Xu Yangfan, Yi Lingrong, Lin Yangyang, Peng Suiying, Wang Weiming, Lin Wujian, Chen Peize, Zhang Weichao, Deng Yujie, Guo Suimin, Shi Le, Wang Yuling, Molloy D William, O'Caoimh Rónán
Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Rehabilitation Medicine, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Front Neurol. 2021 Mar 5;12:608188. doi: 10.3389/fneur.2021.608188. eCollection 2021.
Screening for post-stroke cognitive impairment (PSCI) is necessary because stroke increases the incidence of and accelerates premorbid cognitive decline. The Quick Mild Cognitive Impairment (Q) screen is a short, reliable and accurate cognitive screening instrument but is not yet validated in PSCI. We compared the diagnostic accuracy of a Chinese version of the Q screen (Q-CN) compared with the widely-used Chinese versions of the Montreal Cognitive Assessment (MoCA-CN) and Mini-Mental State Examination (MMSE-CN). We recruited 34 patients who had recovered from a stroke in rehabilitation unit clinics in 2 university hospitals in China: 11 with post-stroke dementia (PSD), 15 with post-stroke cognitive impairment no dementia (PSCIND), and 8 with normal cognition (NC). Classification was made based on clinician assessment supported by a neuropsychological battery, independent of the screening test scores. The Q-CN, MoCA-CN, and MMSE-CN screens were administered randomly by a trained rater, blind to the diagnosis. The mean age of the sample was 63 ± 13 years and 61.8% were male. The Q-CN had statistically similar diagnostic accuracy in differentiating PSD from NC, an area under the curve (AUC) of 0.94 compared to 0.99 for the MoCA-CN ( = 0.237) and 0.99 for the MMSE-CN ( = 0.293). The Q-CN (AUC 0.91), MoCA-CN (AUC 0.94), and MMSE-CN (AUC 0.79) also had statistically similar accuracy in separating PSD from PSCIND. The MoCA-CN more accurately distinguished between PSCIND and normal cognition than the Q-CN ( = 0.015). Compared to the MoCA-CN, the administration times of the Q-CN (329s vs. 611s, respectively, < 0.0001) and MMSE-CN (280 vs. 611s, respectively, < 0.0001) were significantly shorter. The Q-CN is accurate in identifying PSD and separating PSD from PSCIND in patients post-stroke following rehabilitation and is comparable to the widely-used MoCA-CN, albeit with a significantly shorter administration time. The Q-CN had relatively poor accuracy in identifying PSCIND from NC and hence may lack accuracy for certain subgroups. However, given the small sample size, the study is under-powered to show superiority of one instrument over another. Further study is needed to confirm these findings in a larger sample size and in other settings (countries and languages).
筛查卒中后认知障碍（PSCI）很有必要，因为卒中会增加发病率并加速病前认知衰退。快速轻度认知障碍（Q）筛查是一种简短、可靠且准确的认知筛查工具，但尚未在PSCI中得到验证。我们比较了中文版Q筛查（Q-CN）与广泛使用的中文版蒙特利尔认知评估量表（MoCA-CN）和简易精神状态检查表（MMSE-CN）的诊断准确性。我们在中国两所大学医院的康复科诊所招募了34名卒中后康复的患者：11例患有卒中后痴呆（PSD），15例患有卒中后非痴呆性认知障碍（PSCIND），8例认知正常（NC）。分类基于临床医生的评估，并得到神经心理测试组的支持，与筛查测试分数无关。Q-CN、MoCA-CN和MMSE-CN筛查由一名经过培训的评分者随机进行，评分者对诊断结果不知情。样本的平均年龄为63±13岁，男性占61.8%。在区分PSD与NC方面，Q-CN的诊断准确性在统计学上与其他两者相似，曲线下面积（AUC）为0.94，而MoCA-CN为0.99（P = 0.237），MMSE-CN为0.99（P = 0.293）。在区分PSD与PSCIND方面，Q-CN（AUC 0.91）、MoCA-CN（AUC 0.94）和MMSE-CN（AUC 0.79）在统计学上也具有相似的准确性。MoCA-CN在区分PSCIND与正常认知方面比Q-CN更准确（P = 0.015）。与MoCA-CN相比，Q-CN（分别为329秒对611秒，P < 0.0001）和MMSE-CN（分别为280秒对611秒，P < 0.0001）的施测时间明显更短。Q-CN在识别卒中后康复患者的PSD以及区分PSD与PSCIND方面是准确的，并且与广泛使用的MoCA-CN相当，尽管施测时间明显更短。Q-CN在从NC中识别PSCIND方面准确性相对较差，因此可能对某些亚组缺乏准确性。然而，鉴于样本量较小，该研究的效能不足以显示一种工具优于另一种工具。需要进一步研究以在更大样本量和其他环境（国家和语言）中证实这些发现。
