Department of Surgery, 4/F Clinical Science Building, Prince of Wales Hospital, 1 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR, China.
J Neurol Neurosurg Psychiatry. 2012 Nov;83(11):1112-7. doi: 10.1136/jnnp-2012-302217. Epub 2012 Jul 31.
Identification of patients with aneurysmal subarachnoid haemorrhage (aSAH) with cognitive impairment is important for patient management (medical treatment, cognitive rehabilitation and social arrangements). The Montreal cognitive assessment (MoCA) is currently recommended over the mini-mental state examination (MMSE) by the U.S. National Institute of Neurological Disorder, in the chronic post-stroke setting. We hypothesised that the MoCA has a better correlation with functional outcome at 3 months than the MMSE.
We carried out a prospective observational study in Hong Kong over a 2 year period, recruiting patients aged 21-75 years with aSAH admitted within 96 h of ictus. The assessments included the modified Rankin Scale, Lawton Instrumental Activity of Daily Living (IADL), Short Form-36, MoCA and MMSE at 3 months after ictus. Analyses were carried out to compare MoCA with MMSE.
90 patients completed the 3 month assessments. Cognitive impairment (MoCA <26) was determined in 73% of patients at 3 months. Delayed cerebral infarction explained the 31-38% variance in cognitive outcomes (MMSE and MoCA) at 3 months. MoCA demonstrated good discrimination of favourable neurological and IADL outcomes similar to the MMSE in receiver operating characteristics curve analyses.
MoCA defined cognitive impairment was common at 3 months after aSAH and MoCA correlated with functional outcomes similar, but not superior, to the MMSE. The study is registered at ClinicalTrials.gov of the US National Institutes of Health (NCT01038193).
识别患有蛛网膜下腔出血（aSAH）伴认知障碍的患者对于患者管理（药物治疗、认知康复和社会安排）非常重要。美国国立神经病学、语言障碍和卒中研究所目前建议在慢性卒中后环境中使用蒙特利尔认知评估（MoCA）代替简易精神状态检查（MMSE）。我们假设 MoCA 与 3 个月时的功能结局的相关性优于 MMSE。
我们在香港进行了一项为期 2 年的前瞻性观察性研究，招募了发病后 96 小时内入院的年龄在 21-75 岁之间的 aSAH 患者。评估包括改良 Rankin 量表、Lawton 工具性日常生活活动（IADL）、简短健康调查量表-36（SF-36）、MoCA 和 MMSE，评估时间为发病后 3 个月。分析比较了 MoCA 和 MMSE。
90 例患者完成了 3 个月的评估。3 个月时，73%的患者存在认知障碍（MoCA<26）。迟发性脑梗死解释了 3 个月时认知结局（MMSE 和 MoCA）的 31-38%差异。MoCA 在受试者工作特征曲线分析中表现出良好的区分有利的神经学和 IADL 结局的能力，与 MMSE 相似，但并不优于 MMSE。该研究在美国国立卫生研究院临床试验注册（NCT01038193）。
