BC Cancer Agency, Centre for North, Prince George, BC, Canada.
J Neurooncol. 2011 Nov;105(2):337-44. doi: 10.1007/s11060-011-0595-4. Epub 2011 Apr 26.
Cognitive screening tests are frequently used in brain tumor clinics. The Mini Mental State Examination (MMSE) is the most commonly used, and the Montreal Cognitive Assessment (MoCA) is an alternative. This study compares the diagnostic accuracy of both screening tests. Fifty-eight patients with brain tumors were prospectively accrued and administered the MMSE and MoCA, 67% of who completed a comprehensive neuropsychological evaluation as a gold standard comparison. Quality of life and community integration were measured with the Functional Assessment of Cancer Therapy-Brain (FACT-Br) and Community Integration Questionnaire (CIQ), respectively. At the pre-defined cut-off scores, the MoCA had superior sensitivity (61.9% vs. 19.0%, P < 0.005) and the MMSE had superior specificity (94.4% vs. 55.6%, P < 0.017). The areas under the ROC curve for the MMSE (0.615, standard error = 0.091) and MoCA (0.606, standard error = 0.092) were poor, indicating that at no single cut-off score is either test both sensitive and specific. Neither the MMSE (ρ = 0.12; P < 0.444) nor MoCA (ρ = 0.24; P < 0.108) were significantly correlated with the FACT-Br. The MoCA was modestly correlated with the CIQ (ρ = 0.35; P < 0.017), but the MMSE was not (ρ = 0.14; P < 0.359). The MMSE has extremely poor sensitivity. Using this test in clinical practice, research, and clinical trials will result in failing to detect cognitive impairment in a substantial percentage of patients. The MoCA has superior sensitivity, and is better correlated with self reported measures of community integration, and therefore should be preferentially chosen in practice and clinical trials.
认知筛查测试常用于脑肿瘤临床。最常用的是简易精神状态检查（MMSE），而蒙特利尔认知评估（MoCA）则是另一种选择。本研究比较了这两种筛查测试的诊断准确性。前瞻性纳入 58 例脑肿瘤患者，分别进行 MMSE 和 MoCA 检查，其中 67%的患者完成了全面的神经心理评估作为金标准比较。采用癌症治疗脑功能评估量表（FACT-Br）和社区融入问卷（CIQ）分别评估生活质量和社区融入。在预设的截断分数下，MoCA 的敏感性更高（61.9%比 19.0%，P < 0.005），而 MMSE 的特异性更高（94.4%比 55.6%，P < 0.017）。MMSE 的 ROC 曲线下面积为 0.615（标准误差=0.091），MoCA 的 ROC 曲线下面积为 0.606（标准误差=0.092），表明在任何单一的截断分数下，两种测试都不敏感和特异。MMSE（ρ=0.12；P < 0.444）和 MoCA（ρ=0.24；P < 0.108）均与 FACT-Br 无显著相关性。MoCA 与 CIQ 中度相关（ρ=0.35；P < 0.017），但 MMSE 无相关性（ρ=0.14；P < 0.359）。MMSE 的敏感性极差。在临床实践、研究和临床试验中使用该测试将导致相当一部分患者的认知障碍无法被检测到。MoCA 的敏感性更高，与自我报告的社区融入测量指标相关性更好，因此在实践和临床试验中应优先选择。
