Chen Matthew Zhixuan, Chan Yiong Huak, Wong Michael Wai Kit, Merchant Reshma Aziz
Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore.
Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Psychogeriatrics. 2022 Jul;22(4):460-468. doi: 10.1111/psyg.12841. Epub 2022 May 16.
The Montreal Cognitive Assessment (MoCA) was developed as a screening tool for mild cognitive impairment (MCI). Given the need for a rapid screening test in settings such as primary care, we compare the validity of the Rapid Cognitive Screen (RCS) against the MoCA, and determine cut-off scores in the old and old-old.
Cross-sectional study involving community-dwelling 'old' (65 to 79 years old) and 'old-old' (≥ 80 years old) without dementia. Cognitive impairment was defined by MoCA score 17 to 22. Validation was done using the receiver operating characteristic (ROC) curve analysis: area under the curve (AUC), sensitivity (Sn), and specificity (Sp).
Of the 183 participants (mean age 72.1 ± 5.2 years),15.8% (n = 29) were classified as cognitively impaired. The overall ROC curve had an AUC of 0.82 (95% CI 0.75-0.90, P < 0.01) with an optimal cut-off of 7/8 on RCS (Sn 0.77, Sp 0.72). The 'old' and 'old-old' group had AUC of 0.82 (95% CI 0.74-0.91, P < 0.01) with 8/9 as optimal cut-off (Sn 0.51, Sp 0.96) and AUC of 0.85 (95% CI 0.66-1.03, P < 0.01) with 7/8 as optimal cut-off (Sn 0.71, Sp 1.00) respectively. In multivariate analysis, age was associated with 0.05 (95% CI -0.10-0.00, P < 0.04) point decrement, while >6 years of education was associated with 0.82 (95% CI 0.32-1.33, P < 0.01) point increment in RCS scores.
The three-item RCS is quick and easy to administer. Although RCS met the criterion for good validity against MoCA in predicting cognitive impairment, its utility as a first-line screening tool needs to be further validated in a large-scale population study.
蒙特利尔认知评估量表（MoCA）是作为轻度认知障碍（MCI）的筛查工具而开发的。鉴于在初级保健等环境中需要一种快速筛查测试，我们比较了快速认知筛查（RCS）与MoCA的有效性，并确定了老年人和高龄老年人的临界值。
对无痴呆的社区居住“老年人”（65至79岁）和“高龄老年人”（≥80岁）进行横断面研究。认知障碍由MoCA评分为17至22定义。使用受试者工作特征（ROC）曲线分析进行验证：曲线下面积（AUC）、敏感性（Sn）和特异性（Sp）。
183名参与者（平均年龄72.1±5.2岁）中，15.8%（n = 29）被归类为认知障碍。总体ROC曲线的AUC为0.82（95%CI 0.75 - 0.90，P < 0.01），RCS的最佳临界值为7/8（Sn 0.77，Sp 0.72）。“老年人”组和“高龄老年人”组的AUC分别为0.82（95%CI 0.74 - 0.91，P < 0.01），最佳临界值为8/9（Sn 0.51，Sp 0.96）和0.85（95%CI 0.66 - 1.03，P < 0.01），最佳临界值为7/8（Sn 0.71，Sp 1.00）。在多变量分析中，年龄与RCS评分降低0.05（95%CI -0.10 - 0.00，P < 0.04）分相关，而受教育年限>6年与RCS评分增加0.82（95%CI 0.32 - 1.33，P < 0.01）分相关。
三项RCS快速且易于实施。虽然RCS在预测认知障碍方面符合针对MoCA的良好有效性标准，但其作为一线筛查工具的效用需要在大规模人群研究中进一步验证。
