tested by MoCA and mini-mental state examination(MMSE). The validities of MoCA and MMSE were compared. The age, sex, education and nature of the work in the two groups were stratified and analyzed. Results    Education and nature of the work had statistical differences between MoCA and MMSE. In persons whose education level was below junior high school, the cutoff score for MoCA was ≥22, and the sensitivity was 83.3%, which was higher than that for MMSE sensitivity (46.7%); in those whose education level was above junior high school, the cutoff score for MoCA was ≥25, the sensitivity was 85%, which was higher than that for MMSE (50%). Conclusion     MoCA has a higher screening sensitivity for VCI than MMSE do. Adjustment in the cutoff scores would improve the detection of VCI by reducing false negativity. MoCA scores should be used to identify current cognitive difficulties but not be used to make formal diagnosis.