Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada.
Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
Int J Stroke. 2016 Jun;11(4):420-4. doi: 10.1177/1747493016632238. Epub 2016 Feb 10.
Executive dysfunction predicts stroke risk, dementia, and mortality. The Montreal cognitive assessment detects more visuoexecutive dysfunction than the mini-mental state examination but it is unclear which of the individual Montreal cognitive assessment visuoexecutive items contribute to the better performance of the Montreal cognitive assessment. We therefore determined the relative performance of the Montreal cognitive assessment visuoexecutive sub-tests versus the mini-mental state examination pentagon copying in patients with stroke and transient ischemic attack.
Mini-mental state examination and Montreal cognitive assessment were administered to a prospective, population-based cohort of stroke, and transient ischemic attack patients from the Oxford Vascular Study at six month or five-year follow-up between November 2007 and June 2009. We compared the proportion of participants with incorrect Montreal cognitive assessment visuoexecutive tasks and sub-tasks but correct mini-mental state examination pentagon copying versus the proportion with incorrect MMSE pentagon copying but correct visuoexecutive Montreal cognitive assessment sub-test and individual sub-test items.
Among 412 patients assessed with the mini-mental state examination and Montreal cognitive assessment, the Montreal cognitive assessment detected more visuoexecutive dysfunction than the mini-mental state examination (OR 11.4, 95% CI 8.2-15.8, p < 0.001). The likelihood of incorrect mini-mental state examination pentagon copying increased as the numbers of correct MoCA visuoexecutive responses decreased: 2/106 (1.9%) and 9/10 (90.0%) incorrect mini-mental state examination pentagon copying for 5/5 and 0/5 correct Montreal cognitive assessment visuoexecutive tasks, respectively (p for trend 0.005). Each Montreal cognitive assessment visuoexecutive sub-task, including trails (39.6%), cube copying (49.5%), and clock drawing (59.0%), detected more patients with visuoexecutive dysfunction than the mini-mental state examination pentagon copying (20.6%, p < 0.001).
All three of the Montreal cognitive assessment visuoexecutive sub-tests detected more abnormalities than the mini-mental state examination pentagon copying and thus contributed to the over 10-fold superiority of Montreal cognitive assessment over the mini-mental state examination for detection of visuoexecutive dysfunction.
执行功能障碍可预测中风风险、痴呆和死亡率。蒙特利尔认知评估（MoCA）比简易精神状态检查（MMSE）检测到更多的视空间执行功能障碍，但尚不清楚 MoCA 的哪些视空间执行项目对 MoCA 的更好表现做出了贡献。因此，我们确定了 MoCA 视空间执行子测试与 MMSE 五边形复制在中风和短暂性脑缺血发作患者中的相对表现。
2007 年 11 月至 2009 年 6 月，在牛津血管研究的前瞻性、基于人群的中风和短暂性脑缺血发作患者队列中，在 6 个月或 5 年随访时，对 MMSE 和 MoCA 进行了评估。我们比较了 MoCA 视空间执行任务和子任务有错误但 MMSE 五边形复制正确的参与者比例与 MMSE 五边形复制错误但 MoCA 视空间执行子测试和个别子测试项目正确的参与者比例。
在接受 MMSE 和 MoCA 评估的 412 名患者中，MoCA 检测到的视空间执行功能障碍多于 MMSE（OR 11.4，95%CI 8.2-15.8，p<0.001）。随着 MoCA 视空间执行反应正确数目的减少，MMSE 五边形复制错误的可能性增加：5/5 和 0/5 正确的 MoCA 视空间执行任务分别有 2/106（1.9%）和 9/10（90.0%）错误的 MMSE 五边形复制（p 趋势值 0.005）。MoCA 的每个视空间执行子测试，包括连线测试（39.6%）、立方体复制（49.5%）和时钟绘制（59.0%），都比 MMSE 五边形复制检测到更多的视空间执行功能障碍患者（20.6%，p<0.001）。
MoCA 的所有三个视空间执行子测试都比 MMSE 五边形复制检测到更多的异常，因此对 MoCA 对视空间执行功能障碍的检测优于 MMSE 五边形复制的 10 倍以上。
