Département de Psychologie, Université de Montréal, Montreal, QC; Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, QC; Centre de Recherche, Hôpital du Sacré-Coeur de Montréal, Montreal, QC.
Centre de Recherche, Hôpital du Sacré-Coeur de Montréal, Montreal, QC; Department of Exercise Science, Concordia University, Montreal, QC.
Chest. 2012 Dec;142(6):1516-1523. doi: 10.1378/chest.11-3035.
Cognitive impairment is a frequent feature of COPD. However, the proportion of patients with COPD with mild cognitive impairment (MCI) is still unknown, and no screening test has been validated to date for detecting MCI in this population. The goal of this study was to determine the frequency and subtypes of MCI in patients with COPD and to assess the validity of two cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), in detecting MCI in patients with COPD.
Forty-five patients with moderate to severe COPD and 50 healthy control subjects underwent a comprehensive neuropsychologic assessment using standard MCI criteria. Receiver operating characteristic curves were obtained to assess the validity of the MMSE and the MoCA to detect MCI in patients with COPD.
MCI was found in 36% of patients with COPD compared with 12% of healthy subjects. Patients with COPD with MCI had mainly the nonamnestic MCI single domain subtype with predominant attention and executive dysfunctions. The optimal MoCA screening cutoff was 26 (≤ 25 indicates impairment, with 81% sensitivity, 72% specificity, and 76% correctly diagnosed). No MMSE cutoff had acceptable validity.
In this preliminary study, a substantial proportion of patients with COPD were found to have MCI, a known risk factor for dementia. Longitudinal follow-up on these patients is needed to determine the risk of developing more severe cognitive and functional impairments. Moreover, the MoCA is superior to the MMSE in detecting MCI in patients with COPD.
认知障碍是 COPD 的常见特征。然而，目前尚不清楚 COPD 患者中轻度认知障碍（MCI）的比例，并且尚未有验证的筛查测试用于检测该人群中的 MCI。本研究旨在确定 COPD 患者中 MCI 的频率和亚型，并评估两项认知筛查测试，即简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA），在检测 COPD 患者 MCI 中的有效性。
45 名中重度 COPD 患者和 50 名健康对照者接受了使用标准 MCI 标准的全面神经心理学评估。获得受试者工作特征曲线以评估 MMSE 和 MoCA 在检测 COPD 患者 MCI 中的有效性。
与 12%的健康对照组相比，36%的 COPD 患者存在 MCI。有 MCI 的 COPD 患者主要为非遗忘型 MCI 单一域亚型，主要表现为注意力和执行功能障碍。最佳的 MoCA 筛查临界值为 26（≤25 表示受损，具有 81%的敏感性、72%的特异性和 76%的正确诊断率）。没有 MMSE 临界值具有可接受的有效性。
在这项初步研究中，发现相当一部分 COPD 患者存在 MCI，这是痴呆的已知危险因素。需要对这些患者进行纵向随访，以确定发生更严重认知和功能障碍的风险。此外，MoCA 在检测 COPD 患者的 MCI 方面优于 MMSE。
