联合使用蒙特利尔认知评估量表和符号数字模态测试可提高心搏骤停后神经认知筛查的准确性：TTM2 试验的验证性亚研究。

Combined use of the Montreal Cognitive Assessment and Symbol Digit Modalities Test improves neurocognitive screening accuracy after cardiac arrest: A validation sub-study of the TTM2 trial.

机构信息

Lund University, Department of Clinical Sciences Lund, Neurology, Lund, Sweden; Skane University Hospital, Department of Rehabilitation Medicine, Lund, Sweden.

Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.

出版信息

Resuscitation. 2024 Sep;202:110361. doi: 10.1016/j.resuscitation.2024.110361. Epub 2024 Aug 13.

DOI:10.1016/j.resuscitation.2024.110361

PMID:39147306

Abstract

AIM

To assess the merit of clinical assessment tools in a neurocognitive screening following out-of-hospital cardiac arrest (OHCA).

METHODS

The neurocognitive screening that was evaluated included the performance-based Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test (SDMT), the patient-reported Two Simple Questions (TSQ) and the observer-reported Informant Questionnaire on Cognitive Decline in the Elderly-Cardiac Arrest (IQCODE-CA). These instruments were administered at 6-months in the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. We used a comprehensive neuropsychological test battery from a TTM2 trial sub-study as a gold standard to evaluate the sensitivity and specificity of the neurocognitive screening.

RESULTS

In our cohort of 108 OHCA survivors (median age = 62, 88% male), the most favourable cut-off scores were: MoCA < 26; SDMT z ≤ -1; IQCODE-CA ≥ 3.04. The MoCA (sensitivity 0.64, specificity 0.85) and SDMT (sensitivity 0.59, specificity 0.83) had a higher classification accuracy than the TSQ (sensitivity 0.28, specificity 0.74) and IQCODE-CA (sensitivity 0.42, specificity 0.60). When using the cut-points for MoCA or SDMT in combination to identify neurocognitive impairment, sensitivity improved (0.81, specificity 0.74), area under the curve = 0.77, 95% CI [0.69, 0.85]. The most common unidentified impairments were within the episodic memory and executive functions domains, with fewer false negative cases on the MoCA or SDMT combined.

CONCLUSION

The MoCA and SDMT have acceptable diagnostic accuracy for screening for neurocognitive impairment in an OHCA population, and when used in combination the sensitivity improves. Patient and observer-reports correspond poorly with neurocognitive performance.

CLINICALTRIALS

gov Identifier: NCT03543371.

摘要

目的

评估院外心脏骤停（OHCA）后神经认知筛查中临床评估工具的价值。

方法

评估的神经认知筛查包括基于表现的蒙特利尔认知评估（MoCA）和符号数字模态测试（SDMT）、患者报告的两个简单问题（TSQ）和观察者报告的认知下降老年患者院外心脏骤停 informant 问卷（IQCODE-CA）。这些工具在 TTM2 试验中的 6 个月时进行。我们使用 TTM2 试验子研究中的综合神经心理学测试组合作为金标准，评估神经认知筛查的敏感性和特异性。

结果

在我们的 108 例 OHCA 幸存者队列中（中位数年龄=62 岁，88%为男性），最有利的截断分数为：MoCA<26；SDMT z≤-1；IQCODE-CA≥3.04。MoCA（敏感性 0.64，特异性 0.85）和 SDMT（敏感性 0.59，特异性 0.83）的分类准确性高于 TSQ（敏感性 0.28，特异性 0.74）和 IQCODE-CA（敏感性 0.42，特异性 0.60）。当使用 MoCA 或 SDMT 的截断点结合来识别神经认知障碍时，敏感性提高（0.81，特异性 0.74），曲线下面积为 0.77，95%置信区间为[0.69，0.85]。最常见的未识别障碍是在情景记忆和执行功能领域，MoCA 或 SDMT 联合使用时假阴性病例较少。