Department of Geriatric Psychiatry, Institute of Mental Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
J Am Med Dir Assoc. 2019 Aug;20(8):1054.e11-1054.e20. doi: 10.1016/j.jamda.2019.02.028. Epub 2019 Apr 13.
Early diagnosis of cognitive impairment is increasingly emphasized in the literature to facilitate timely preventive interventions. Although bedside cognitive tests such as the Montreal Cognitive Assessment (MoCA) are widely used for such early diagnostic purposes, they may not have comparable performance to a full neuropsychological battery (FNB) in diagnosing early cognitive impairment. This study investigated whether a small subset of neuropsychological tests can be added on to MoCA to match its performance to that of the FNB in discriminating mild cognitive impairment and dementia (MCI/dementia) from normal cognition.
Cross-sectional diagnostic study.
Alzheimer's Disease Centers across the United States.
Older participants (≥50 years) who completed MoCA and the FNB (N = 9187).
The study sample was split into two: the derivation sample (n = 1837) was used to develop a brief neuropsychological battery that best discriminated MCI/dementia (using the best-subset approach with 10-fold cross-validation); while the validation sample (n = 7350) verified its actual performance in discriminating MCI/dementia.
A 3-item neuropsychological battery was identified, comprising MoCA, Benson Complex Figure Recall, and Craft Story 21 Delayed Recall. It had excellent performance in discriminating MCI/dementia from normal cognition (area under the receiver operating characteristic curve [AUROC] 90.0%, 95% confidence interval [CI] 89.2%-90.7%), which was comparable to that of the FNB (AUROC 88.4%, 95% CI 87.6%-89.2%). By contrast, MoCA alone had significantly worse AUROC (86.9%, 95% CI 86.0%-87.7%) than that of the FNB.
CONCLUSIONS/IMPLICATIONS: Using rigorous methods, this study developed a brief neuropsychological battery that maintained the brevity of a bedside cognitive test, while rivaling the diagnostic performance of an FNB in early cognitive impairment. This brief battery offers a viable alternative when the FNB is needed but cannot be feasibly administered in nonspecialty clinics. It can have a wider health systems effect of improving patients' access to accurate diagnosis in early cognitive impairment and facilitating timely interventions to delay the progression of cognitive impairment.
文献越来越强调认知障碍的早期诊断，以促进及时的预防干预。虽然床边认知测试，如蒙特利尔认知评估（MoCA），广泛用于此类早期诊断目的，但它们在诊断早期认知障碍方面的表现可能不如完整的神经心理学测试（FNB）。本研究旨在探讨是否可以在 MoCA 上增加一小部分神经心理学测试，以使其在区分轻度认知障碍和痴呆（MCI/痴呆）与正常认知方面的表现与 FNB 相匹配。
横断面诊断研究。
美国各地的阿尔茨海默病中心。
完成 MoCA 和 FNB 的老年参与者（≥50 岁）（n=9187）。
将研究样本分为两组：推导样本（n=1837）用于开发最佳区分 MCI/痴呆的简短神经心理学测试（使用 10 倍交叉验证的最佳子集方法）；验证样本（n=7350）验证其在区分 MCI/痴呆方面的实际性能。
确定了一个 3 项神经心理学测试，包括 MoCA、Benson 复杂图形回忆和 Craft Story 21 延迟回忆。它在区分 MCI/痴呆与正常认知方面表现出色（受试者工作特征曲线下面积[AUROC]为 90.0%，95%置信区间[CI]为 89.2%-90.7%），与 FNB 相当（AUROC 为 88.4%，95%CI 为 87.6%-89.2%）。相比之下，MoCA 单独使用时的 AUROC 明显低于 FNB（86.9%，95%CI 为 86.0%-87.7%）。
结论/意义：本研究采用严格的方法，开发了一种简短的神经心理学测试，在保持床边认知测试简洁性的同时，与 FNB 在早期认知障碍中的诊断性能相媲美。当需要 FNB 但在非专业诊所无法进行时，这种简短的测试提供了一种可行的替代方案。它可以对更广泛的医疗系统产生影响，改善患者获得早期认知障碍准确诊断的机会，并促进及时干预以延缓认知障碍的进展。
