提高神经认知障碍诊断准确性：蒙特利尔认知评估修订后的截断值方法。
Enhanced diagnostic accuracy for neurocognitive disorders: a revised cut-off approach for the Montreal Cognitive Assessment.
机构信息
Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Burgfelderstrasse 101, CH-4055, Basel, Switzerland.
Anesthesiology, University Hospital Basel, Basel, Switzerland.
出版信息
Alzheimers Res Ther. 2020 Apr 7;12(1):39. doi: 10.1186/s13195-020-00603-8.
BACKGROUND
The Montreal Cognitive Assessment (MoCA) has good sensitivity for mild cognitive impairment, but specificity is low when the original cut-off (25/26) is used. We aim to revise the cut-off on the German MoCA for its use in clinical routine.
METHODS
Data were analyzed from 496 Memory Clinic outpatients (447 individuals with a neurocognitive disorder; 49 with cognitive normal findings) and from 283 normal controls. Cut-offs were identified based on (a) Youden's index and (b) the 10th percentile of the control group.
RESULTS
A cut-off of 23/24 on the MoCA had better correct classification rates than the MMSE and the original MoCA cut-off. Compared to the original MoCA cut-off, the cut-off of 23/24 points had higher specificity (92% vs 63%), but lower sensitivity (65% vs 86%). Introducing two separate cut-offs increased diagnostic accuracies with 92% specificity (23/24 points) and 91% sensitivity (26/27 points). Scores between these two cut-offs require further examinations.
CONCLUSIONS
Using two separate cut-offs for the MoCA combined with scores in an indecisive area enhances the accuracy of cognitive screening.
背景
蒙特利尔认知评估（MoCA）对于轻度认知障碍具有很好的敏感性，但当使用原始截断值（25/26）时，特异性较低。我们旨在修订 MoCA 的德国截断值，以便在临床常规中使用。
方法
对 496 名记忆诊所门诊患者（447 名患有神经认知障碍的个体；49 名认知正常的个体）和 283 名正常对照组进行数据分析。基于（a）约登指数和（b）对照组的第 10 百分位数确定截断值。
结果
MoCA 的截断值为 23/24 时，比 MMSE 和原始 MoCA 截断值具有更好的正确分类率。与原始 MoCA 截断值相比，23/24 分的截断值具有更高的特异性（92%比 63%），但敏感性较低（65%比 86%）。引入两个单独的截断值可提高诊断准确性，特异性为 92%（23/24 分），敏感性为 91%（26/27 分）。这两个截断值之间的分数需要进一步检查。
结论
使用 MoCA 的两个单独截断值并结合不确定区域的分数可以提高认知筛查的准确性。
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