Chalhoub N E, Luggen M E
Division of Immunology, Allergy, and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, USA.
Lupus. 2019 Jan;28(1):51-58. doi: 10.1177/0961203318815299. Epub 2018 Nov 27.
Cognitive dysfunction (CD) is among the most common neuropsychiatric manifestations of systemic lupus erythematosus (SLE). Traditional neuropsychological testing and the Automated Neuropsychologic Assessment Metrics (ANAM) have been used to assess CD but neither is an ideal screening test. The Montreal Cognitive Assessment Questionnaire (MoCA) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) are brief and inexpensive tests. This study evaluated the MoCA and IQCODE as screening tools.
SLE patients fulfilling American College of Rheumatology (ACR) classification criteria were evaluated using the ANAM as the reference standard. The performance characteristics of the MoCA and IQCODE were assessed in comparison with normal controls (NCs) and rheumatoid arthritis (RA) patients. Four different definitions of CD were utilized.
In total, 78 patients were evaluated. MoCA and ANAM scores were significantly correlated ( r = 0.51, p < 0.001). At the optimal cutoff, the sensitivity of the MoCA was ≥ 90% (depending on definition of CD) vs RA patients and ≥83% vs NCs. ANAM and IQCODE scores did not correlate ( p = 0.8152). IQCODE sensitivities were low for both RA patients and NCs regardless of definition and cutoff used.
The MoCA appears to be a promising and practical screening tool for identification of patients with SLE at risk for CD.
认知功能障碍（CD）是系统性红斑狼疮（SLE）最常见的神经精神表现之一。传统的神经心理学测试和自动神经心理评估指标（ANAM）已被用于评估CD，但两者都不是理想的筛查测试。蒙特利尔认知评估问卷（MoCA）和老年人认知功能下降知情者问卷（IQCODE）是简短且成本低廉的测试。本研究评估了MoCA和IQCODE作为筛查工具的情况。
以ANAM作为参考标准，对符合美国风湿病学会（ACR）分类标准的SLE患者进行评估。将MoCA和IQCODE的表现特征与正常对照（NC）和类风湿关节炎（RA）患者进行比较。采用了四种不同的CD定义。
总共评估了78例患者。MoCA和ANAM评分显著相关（r = 0.51，p < 0.001）。在最佳临界值时，MoCA对RA患者的敏感性≥90%（取决于CD的定义），对NC的敏感性≥83%。ANAM和IQCODE评分不相关（p = 0.8152）。无论采用何种定义和临界值，IQCODE对RA患者和NC的敏感性都较低。
MoCA似乎是一种有前景且实用的筛查工具，可用于识别有CD风险的SLE患者。
