Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, Enschede, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands.
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
Resuscitation. 2022 Mar;172:130-136. doi: 10.1016/j.resuscitation.2021.12.024. Epub 2021 Dec 25.
The survival rate of out-of-hospital cardiac arrest (OHCA) patients has increased over the past decades. This gives rise to a growing number of patients with hypoxic-ischemic brain damage and cognitive impairment. Currently, cognitive impairment is underdiagnosed in OHCA patients. There is a need for a validated cognitive screening instrument to identify patients with cognitive impairment. This study aimed to examine the diagnostic value of the Montreal Cognitive Assessment (MoCA) in patients after OHCA.
Survivors (age ≥ 18 years) of OHCA completed the MoCA and a gold standard neuropsychological test battery, including tests for memory, attention, perception, language, reasoning, and executive functioning, at around one year after OHCA. Results of the MoCA are related to the results of the neuropsychological test battery. Analyses of diagnostic accuracy included receiver operating characteristics and calculation of predictive values.
We included 54 OHCA survivors (mean age = 57.3, 74% male). The area under the curve (AUC) was 0.8, 95% CI [0.67, 0.93]. The MoCA showed excellent sensitivity of 86%, 95% CI [57, 98] and adequate specificity of 70.0%, 95% CI [53, 83] to detect cognitive impairment at the regular cut-off score of 26. The positive predictive value of the MoCA was 50%, 95% CI [30, 70] and the negative predictive value was 93%, 95% CI [76, 99].
This study shows that the MoCA may be a valid cognitive screening instrument for use in the OHCA patient population.
在过去几十年中，院外心脏骤停（OHCA）患者的存活率有所提高。这导致越来越多的患者出现缺氧缺血性脑损伤和认知障碍。目前，OHCA 患者的认知障碍存在漏诊。因此，需要一种经过验证的认知筛查工具来识别认知障碍患者。本研究旨在探讨蒙特利尔认知评估（MoCA）在 OHCA 患者中的诊断价值。
OHCA 幸存者（年龄≥18 岁）在 OHCA 后约 1 年完成 MoCA 和神经心理学测试组合，包括记忆、注意力、知觉、语言、推理和执行功能测试。MoCA 的结果与神经心理学测试组合的结果相关。分析诊断准确性包括接收者操作特征和预测值的计算。
我们纳入了 54 名 OHCA 幸存者（平均年龄 57.3 岁，74%为男性）。曲线下面积（AUC）为 0.8，95%CI[0.67，0.93]。MoCA 在常规截断值 26 分下显示出良好的敏感性（86%，95%CI[57,98]）和适度的特异性（70.0%，95%CI[53,83]），以检测认知障碍。MoCA 的阳性预测值为 50%，95%CI[30,70]，阴性预测值为 93%，95%CI[76,99]。
本研究表明，MoCA 可能是 OHCA 患者人群中一种有效的认知筛查工具。
