Qi Gao, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Beijing 100069, China. Tel.: +010 83911497; E-mail:
J Prev Alzheimers Dis. 2022;9(4):589-600. doi: 10.14283/jpad.2022.70.
The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are low costing and noninvasive neuropsychological tests in screening Mild Cognitive Impairment (MCI) due to Alzheimer's disease (AD). There is no consensus on which test performs better in detecting MCI due to AD based on the different imperfect reference standards. Therefore, we conducted a meta-analysis to assess the diagnostic performance of MMSE and MoCA for screening MCI due to AD in the absence of a gold standard.
Six electronic databases were searched for relevant studies until April, 2022. A hierarchical Bayesian latent class model was used to estimate the pooled sensitivity and specificity of MoCA and MMSE in the absence of a gold standard.
90 eligible studies covering 21273 individuals for MMSE, 26631 individuals for MoCA were included in this meta-analysis. The pooled sensitivity was 0.71(95%CI: 0.67-0.74) for MMSE and 0.85(95%CI: 0.83-0.88) for MoCA, while the pooled specificity was 0.71(95%CI: 0.68-0.74) for MMSE and 0.79(95%CI: 0.76-0.81) for MoCA. MoCA was useful to "rule in" and "rule out" the diagnosis of MCI due to AD with higher positive likelihood ratio (4.07; 95%CI: 3.60-4.62) and lower negative likelihood ratio (0.18; 95%CI: 0.16-0.22). Moreover, the diagnostic odds ratio of MoCA was 22.08(95%CI: 17.24-28.29), which showed significantly favorable diagnostic performance.
It suggests that MoCA has greater diagnostic performance than MMSE for differentiating MCI due to AD when the gold standard is absent. However, these results should be taken with caution given the heterogeneity observed.
简易精神状态检查(MMSE)和蒙特利尔认知评估(MoCA)是两种低成本、非侵入性的神经心理学测试,可用于筛查阿尔茨海默病(AD)导致的轻度认知障碍(MCI)。由于不同的不完美参考标准,哪种测试在检测 AD 导致的 MCI 方面表现更好,目前尚无共识。因此,我们进行了一项荟萃分析,以评估在没有金标准的情况下,MMSE 和 MoCA 对 AD 导致的 MCI 的诊断性能。
检索了六个电子数据库,以获取截至 2022 年 4 月的相关研究。使用分层贝叶斯潜在类别模型来估计在没有金标准的情况下,MoCA 和 MMSE 的汇总敏感性和特异性。
共有 90 项符合条件的研究纳入了 MMSE(共 21273 人)和 MoCA(共 26631 人)的分析。MMSE 的汇总敏感性为 0.71(95%CI:0.67-0.74),MoCA 的汇总敏感性为 0.85(95%CI:0.83-0.88),MMSE 的汇总特异性为 0.71(95%CI:0.68-0.74),MoCA 的汇总特异性为 0.79(95%CI:0.76-0.81)。MoCA 有助于“诊断为”和“排除” AD 导致的 MCI,阳性似然比较高(4.07;95%CI:3.60-4.62),阴性似然比较低(0.18;95%CI:0.16-0.22)。此外,MoCA 的诊断比值比为 22.08(95%CI:17.24-28.29),表明其具有显著的诊断性能。
在没有金标准的情况下,MoCA 对 AD 导致的 MCI 的鉴别诊断性能优于 MMSE。但是,鉴于观察到的异质性,这些结果应谨慎对待。