Malek-Ahmadi Michael, Nikkhahmanesh Nia
Banner Alzheimer's Institute, Phoenix, AZ, United States.
College of Medicine, University of Arizona, Phoenix, AZ, United States.
Front Psychol. 2024 Feb 13;15:1369766. doi: 10.3389/fpsyg.2024.1369766. eCollection 2024.
The Montreal Cognitive Assessment (MoCA) is one of the most widely-used cognitive screening instruments and has been translated into several different languages and dialects. Although the original validation study suggested to use a cutoff of ≤26, subsequent studies have shown that lower cutoff values may yield fewer false-positive indications of cognitive impairment. The aim of this study was to summarize the diagnostic accuracy and mean difference of the MoCA when comparing cognitively unimpaired (CU) older adults to those with amnestic mild cognitive impairment (aMCI).
PubMed and EMBASE databases were searched from inception to 22 February 2022. Meta-analyses for area under the curve (AUC) and standardized mean difference (SMD) values were performed.
Fifty-five observational studies that included 17,343 CU and 8,413 aMCI subjects were selected for inclusion. Thirty-nine studies were used in the AUC analysis while 44 were used in the SMD analysis. The overall AUC value was 0.84 (95% CI: 0.81, 0.87) indicating good diagnostic accuracy and a large effect size was noted for the SMD analysis (Hedge's = 1.49, 95% CI: 1.33, 1.64). Both analyses had high levels of between-study heterogeneity. The median cutoff score for identifying aMCI was <24.
The MoCA has good diagnostic accuracy for detecting aMCI across several different languages. The findings of this meta-analysis also support the use of 24 as the optimal cutoff when the MoCA is used to screen for suspected cognitive impairment.
蒙特利尔认知评估量表（MoCA）是使用最广泛的认知筛查工具之一，已被翻译成多种不同语言和方言。尽管最初的验证研究建议使用≤26的临界值，但随后的研究表明，较低的临界值可能会减少认知障碍的假阳性指征。本研究的目的是总结在比较认知未受损（CU）的老年人与遗忘型轻度认知障碍（aMCI）患者时，MoCA的诊断准确性和平均差异。
检索PubMed和EMBASE数据库，检索时间从建库至2022年2月22日。对曲线下面积（AUC）和标准化平均差（SMD）值进行荟萃分析。
选取了55项观察性研究，包括17343名CU受试者和8413名aMCI受试者。39项研究用于AUC分析，44项研究用于SMD分析。总体AUC值为0.84（95%CI：0.81，0.87），表明诊断准确性良好，SMD分析显示效应量较大（Hedge's = 1.49，95%CI：1.33，1.64）。两项分析的研究间异质性均较高。识别aMCI的中位数临界分为<24。
MoCA在多种不同语言中检测aMCI具有良好的诊断准确性。本荟萃分析的结果也支持在使用MoCA筛查疑似认知障碍时，将24作为最佳临界值。
