Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.
Nursing Department, Gansu Provincial Hospital, Lanzhou, China.
Int J Stroke. 2023 Oct;18(8):908-916. doi: 10.1177/17474930231178660.
Post-stroke cognitive impairment (PSCI) is one of the serious complications of stroke. The Montreal Cognitive Assessment (MoCA), as a brief cognitive impairment screening tool, is widely used in stroke survivors. However, some studies have suggested that the use of the universal cutoff value of 26 may be inappropriate for detecting cognitive impairments in stroke settings.
We conducted this study to identify the optimal cutoff value of the MoCA in screening for PSCI.
PubMed, CINAHL, Embase, the Cochrane Library, and Web of Science were searched for eligible studies until March 23, 2023. All studies were screened by two independent researchers. The quality of each article was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate mixed-effects model was used to pool sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the summary receiver operating characteristic curve.
Twenty-four studies with a total of 4231 patients were included in this review. Despite the lack of evidence of publication bias, a high degree of heterogeneity was observed. A meta-analysis revealed that a cutoff value of 21/22 yielded the best diagnostic accuracy. The optimal cutoff varied in different regions, stroke types, and stroke phases as well.
The optimal cutoff of MoCA was 21/22 for stroke populations rather than the initially recommended cutoff of 26. A revised (lower) cutoff should be considered for stroke survivors.
脑卒中后认知障碍（PSCI）是脑卒中的严重并发症之一。蒙特利尔认知评估（MoCA）作为一种简短的认知障碍筛查工具，在脑卒中幸存者中得到了广泛应用。然而，一些研究表明，使用 26 的通用截断值可能不适合在脑卒中环境中检测认知障碍。
我们进行了这项研究，以确定 MoCA 在筛查 PSCI 中的最佳截断值。
检索 PubMed、CINAHL、Embase、Cochrane 图书馆和 Web of Science 以获取合格的研究，截至 2023 年 3 月 23 日。由两名独立研究人员筛选所有研究。使用 Quality Assessment of Diagnostic Accuracy Studies-2 工具评估每个文章的质量。使用双变量混合效应模型汇总敏感性、特异性、阳性似然比、阴性似然比、诊断比值比和综合受试者工作特征曲线。
本综述共纳入了 24 项研究，共计 4231 名患者。尽管没有发表偏倚的证据，但观察到高度的异质性。荟萃分析显示，截断值为 21/22 时具有最佳的诊断准确性。最佳截断值在不同地区、脑卒中类型和脑卒中阶段有所不同。
MoCA 的最佳截断值为 21/22，适用于脑卒中人群，而不是最初推荐的 26。对于脑卒中幸存者，应考虑使用修订后的（较低）截断值。
