Department of Pharmacology, National University of Singapore, Singapore.
Memory Aging and Cognition Centre, National University Health System, Singapore.
J Alzheimers Dis. 2018;62(1):409-416. doi: 10.3233/JAD-170831.
Researchers have questioned the utility of brief cognitive tests such as the Mini-Mental Status Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in serial administration and suggested that brief cognitive tests may not accurately track changes in Global Cognition.
To examine the accuracy of longitudinal changes on brief cognitive tests in reflecting progression in Global Cognition measured using comprehensive neuropsychological assessments.
Two hundred and seven participants were assessed with the MMSE, MoCA, and a validated comprehensive neuropsychological battery. Global z-scores on the battery were derived and used to assess overall and significant (≥0.5 standard deviation) decline on Global Cognition. Different patterns of decline on MMSE/MoCA were classified. Accuracy was examined using receiver operating characteristic curve, and sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were reported.
The overall ability of MMSE/MoCA change scores to discriminate participants who did and did not decline on Global Cognition was fair-to-moderate (AUC [95% CI] = 0.71 [0.64-0.78] & 0.73 [0.66-0.80] for overall decline; 0.78 [0.70-0.85] & 0.80 [0.73-0.86] for significant decline, respectively). Changes in MMSE/MoCA had low accuracy in identifying significant Global Cognitive Decline (PPV = 0.41 & 0.46, respectively) but high accuracy in ruling out significant decline and identifying cognitively stable participants (NPV = 0.89 & 0.88, respectively).
There is limited utility in brief cognitive tests for tracking cognitive decline. Instead, they should be used for identifying participants who remain cognitively stable on follow up. These results accentuate the importance of acknowledging the limitations of brief cognitive tests when assessing cognitive change.
研究人员对简短认知测试（如 Mini-Mental Status Examination [MMSE] 和 Montreal Cognitive Assessment [MoCA]）在连续评估中的实用性提出了质疑，并认为这些简短的认知测试可能无法准确跟踪整体认知的变化。
研究在反映使用综合神经心理学评估测量的整体认知进展方面，简短认知测试的纵向变化的准确性。
对 207 名参与者进行了 MMSE、MoCA 和经过验证的综合神经心理学测试。得出了该测试的整体 z 分数，并用于评估整体和显著（≥0.5 标准差）的整体认知下降。对 MMSE/MoCA 的不同下降模式进行了分类。使用接收者操作特征曲线检查准确性，并报告敏感性、特异性、阳性（PPV）和阴性（NPV）预测值。
MMSE/MoCA 变化评分区分在整体认知上下降和未下降的参与者的整体能力为中等（AUC [95% CI] = 0.71 [0.64-0.78] 和 0.73 [0.66-0.80] 用于整体下降；0.78 [0.70-0.85] 和 0.80 [0.73-0.86] 用于显著下降，分别）。MMSE/MoCA 的变化在识别显著的整体认知下降方面准确性较低（PPV = 0.41 和 0.46，分别），但在排除显著下降和识别认知稳定的参与者方面具有较高的准确性（NPV = 0.89 和 0.88，分别）。
简短认知测试在跟踪认知下降方面的实用性有限。相反，它们应该用于识别在随访中认知稳定的参与者。这些结果强调了在评估认知变化时承认简短认知测试的局限性的重要性。
