Zhao Xiaoxiao, Dai Shujuan, Zhang Rong, Chen Xinjie, Zhao Mingjie, Bergeron Michael F, Zhou Xianbo, Zhang Junyan, Zhong Lianmei, Ashford J Wesson, Liu Xiaolei
Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Yunnan Province Clinical Research Center for Neurological Disease, Kunming, China.
Front Hum Neurosci. 2023 Jul 17;17:1195220. doi: 10.3389/fnhum.2023.1195220. eCollection 2023.
Whereas the Montreal Cognitive Assessment (MoCA) and Addenbrooke's cognitive examination-revised (ACE-R) are commonly used tests for the detection of post-stroke cognitive impairment (PSCI), these instruments take 10-30 min to administer and do not assess processing speed, which is a critical impairment in PSCI. MemTrax (MTx) is a continuous recognition test, which evaluates complex information processing, accuracy, speed, and attention, in 2 min.
To evaluate whether MTx is an effective and practical tool for PSCI assessment.
This study enrolled acute ischemic stroke (AIS) patients who have assessed the cognitive status including MTx, clinical dementia rating (CDR), MoCA, Neuropsychiatric Inventory (NPI), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), the National Institute of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), and Barthel Index of activity of daily living (BI) combined with the physical examinations of the neurologic system at the 90-day (D90) after the AIS. The primary endpoint of this study was establishing MTx cut-offs for distinguishing PSCI from AIS.
Of the 104 participants, 60 were classified to the PSCI group. The optimized cut-off value of MTx-%C (percent correct) was 78%, with a sensitivity and specificity for detecting PSCI from Non-PSCI of 90.0 and 84.1%, respectively, and an AUC of 0.919. Regarding the MTx-Cp (Composite score = MTx-%C/MTx-RT), using 46.3 as a cut-off value, the sensitivity and specificity for detecting PSCI from Non-PSCI were 80.0 and 93.2%, with an AUC of 0.925. Multivariate linear regression showed that PSCI reduced the MTx-%C (Coef. -14.18, 95% CI -18.41∼-9.95, < 0.001) and prolonged the MTx-RT (response time) (Coef. 0.29, 95% CI 0.16∼0.43, < 0.001) and reduced the MTx-CP (Coef. -19.11, 95% CI -24.29∼-13.93, < 0.001).
MemTrax (MTx) is valid and effective for screening for PSCI among target patients and is a potentially valuable and practical tool in the clinical follow-up, monitoring, and case management of PSCI.
蒙特利尔认知评估量表（MoCA）和修订版剑桥认知功能量表（ACE-R）是检测卒中后认知障碍（PSCI）常用的测试工具，但这些测试需要10 - 30分钟来进行，且未评估处理速度，而处理速度是PSCI中的一项关键损伤。MemTrax（MTx）是一种连续识别测试，可在2分钟内评估复杂信息处理、准确性、速度和注意力。
评估MTx是否是一种用于PSCI评估的有效且实用的工具。
本研究纳入急性缺血性卒中（AIS）患者，在AIS后90天（D90）时对其进行认知状态评估，包括MTx、临床痴呆评定量表（CDR）、MoCA、神经精神科问卷（NPI）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS）和日常生活活动能力Barthel指数（BI），并结合神经系统体格检查。本研究的主要终点是确定MTx区分PSCI与AIS的临界值。
104名参与者中，60名被归类为PSCI组。MTx-%C（正确百分比）的最佳临界值为78%，从非PSCI中检测PSCI的灵敏度和特异度分别为90.0%和84.1%，曲线下面积（AUC）为0.919。关于MTx-Cp（综合评分=MTx-%C/MTx-RT），以46.3作为临界值，从非PSCI中检测PSCI的灵敏度和特异度分别为80.0%和93.2%，AUC为0.925。多变量线性回归显示，PSCI降低了MTx-%C（系数 -14.18，95%置信区间 -18.41∼-9.95，P < 0.001），延长了MTx-RT（反应时间）（系数0.29，95%置信区间0.16∼0.43，P < 0.001），并降低了MTx-CP（系数 -19.11，95%置信区间 -24.29∼-13.93，P < 0.001）。
MemTrax（MTx）在目标患者中筛查PSCI是有效且可行的，并且在PSCI的临床随访、监测和病例管理中是一种潜在有价值且实用的工具。
