Department of Medicine, National University Health System, Singapore.
J Neurol Sci. 2010 Dec 15;299(1-2):15-8. doi: 10.1016/j.jns.2010.08.051.
The majority of patient with post-stroke Vascular Cognitive Impairment (VCI) have Vascular Cognitive Impairment No Dementia (VCIND). The Mini-Mental State Examination (MMSE) has been criticized as a poor screening test for VCIND due to insensitivity to visuospatial and executive function impairments. The Montreal Cognitive Assessment (MoCA) was designed to be more sensitive to such deficits and may therefore be a superior screening instrument for VCIND.
Stable patients within 14days of their index stroke without significant physical disability, aphasia, dysarthria, active psychiatric illness or pre-existing dementia were eligible. Cognitive and neurological measures were administered after informed consent.
100 patients were recruited. Of the 57 patients with unimpaired MMSE scores, 18 (32%) patients had an impaired MoCA score. By comparison, only 2 out of the 41 (4.9%) patients with unimpaired MoCA scores had impaired MMSE scores. Moreover, MMSE domain subtest scores could not differentiate between groups of differing screening test results, whilst MoCA domain subtest scores (Visuospatial/Executive Function, Attention and Recall) could.
The MoCA is more sensitive than the MMSE in screening for cognitive impairment after acute stroke. Longitudinal studies are required to establish the prognostic value of MoCA and MMSE evaluation in the acute post-stroke period for cognitive impairment as defined by the standard method of formal neuropsychological evaluation 3-6 months after stroke.
大多数患有中风后血管性认知障碍（VCI）的患者都患有血管性认知障碍但无痴呆（VCIND）。由于对视觉空间和执行功能障碍不敏感，简易精神状态检查（MMSE）已被批评为 VCIND 的筛选测试不佳。蒙特利尔认知评估（MoCA）旨在对这些缺陷更敏感，因此可能是 VCIND 的更好筛选工具。
稳定的患者在指数中风后 14 天内，无明显身体残疾、失语症、构音障碍、活动性精神疾病或预先存在的痴呆症，符合条件。在获得知情同意后，对认知和神经测量进行了评估。
共招募了 100 名患者。在未受损 MMSE 评分的 57 名患者中，有 18 名（32%）患者的 MoCA 评分受损。相比之下，在未受损 MoCA 评分的 41 名患者中，只有 2 名患者的 MMSE 评分受损。此外，MMSE 域子测试评分无法区分不同筛选测试结果的组，而 MoCA 域子测试评分（视觉空间/执行功能、注意力和记忆力）可以。
MoCA 比 MMSE 更能敏感地筛查急性中风后认知障碍。需要进行纵向研究，以确定 MoCA 和 MMSE 评估在急性中风后 3-6 个月后根据正式神经心理评估标准定义的认知障碍的预后价值。
