Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease
Responsiveness to Change of the Montreal Cognitive Assessment, Mini-Mental State Examination, and SCOPA-Cog in Non-Demented Patients with Parkinson's Disease
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DOI：
10.1159/000496454
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发表时间：
2019-10-01
影响因子：
2.4
通讯作者：
Marras, Connie
中科院分区：
文献类型：
--
作者：
Faust-Socher, Achinoam;Duff-Canning, Sarah;Marras, Connie
背景：临床监测帕金森病（PD）患者的认知功能下降是护理的重要组成部分。蒙特利尔认知评估（莫卡）已被提议为评估PD认知障碍的敏感工具。本研究的目的是比较莫卡对认知下降的反应性与简易精神状态检查（MMSE）和帕金森病认知结局量表（SCOPA-Cog）的反应性。方法：2008年至2011年期间，在6个北美运动障碍中心招募了无痴呆的PD患者。参与者接受年度评估，包括莫卡，MMSE和SCOPA-Cog，然后进行正式的神经心理学测试。认知变化的金标准被定义为年度评估中神经心理学测试分数的变化。可靠变化方法用于估计偶然获得给定差异评分的概率。使用受试者工作特征（ROC）曲线量化莫卡、MMSE和SCOPA-Cog对变化的敏感性。结果：117例患者纳入分析。对参与者进行随访，平均间隔为11 +/- 2个月，中位数为2次（最多5次）访视。根据可靠的变化指数，56个间隔的认知测试显示整体认知下降。与金标准检验相比，莫卡、MMSE和SCOPA-Cog总体评分变化的ROC分析发现曲线下面积（AUC）分别为0.55（95% CI 0.48-0.62）、0.56（0.48-0.63）和0.63（0.55-0.70）。各试验的AUC无显著差异。莫卡、MMSE和SCOPA-Cog对评分下降的各种阈值变化的敏感性最高达到71%，SCOPA-Cog的临界值为1分变化。结论：使用神经心理学测试作为金标准比较，莫卡，MMSE和SCOPA-Cog检测非痴呆PD患者在1年内下降的性能较差。这对临床实践有影响;稳定的分数可能不能保证没有认知能力下降。
Background: Clinical monitoring of patients with Parkinson's disease (PD) for cognitive decline is an important element of care. The Montreal Cognitive Assessment (MoCA) has been proposed to be a sensitive tool for assessing cognitive impairment in PD. The aim of our study was to compare the responsiveness of the MoCA to decline in cognition to the responsiveness of the Mini Mental State Examination (MMSE) and the Scales for Outcomes of Parkinson's disease-cognition (SCOPA-Cog). Methods: PD patients without dementia were enrolled at 6 North American movement disorders centers between 2008 and 2011. Participants received annual evaluations including the MoCA, MMSE, and SCOPA-Cog followed by formal neuropsychological testing. The gold standard for change in cognition was defined as the change on the neuropsychological test scores over the annual assessments. The Reliable Change Method was used to provide an estimate of the probability that a given difference score would be obtained by chance. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change was quantified using receiver operating characteristics (ROC) curves. Results: One hundred seventeen patients were included in the analysis. Participants were followed at mean intervals of 11 +/- 2 months for a median of 2 (maximum 5) visits. According to the reliable change index, 56 intervals of cognitive testing showed a decline in global cognition. ROC analysis of change in MoCA, MMSE, and SCOPA-Cog global scores compared to gold standard testing found an area under the curve (AUC) of 0.55 (95% CI 0.48-0.62), 0.56 (0.48-0.63), and 0.63 (0.55-0.70) respectively. There were no significant differences in the AUCs across the tests. The sensitivity of the MoCA, MMSE, and SCOPA-Cog to change at various thresholds for decline in scores reached a maximum of 71% for a cut-off of 1 point change on the SCOPA-Cog. Conclusion: Using neuropsychological testing as a gold standard comparator, the performance of the MoCA, MMSE, and SCOPA-Cog for detecting decline in non-demented PD patients over a 1-year interval is poor. This has implications for clinical practice; stable scores may not be taken as reassurance of the absence of cognitive decline.