Hoops S, Nazem S, Siderowf A D, Duda J E, Xie S X, Stern M B, Weintraub D
Departments of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
Neurology. 2009 Nov 24;73(21):1738-45. doi: 10.1212/WNL.0b013e3181c34b47.
Due to the high prevalence of mild cognitive impairment (MCI) and dementia in Parkinson disease (PD), routine cognitive screening is important for the optimal management of patients with PD. The Montreal Cognitive Assessment (MoCA) is more sensitive than the commonly used Mini-Mental State Examination (MMSE) in detecting MCI and dementia in patients without PD, but its validity in PD has not been established.
A representative sample of 132 patients with PD at 2 movement disorders centers was administered the MoCA, MMSE, and a neuropsychological battery with operationalized criteria for deficits. MCI and PD dementia (PDD) criteria were applied by an investigator blinded to the MoCA and MMSE results. The discriminant validity of the MoCA and MMSE as screening and diagnostic instruments was ascertained.
Approximately one third of the sample met diagnostic criteria for a cognitive disorder (12.9% PDD and 17.4% MCI). Mean (SD) MoCA and MMSE scores were 25.0 (3.8) and 28.1 (2.0). The overall discriminant validity for detection of any cognitive disorder was similar for the MoCA and the MMSE (receiver operating characteristic area under the curve [95% confidence interval]): MoCA (0.79 [0.72, 0.87]) and MMSE (0.76 [0.67, 0.85]), but as a screening instrument the MoCA (optimal cutoff point = 26/27, 64% correctly diagnosed, lack of ceiling effect) was superior to the MMSE (optimal cutoff point = 29/30, 54% correctly diagnosed, presence of ceiling effect).
The Montreal Cognitive Assessment, but not the Mini-Mental State Examination, has adequate psychometric properties as a screening instrument for the detection of mild cognitive impairment or dementia in Parkinson disease. However, a positive screen using either instrument requires additional assessment due to suboptimal specificity at the recommended screening cutoff point.
由于帕金森病（PD）患者中轻度认知障碍（MCI）和痴呆的患病率较高，常规认知筛查对于PD患者的最佳管理至关重要。蒙特利尔认知评估量表（MoCA）在检测非PD患者的MCI和痴呆方面比常用的简易精神状态检查表（MMSE）更敏感，但其在PD患者中的有效性尚未得到证实。
在2个运动障碍中心对132例PD患者的代表性样本进行了MoCA、MMSE测试，并进行了一套具有缺陷操作标准的神经心理测试。由一名对MoCA和MMSE结果不知情的研究人员应用MCI和帕金森病痴呆（PDD）标准。确定了MoCA和MMSE作为筛查和诊断工具的判别效度。
约三分之一的样本符合认知障碍的诊断标准（12.9%为PDD，17.4%为MCI）。MoCA和MMSE的平均（标准差）得分分别为25.0（3.8）和28.1（2.0）。MoCA和MMSE在检测任何认知障碍方面的总体判别效度相似（受试者工作特征曲线下面积[95%置信区间]）：MoCA为0.79（0.72，0.87），MMSE为0.76（0.67，0.85），但作为一种筛查工具，MoCA（最佳截断点=26/27，64%正确诊断，无天花板效应）优于MMSE（最佳截断点=29/30，54%正确诊断，有天花板效应）。
蒙特利尔认知评估量表，而非简易精神状态检查表，具有足够的心理测量学特性，可作为检测帕金森病患者轻度认知障碍或痴呆的筛查工具。然而，由于在推荐的筛查截断点特异性欠佳，使用任一工具筛查结果为阳性时均需进一步评估。
