Value of Mini Mental State Examination and Montreal Cognitive Assessment in screening mild vascular cognitive impairment at post-stroke

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

Abstract

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

CLC Number:

R743.3

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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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.03.004

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

Figures/Tables 4

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

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

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

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

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

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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