Wei Xiaoqin, Liu Yuxiang, Li Jia, Zhu Ying, Li Wenyuan, Zhu Yu, Hua Longchun, Cao Jianxun, Ma Yuxia
Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.
J Neurol. 2025 May 18;272(6):407. doi: 10.1007/s00415-025-13146-5.
Post-stroke cognitive impairment (PSCI) is one of the serious complications of stroke, which profoundly influences the quality of life of stroke survivors. The Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) are the two cognitive screening tools most widely used in stroke settings. Previous studies investigated the diagnostic accuracy of MoCA and MMSE but yielded controversial results. We conducted this study to compare the diagnostic accuracy of MoCA with MMSE for PSCI.
Embase, PubMed, CINAHL, Web of Science, and The Cochrane Library were searched until August 17, 2024 for diagnostic accuracy studies comparing MoCA and MMSE. Data extraction was performed by two independent researchers. Risk of bias and applicability assessment was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Coupled forest plots and hierarchical summary receiver operating characteristic (hsROC) curves were created in R statistical software.
9 studies with 1,135 patients were included in this review. Most studies were at high risk of bias. MoCA displayed a pooled sensitivity of 0.80 (95% CI 0.72 to 0.86) and specificity of 0.79 (95% CI 0.71 to 0.85). MMSE displayed a sensitivity and specificity of 0.76 (95% CI 0.71 to 0.81) and 0.78 (95% CI 0.73 to 0.83), respectively. No difference was shown between these modalities (SEN p = 0.36, SPE p = 0.80).
No difference was observed between MoCA and MMSE in the detection of PSCI. We recommend both screeners be considered for the detection of PSCI based on the purpose of the test and by other metrics, such as acceptability and feasibility. Although it should be noted MoCA and MMSE were cognitive screening tools in stroke settings and not a substitute for detailed clinical assessment.
卒中后认知障碍（PSCI）是卒中的严重并发症之一，对卒中幸存者的生活质量有深远影响。蒙特利尔认知评估量表（MoCA）和简易精神状态检查表（MMSE）是卒中领域最广泛使用的两种认知筛查工具。既往研究调查了MoCA和MMSE的诊断准确性，但结果存在争议。我们开展本研究以比较MoCA和MMSE对PSCI的诊断准确性。
检索Embase、PubMed、CINAHL、Web of Science和Cochrane图书馆，直至2024年8月17日，查找比较MoCA和MMSE诊断准确性的研究。由两名独立研究人员进行数据提取。采用诊断准确性研究质量评估-2工具评估偏倚风险和适用性。在R统计软件中绘制耦合森林图和分层汇总受试者工作特征（hsROC）曲线。
本综述纳入了9项研究，共1135例患者。大多数研究存在高偏倚风险。MoCA的合并灵敏度为0.80（95%CI 0.72至0.86），特异度为0.79（95%CI 0.71至0.85）。MMSE的灵敏度和特异度分别为0.76（95%CI 0.71至0.81）和0.78（95%CI 0.73至0.83）。这些方法之间未显示出差异（灵敏度p = 0.36，特异度p = 0.80）。
在检测PSCI方面，MoCA和MMSE之间未观察到差异。我们建议根据检测目的以及其他指标（如可接受性和可行性）考虑使用这两种筛查工具来检测PSCI。不过应注意，MoCA和MMSE是卒中领域的认知筛查工具，不能替代详细的临床评估。
