Lazo-Porras María, Pesantes María A, Miranda J Jaime, Bernabe-Ortiz Antonio
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; CONEVID Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
eNeurologicalSci. 2016 Dec 1;5:35-40. doi: 10.1016/j.ensci.2016.11.012. eCollection 2016 Dec.
The evaluation of cognitive impairment in adulthood merits attention in societies in transition and especially in people with chronic diseases. Screening tools available for clinical practice and epidemiological studies have been designed in high-income but not in resource-constrained settings. The aim of this study was to assess the agreement and bias of three common tools used for screening of cognitive impairment in people with hypertension: the modified Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Leganés Cognitive Test (LCT).
A cross-sectional study enrolling participants with hypertension from a semi-urban area in Peru was performed. The three screening tools for cognitive impairment were applied on three consecutive days. The prevalence of cognitive impairment was calculated for each test. Pearson's correlation coefficients, Bland-Altman plots, and Kappa statistics were used to assess agreement and bias between screening tools.
We evaluated 139 participants, mean age 76.5 years (SD ± 6.9), 56.1% females. Cognitive impairment was found in 28.1% of individuals using LCT, 63.3% using MMSE, and 100% using MoCA. Correlation coefficients ranged from 0.501 between LCT and MoCA, to 0.698 between MMSE and MoCA. Bland-Altman plots confirmed bias between screening tests. The agreement between MMSE and LCT was 60.4%, between MMSE and MoCA was 63.3%, and between MoCA and LCT was 28.1%.
Three of the most commonly used screening tests to evaluate cognitive impairment showed major discrepancies in a resource-constrained setting, signaling towards a sorely need to develop and validate appropriate tools.
在社会转型期，尤其是对患有慢性病的人群而言，成年期认知障碍的评估值得关注。用于临床实践和流行病学研究的筛查工具是在高收入环境中设计的，而非资源有限的环境。本研究的目的是评估用于筛查高血压患者认知障碍的三种常用工具的一致性和偏差：改良简易精神状态检查表（MMSE）、蒙特利尔认知评估量表（MoCA）和莱加内斯认知测试（LCT）。
在秘鲁一个半城市地区开展了一项横断面研究，纳入高血压患者。连续三天应用这三种认知障碍筛查工具。计算每项测试的认知障碍患病率。采用Pearson相关系数、Bland-Altman图和Kappa统计量来评估筛查工具之间的一致性和偏差。
我们评估了139名参与者，平均年龄76.5岁（标准差±6.9），女性占56.1%。使用LCT检测出28.1%的个体存在认知障碍，使用MMSE检测出63.3%，使用MoCA检测出100%。相关系数范围从LCT与MoCA之间的0.501到MMSE与MoCA之间的0.698。Bland-Altman图证实了筛查测试之间存在偏差。MMSE与LCT之间的一致性为60.4%，MMSE与MoCA之间为63.3%，MoCA与LCT之间为28.1%。
在资源有限的环境中，用于评估认知障碍的三种最常用筛查测试显示出重大差异，这表明迫切需要开发和验证合适的工具。
