MMSE和MoCA对卒中后轻度血管性认知障碍早期筛查的价值

doi:10.3969/j.issn.1004-583X.2023.03.004

摘要/Abstract

摘要：

目的探讨简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)在急性缺血性卒中后轻度血管性认知障碍(mVCI)筛查中的应用价值。方法本研究为基于卒中数据库的横断面研究,选取2019年10月至2021年10月急性首次缺血性卒中患者135例,依据mVCI诊断标准分为mVCI组及无认知障碍(NCI)组。采用MMSE和MoCA对2组进行神经心理学评估,通过ROC曲线确定MMSE和MoCA最佳截断点,采用 $t$ 检验、Mann-Whitney U检验进行组间MMSE和MoCA各认知亚项比较,并评估两种认知筛查方法的临床应用效果。结果 135例研究对象中mVCI组56例,NCI组79例。MMSE和MoCA筛查mVCI的最佳截断点为25/26和22/23;在此截断点, MMSE和MoCA的ROC曲线下面积分别为0.737和0.847;51/135例(86.4%)MMSE与MoCA总分均低于截断点值,37/51例(72.5%)为mVCI组, 14/51例(27.5%)为NCI组;30/135例(39.5%)MMSE总分正常,而MoCA低于截断点值,其中15/30例(50.0%)为mVCI组, 15/30例(50.0%)为NCI组;8/135例(13.6%)MoCA正常,而MMSE低于截断点值,其中1/8例(12.5%)为mVCI组, 7/8例(87.5%)为NCI组;2组MMSE在即刻回忆、注意力、语言等认知亚项差异有统计学意义( $P$ <0.05);而2组MoCA在视空间和执行功能、延迟回忆、抽象能力、定向力各认知亚项差异有统计学意义( $P$ <0.05)。结论对于急性缺血性卒中后mVCI的筛查,MoCA可能更为敏感,尤其体现在视空间和执行功能, 但仍需采用纵向研究进一步明确MMSE和MoCA对卒中后mVCI的筛查价值。

关键词: 急性缺血性卒中, 轻度血管性认知障碍, MMSE, MoCA

Abstract:

Objective To investigate the clinical application value of the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in screening mild vascular cognitive impairment (mVCI) following acute ischemic stroke. Methods It was a cross-sectional study involving 135 patients with the first onset of acute ischemic stroke from October 2019 to October 2021. They were divided into mVCI group and non-cognitive impairment (NCI) group according to mVCI diagnostic criteria. Neuropsychological conditions were assessed by MMSE and MoCA, and their cut-off values were determined based on the plotted receiver operating characteristic (ROC) curve. MMSE and MoCA items were compared by the t test and Mann-Whitney U test, and their effect on screening mVCI was compared. Results A total of 135 patients were recruited, involving 56 cases in mVCI group and 79 cases in NCI group. The optimal cut-off values of MMSE and MoCA were 25/26, and 22/23, respectively. The area under the curve (AUC) of MMSE and MoCA was 0.737 and 0.847, respectively. The total scores of MMSE and MoCA in 51/135 patients (86.4%) were lower than the cut-off values, with 37/51 (72.5%) patients in the mVCI group and 14/51 (27.5%) patients in the NCI group. Totally 30/135 patients (39.5%) had normal total scores of MMSE, while their MoCA scores were lower than the cut-off values. Among them, 15/30 (50.0%) patients were in the mVCI group and 15/30 (50.0%) patients were in the NCI group. Totally 8/135 patients (13.6%) had normal total scores of MoCA, while their MMSE scores were lower than the cut-off values. Among them, 1/8 (12.5%) patients were in the mVCI group, and 7/8 (87.5%) patients were in the NCI group. There were significant differences in the scores of MMSE domains of recall, attention and language between groups ( $P$ <0.05), and those of MoCA domains of visuospatial executive function, abstraction and delayed recall and orientation ( $P$ <0.05). Conclusion The MoCA is more sensitive than the MMSE in screening mVCI after acute ischemic stroke, especially in visuospatial and executive function. Longitudinal studies are required to establish the prognostic values of MMSE and MoCA in mVCI after acute stroke.

Key words: acute ischemic stroke, mild vascular cognitive impairment (mVCI), MMSE, MoCA

中图分类号:

R743.3

贾阳娟, 韩凝, 郭慧, 李岩鹏, 李灿灿, 李建国. MMSE和MoCA对卒中后轻度血管性认知障碍早期筛查的价值[J]. 临床荟萃, 2023, 38(3): 221-226.

