在60岁以上人群的轻度认知障碍（MCI）检测中，蒙特利尔认知评估量表（MoCA）测试是否比简易精神状态检查表（MMSE）更适用？荟萃分析。
Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis.
作者信息
Ciesielska Natalia, Sokołowski Remigiusz, Mazur Ewelina, Podhorecka Marta, Polak-Szabela Anna, Kędziora-Kornatowska Kornelia
机构信息
Katedra i Klinika Geriatrii, Collegium Medicum, Uniwersytet Mikołaja Kopernika, Bydgoszcz.
出版信息
Psychiatr Pol. 2016 Oct 31;50(5):1039-1052. doi: 10.12740/PP/45368.
OBJECTIVES
Screening tests play a crucial role in dementia diagnostics, thus they should be very sensitive for mild cognitive impairment (MCI) assessment. Nowadays, the MiniMental State Examination (MMSE) is the most commonly used scale in cognitive function evaluation, albeit it is claimed to be imprecise for MCI detection. The Montreal Cognitive Assessment (MoCA), was created as an alternative method for MMSE. Aim. MoCA vs. MMSE credibility assessment in detecting MCI, while taking into consideration the sensitivity and specificity by cut-off points.
METHODS
A systematic literature search was carried out by the authors using EBSCO host Web, Wiley Online Library, Springer Link, Science Direct and Medline databases. The following medical subject headings were used in the search: mild cognitive impairment, mini-mental state examination, Montreal cognitive assessment, diagnostics value. Papers which met inclusion and exclusion criteria were chosen to be included in this review. At the end, for the evaluation of MoCA 20, and MMSE 13 studies were qualified. Research credibility was established by computing weighted arithmetic mean, where weight is defined as population for which the result of sensitivity and specificity for the cut-off point was achieved. The cut-offs are shown as ROC curve and accuracy of diagnosis for MoCA and MMSE was calculated as the area under the curve (AUC).
RESULTS
ROC curve analysis for MoCA demonstrated that MCI best detection can be achieved with a cut-off point of 24/25 (n = 9350, the sensitivity of 80.48% and specificity of 81.19%). AUC was 0.846 (95% CI 0.823-0.868). For MMSE, it turned out that more important cut-off was of 27/28 (n = 882, 66.34% sensitivity and specificity of 72.94%). AUC was 0.736 (95% CI 0.718-0.767).
CONCLUSIONS
MoCA test better meets the criteria for screening tests for the detection of MCI among patients over 60 years of age than MMSE.
目的
筛查测试在痴呆诊断中起着至关重要的作用，因此它们应对轻度认知障碍（MCI）评估具有高度敏感性。如今，简易精神状态检查表（MMSE）是认知功能评估中最常用的量表，尽管有人声称它在检测MCI方面不够精确。蒙特利尔认知评估量表（MoCA）就是作为MMSE的替代方法而创建的。目的：在考虑临界点的敏感性和特异性的同时，评估MoCA与MMSE在检测MCI方面的可信度。
方法
作者使用EBSCOhost网络、Wiley在线图书馆、SpringerLink、ScienceDirect和Medline数据库进行了系统的文献检索。检索中使用了以下医学主题词：轻度认知障碍、简易精神状态检查表、蒙特利尔认知评估量表、诊断价值。符合纳入和排除标准的论文被选入本综述。最后，有20项关于MoCA和13项关于MMSE的研究符合要求。通过计算加权算术平均值来确定研究可信度，其中权重定义为达到临界点敏感性和特异性结果的人群。临界点以ROC曲线表示，MoCA和MMSE的诊断准确性以曲线下面积（AUC）计算。
结果
MoCA的ROC曲线分析表明，临界点为24/25时可实现对MCI的最佳检测（n = 9350，敏感性为80.48%，特异性为81.19%）。AUC为0.846（95%CI 0.823 - 0.868）。对于MMSE，结果表明更重要的临界点是27/28（n = 882，敏感性为66.34%，特异性为72.94%）。AUC为0.736（95%CI 0.718 - 0.767）。
结论
在60岁以上患者中检测MCI时，MoCA测试比MMSE更符合筛查测试的标准。
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