Stroke Prevention Research Unit, Level 6 West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK.
Stroke. 2012 Feb;43(2):464-9. doi: 10.1161/STROKEAHA.111.633586. Epub 2011 Dec 8.
BACKGROUND AND PURPOSE: The Montreal Cognitive Assessment (MoCA) and Addenbrooke's Cognitive Examination-Revised (ACE-R) are proposed as short cognitive tests for use after stroke, but there are few published validations against a neuropsychological battery. We studied the relationship between MoCA, ACE-R, Mini-Mental State Examination (MMSE) and mild cognitive impairment (MCI) in patients with cerebrovascular disease and mild cognitive impairment (MCI). METHODS: One hundred consecutive non-institutionalized patients had the MMSE, MoCA, ACE-R, and National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Neuropsychological Battery ≥ 1 year after transient ischemic attack or stroke in a population-based study. MCI was diagnosed using modified Petersen criteria in which subjective cognitive complaint is not required (equivalent to cognitive impairment-no dementia) and subtyped by number and type of cognitive domains affected. RESULTS: Among 91 nondemented subjects completing neuropsychological testing (mean/SD age, 73.4/11.6 years; 44% female; 56% stroke), 39 (42%) had MCI (amnestic multiple domain=10, nonamnestic multiple domain=9, nonamnestic single domain=19, amnestic single domain=1). Sensitivity and specificity for MCI were optimal with MoCA <25 (sensitivity=77%, specificity=83%) and ACE-R <94 (sensitivity=83%, specificity=73%). Both tests detected amnestic MCI better than nonamnestic single-domain impairment. MMSE only achieved sensitivity >70% at a cutoff of <29, mainly due to relative insensitivity to single-domain impairment. CONCLUSIONS: The MoCA and ACE-R had good sensitivity and specificity for MCI defined using the Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Battery ≥1 year after transient ischemic attack and stroke, whereas the MMSE showed a ceiling effect. However, optimal cutoffs will depend on use for screening (high sensitivity) or diagnosis (high specificity). Lack of timed measures of processing speed may explain the relative insensitivity of the MoCA and ACE-R to single nonmemory domain impairment.
背景与目的：蒙特利尔认知评估（MoCA）和 Addenbrooke 认知测验修订版（ACE-R）被提议作为中风后的简短认知测试，但针对神经心理测试套件，很少有已发表的验证。我们研究了脑血管病和轻度认知障碍（MCI）患者的 MoCA、ACE-R、简易精神状态检查（MMSE）与轻度认知障碍（MCI）之间的关系。
方法：在一项基于人群的研究中，100 名连续非住院患者在短暂性脑缺血发作或中风后≥1 年进行了 MMSE、MoCA、ACE-R 和国家神经病学和中风-加拿大中风网络血管性认知障碍协调标准神经心理测试套件。使用修改后的 Petersen 标准诊断 MCI，该标准不需要主观认知抱怨（相当于认知障碍-无痴呆），并根据受影响的认知域的数量和类型进行亚型分类。
结果：在完成神经心理测试的 91 名非痴呆受试者中（平均/标准差年龄为 73.4/11.6 岁；44%为女性；56%为中风），39 名（42%）患有 MCI（遗忘多个域=10、非遗忘多个域=9、非遗忘单一域=19、遗忘单一域=1）。MoCA<25 时（敏感性=77%，特异性=83%）和 ACE-R<94 时（敏感性=83%，特异性=73%）对 MCI 的敏感性和特异性最佳。这两种测试都能更好地检测出遗忘性 MCI。MMSE 仅在截断值<29 时达到敏感性>70%，主要是由于对单一域损伤的相对不敏感。
结论：MoCA 和 ACE-R 对神经紊乱和中风-加拿大中风网络血管性认知障碍测试套件≥1 年后的短暂性脑缺血发作和中风后的 MCI 具有良好的敏感性和特异性，而 MMSE 则显示出上限效应。然而，最佳截断值将取决于用于筛查（高敏感性）或诊断（高特异性）的用途。缺乏处理速度的定时测量可能解释了 MoCA 和 ACE-R 对单一非记忆域损伤的相对不敏感性。
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