Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Clin Neuropsychol. 2023 Aug;37(6):1173-1190. doi: 10.1080/13854046.2022.2090442. Epub 2022 Jun 28.
Given the association between essential tremor (ET) and higher rates of cognitive decline, assessing this decline is an important element of research and clinical care. The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are two broad, brief measures that are widely used to monitor cognitive impairment in various neurological disorders. We sought to determine the relative ability of the MoCA and the MMSE to detect cognitive decline in elderly patients with ET. We administered a neuropsychological battery to an ET cohort every 18 months over 4.5 years. We defined the gold standard for change in cognition as the change in neuropsychological test scores over consecutive evaluations and applied the Reliable Change Method to detect meaningful increases/decreases in test scores. We performed receiver operating characteristics (ROC) analysis to quantify the area under the curve (AUC) and compare the ability of the MoCA and the MMSE to detect cognitive decline. The AUCs for the MoCA and the MMSE did not differ significantly at any interval or when all intervals were pooled for analysis. Across all intervals, the ability of the MoCA and the MMSE to detect cognitive decline was consistently fair or poor. We found that the ability of the MoCA and the MMSE to detect cognitive decline in ET patients over 18-month intervals is inadequate. Unchanged scores on the MoCA and the MMSE in ET over time should be approached with caution. We propose that these screening tools should be supplemented with additional neuropsychological tests.
鉴于原发性震颤（ET）与更高的认知能力下降率之间存在关联，评估这种下降是研究和临床护理的重要内容。简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）是两种广泛使用的广泛、简短的测量方法，用于监测各种神经障碍中的认知障碍。我们旨在确定 MoCA 和 MMSE 在检测老年 ET 患者认知下降方面的相对能力。我们在 4.5 年内每隔 18 个月向 ET 队列进行一次神经心理学测试。我们将认知变化的金标准定义为连续评估中神经心理测试分数的变化，并应用可靠变化方法来检测测试分数的有意义增加/减少。我们进行了接收器操作特征（ROC）分析，以量化曲线下面积（AUC），并比较 MoCA 和 MMSE 检测认知下降的能力。MoCA 和 MMSE 的 AUC 在任何间隔或所有间隔汇总分析时均无显着差异。在所有间隔中，MoCA 和 MMSE 检测认知下降的能力始终为中等或较差。我们发现，MoCA 和 MMSE 在 18 个月的间隔内检测 ET 患者认知下降的能力不足。ET 患者的 MoCA 和 MMSE 分数随时间保持不变应谨慎对待。我们建议这些筛选工具应辅以其他神经心理学测试。
