Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy
Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) performance in progressive supranuclear palsy and multiple system atrophy
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DOI：
10.1007/s00702-016-1589-3
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发表时间：
2016-12-01
影响因子：
3.3
通讯作者：
Biundo, Roberta
中科院分区：
文献类型：
--
作者：
Fiorenzato, Eleonora;Weis, Luca;Biundo, Roberta
比较蒙特利尔认知评估（MoCA）在检测可能进行性核上性麻痹（PSP）和多系统萎缩（MSA）患者的认知异常方面是否比常用的简易精神状态检查（MMSE）更敏感。在这项多中心观察性研究中，MMSE和MoCA以随机顺序对130名患者进行管理：35名MSA，30名PSP和65名年龄，教育和性别匹配的PD。我们评估了MMSE、MoCA及其子项目的组间差异。计算受试者工作特征（ROC）曲线。各MSA的MMSE平均值均高于MoCA平均值（27.7 +/-A 2.4 vs. 22.9 +/-A 3.0，p <0.0001），PSP（26.0 +/-A 2.9对比18.2 +/-A 3.9，p <0.0001）和PD（27.3 +/-A 2.0对比22.3 +/-A 3.5，p <0.0001）。MoCA总分及其字母流畅性分项区分PSP与MSA、PD的特异性高、敏感性中等。更具体地，每分钟7个F字或更少的截止分数将支持PSP的诊断（PSP对PD：86%特异性，70%灵敏度; PSP对MSA：71%特异性，70%灵敏度）。相比之下，MMSE在大多数子项目中呈现出总体天花板效应，除了五角形评分，PSP在这方面不如MSA或PD患者。这些初步结果表明，PSP和MSA，类似于PD患者，可能会出现正常的MMSE和降低MoCA性能。总的来说，MoCA在检测非典型帕金森综合征的认知功能障碍方面比MMSE更敏感，并且与语言流畅性一起将是支持PSP诊断的有用测试。
To determine if Montreal Cognitive Assessment (MoCA) is more sensitive than the commonly used Mini-Mental State Examination (MMSE) in detecting cognitive abnormalities in patients with probable progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) compared with Parkinson's disease (PD). In this multicenter observational study, MMSE and MoCA were administered in a random order to 130 patients: 35 MSA, 30 PSP and 65 age, and education and gender matched-PD. We assessed between-group differences for MMSE, MoCA, and their subitems. Receiver-operating characteristic (ROC) curves were calculated. The mean MMSE was higher than the mean MoCA score in each MSA (27.7 +/- A 2.4 vs. 22.9 +/- A 3.0, p < 0.0001), PSP (26.0 +/- A 2.9 vs. 18.2 +/- A 3.9, p < 0.0001), and PD (27.3 +/- A 2.0 vs. 22.3 +/- A 3.5, p < 0.0001). MoCA total score as well as its letter fluency subitem differentiated PSP from MSA and PD with high specificity and moderate sensitivity. More specifically, a cut-off score of 7 F-words or less per minute would support a diagnosis of PSP (PSP vs. PD: 86 % specificity, 70 % sensitivity; PSP vs. MSA: 71 % specificity, 70 % sensitivity). By contrast, MMSE presented an overall ceiling effect for most subitems, except for the pentagon scores, where PSP did less well than MSA or PD patients. These preliminary results suggest that PSP and MSA, similar to PD patients, may present normal MMSE and reduced MoCA performance. Overall, MoCA is more sensitive than MMSE in detecting cognitive impairment in atypical parkinsonism and together with verbal fluency would be a useful test to support PSP diagnosis.