MoCA：适合帕金森病认知障碍的筛查工具。

The MoCA: well-suited screen for cognitive impairment in Parkinson disease.

机构信息

Van der Veer Institute for Parkinson's and Brain Research, 66 Stewart St., Christchurch 8011, New Zealand.

出版信息

Neurology. 2010 Nov 9;75(19):1717-25. doi: 10.1212/WNL.0b013e3181fc29c9.

DOI:10.1212/WNL.0b013e3181fc29c9

PMID:21060094

Abstract

OBJECTIVE

To establish the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) when screening externally validated cognition in Parkinson disease (PD), by comparison with a PD-focused test (Scales for Outcomes in Parkinson disease-Cognition [SCOPA-COG]) and the standardized Mini-Mental State Examination (S-MMSE) as benchmarks.

METHODS

A convenience sample of 114 patients with idiopathic PD and 47 healthy controls was examined in a movement disorders center. The 21 patients with dementia (PD-D) were diagnosed using Movement Disorders Society criteria, externally validated by detailed independent functional and neuropsychological tests. The 21 patients with mild cognitive impairment (PD-MCI) scored 1.5 SD or more below normative data in at least 2 measures in 1 of 4 cognitive domains. Other patients had normal cognition (PD-N).

RESULTS

Primary outcomes using receiver operating characteristic (ROC) curve analyses showed that all 3 mental status tests produced excellent discrimination of PD-D from patients without dementia (area under the curve [AUC], 87%-91%) and PD-MCI from PD-N patients (AUC, 78%-90%), but the MoCA was generally better suited across both assessments. The optimal MoCA screening cutoffs were <21/30 for PD-D (sensitivity 81%; specificity 95%; negative predictive value [NPV] 92%) and <26/30 for PD-MCI (sensitivity 90%; specificity 75%; NPV 95%). Further support that the MoCA is at least equivalent to the SCOPA-COG, and superior to the S-MMSE, came from the simultaneous classification of the 3 PD patient groups (volumes under a 3-dimensional ROC surface, chance = 17%: MoCA 79%, confidence interval [CI] 70%-89%; SCOPA-COG 74%, CI 62%-86%; MMSE-Sevens item 56%, CI 44%-68%; MMSE-World item 62%, CI 50%-73%).

CONCLUSIONS

The MoCA is a suitably accurate, brief test when screening all levels of cognition in PD.

摘要

目的

通过与帕金森病（PD）专用测试（帕金森病认知量表[Scales for Outcomes in Parkinson disease-Cognition，SCOPA-COG]）和标准化简易精神状态检查（Mini-Mental State Examination，S-MMSE）进行比较，来确定蒙特利尔认知评估（MoCA）在外部验证的 PD 认知筛查中的诊断准确性。

方法

在一个运动障碍中心，对 114 例特发性 PD 患者和 47 例健康对照者进行了一项方便抽样研究。根据运动障碍协会标准，21 例痴呆（PD-D）患者被诊断为痴呆，并用详细的独立功能和神经心理学测试进行外部验证。21 例轻度认知障碍（PD-MCI）患者在 4 个认知领域中的至少 2 个领域的至少 2 个测量值中得分低于正常数据 1.5 个标准差。其他患者认知正常（PD-N）。

结果

使用受试者工作特征（ROC）曲线分析的主要结果表明，所有 3 种精神状态检查均能很好地区分 PD-D 与非痴呆患者（曲线下面积[AUC]，87%-91%）和 PD-MCI 与 PD-N 患者（AUC，78%-90%），但 MoCA 总体上更适合这两种评估。用于 PD-D 的 MoCA 最佳筛查截断值为<21/30（敏感性 81%；特异性 95%；阴性预测值[NPV] 92%），用于 PD-MCI 的 MoCA 最佳筛查截断值为<26/30（敏感性 90%；特异性 75%；NPV 95%）。MoCA 至少与 SCOPA-COG 相当，优于 S-MMSE 的进一步证据来自对 3 组 PD 患者的同时分类（三维 ROC 曲面下的体积，机会=17%：MoCA 79%，置信区间[CI] 70%-89%；SCOPA-COG 74%，CI 62%-86%；S-MMSE-Sevens 项目 56%，CI 44%-68%；S-MMSE-World 项目 62%，CI 50%-73%）。