Jia Yangjuan, Han Ning, Guo Hui, Li Yanpeng, Li Cancan, Li Jianguo. Value of Mini Mental State Examination and Montreal Cognitive Assessment in screening mild vascular cognitive impairment at post-stroke[J]. Clinical Focus, 2023, 38(3): 221-226.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.03.004

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I3/221

图/表 4

表1 MoCA和MMSE不同截断点评估认知功能的敏感度和特异度

Tab.1 The sensitivity and specificity of MoCA and MMSE to assess cognitive function at different cut-off points

MMSE截断点	敏感度	特异度	阳性预测值	阴性预测值	MoCA截断点	敏感度	特异度	阳性预测值	阴性预测值
24/25	46.4	86.1	70.3	69.4	21/22	71.4	77.2	69.0	79.2
25/26^*	67.9	73.4	64.4	76.3	22/23^*	92.9	63.3	64.2	92.6
26/27	83.9	35.4	48.0	75.7	23/24	96.4	51.9	58.7	95.3
27/28	92.9	27.8	47.7	84.6	24/25	96.4	32.9	50.5	92.3

表2 MMSE、MoCA确定mVCI的一致性( n=135,例)

Tab.2 Consistency Analysis of mVCI Determined by MMSE and MoCA

MMSE	MoCA		总计
MMSE	≤22	>22	总计
≤25	51	8	59
>25	30	46	76
总计	81	54	135

表3 2组MMSE各认知域比较

Tab.3 Comparison of cognitive domains of MMSE among different groups

组别	例数	总分	定向力	即可回忆	注意力	延迟回忆	语言	视空间
NCI组	79	26(25, 28)	9(8, 10)	3(3, 3)	5(3, 5)	2(2, 3)	8(7, 8)	1(0, 1)
mVCI组	56	25(22.5, 26)	9(8, 10)	2(1, 3)	3(2, 4)	2(1, 3)	7(7, 8)	1(0, 1)
$Z$ 值		-7.208	-0.906	-4.185	-6.764	-1.603	-2.716	-1.489
$P$ 值		0.000	0.365	0.000	0.000	0.107	0.007	0.137

表3 2组MMSE各认知域比较

Tab.3 Comparison of cognitive domains of MMSE among different groups

组别	例数	总分	定向力	即可回忆	注意力	延迟回忆	语言	视空间
NCI组	79	26(25, 28)	9(8, 10)	3(3, 3)	5(3, 5)	2(2, 3)	8(7, 8)	1(0, 1)
mVCI组	56	25(22.5, 26)	9(8, 10)	2(1, 3)	3(2, 4)	2(1, 3)	7(7, 8)	1(0, 1)
$Z$ 值		-7.208	-0.906	-4.185	-6.764	-1.603	-2.716	-1.489
$P$ 值		0.000	0.365	0.000	0.000	0.107	0.007	0.137

表4 2组MoCA各认知域比较

Tab.4 Comparison of cognitive domains of MoCA among different groups

组别	例数	总分	视空间及执行功能	命名	注意力	语言	抽象	延迟回忆	定向力
NCI组	79	24(22, 25.5)	4(3, 4)	3(3, 3)	6(5, 6)	2(2, 2)	1(0, 2)	3(2, 3)	6(5, 6)
mVCI组	56	19(16, 22)	2(1, 3)	3(3, 3)	4(4, 5)	2(1, 2)	0(0, 1)	2(1, 3)	5(4, 6)
$Z$ 值		-7.594	-5.485	-0.611	-7.405	-2.873	-2.869	-5.552	-3.386
$P$ 值		0.000	0.000	0.540	0.000	0.004	0.004	0.000	0.001

表4 2组MoCA各认知域比较

Tab.4 Comparison of cognitive domains of MoCA among different groups

组别	例数	总分	视空间及执行功能	命名	注意力	语言	抽象	延迟回忆	定向力
NCI组	79	24(22, 25.5)	4(3, 4)	3(3, 3)	6(5, 6)	2(2, 2)	1(0, 2)	3(2, 3)	6(5, 6)
mVCI组	56	19(16, 22)	2(1, 3)	3(3, 3)	4(4, 5)	2(1, 2)	0(0, 1)	2(1, 3)	5(4, 6)
$Z$ 值		-7.594	-5.485	-0.611	-7.405	-2.873	-2.869	-5.552	-3.386
$P$ 值		0.000	0.000	0.540	0.000	0.004	0.004	0.000	0.001

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