Utility of the Montreal Cognitive Assessment as a Screening Test for Neurocognitive Dysfunction in Adults with Sickle Cell Disease.
Utility of the Montreal Cognitive Assessment as a Screening Test for Neurocognitive Dysfunction in Adults with Sickle Cell Disease.
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DOI：
10.14423/smj.0000000000000511
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发表时间：
2016-09
影响因子：
1.1
通讯作者：
Lanzkron S
中科院分区：
文献类型：
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作者：
Cichowitz C;Carroll PC;Strouse JJ;Haywood C Jr;Lanzkron S
神经认知功能障碍是镰状细胞病(SCD)的一个重要并发症，但很少有关于筛查这种疾病患者认知障碍的有效性的报道。这项研究的目的是评估蒙特利尔认知评估(MoCA)作为筛查工具的作用，并确定成人镰状细胞疾病患者MoCA表现的预测因素。我们对约翰·霍普金斯成人镰刀细胞中心的第一批100名成年SCD患者进行了一项回顾性的横断面研究，这些患者完成了作为常规临床护理一部分的MoCA。我们从每个参与者的电子病历中提取了到实施MoCA之日为止的人口统计学、实验室和临床数据。采用标准心理测量学统计方法对各维度的因子效度进行分析。我们评估了抽象数据与综合MoCA评分的相关性，并使用多变量回归寻找性能的独立预测因素。MoCA的组成部分在心理测量学分析中表现良好，并发现了其他研究中描述的执行功能缺陷。46%的参与者因轻度认知障碍而低于临界值。而脑血管意外和慢性肾脏疾病是得分下降的独立预测因素(−3.3，95%CI−5.7~−0.97和−3.2，95%CI−6.2~−0.11)。当分析仅限于SCD患者时，受教育程度高(3.7，95%CI−2.2~5.2)和羟基脲治疗史(2.0，95%CI 0.022~4.0)是得分降低的独立预测因素，而慢性肾脏疾病(−3.3，95%CI−6.4至−0.24)和天冬氨酸转氨酶升高(−0.045，95%CI−0.089至−0.0010)是得分下降的独立预测因素。MoCA通过识别重要的认知缺陷以及与慢性并发症和治疗的关联显示了希望。
Neurocognitive dysfunction is an important complication of sickle cell disease(SCD), but little is published on the utility of screening tests for cognitive impairment in people with the disease. The purpose of this study was to evaluate the Montreal Cognitive Assessment (MoCA) as a screening tool and identify predictors of MoCA performance in adults with sickle cell disease. We conducted a retrospective, cross-sectional study of the first 100 adult patients with SCD who completed the MoCA as part of routine clinical care at the Johns Hopkins Sickle Cell Center for Adults. We abstracted demographic, laboratory, and clinical data from each participant’s electronic medical record up to the date that the MoCA was administered. The factorial validity of each MoCA domain was analyzed using standard psychometric statistics. We evaluated the abstracted data for associations with the composite MoCA score and looked for independent predictors of performance using multivariable regressions. Components of the MoCA performed well in psychometric analyses and identified deficits in executive function that were described in other studies. Forty-six percent of participants fell below the cutoff for mild cognitive impairment. Increased education was an independent predictor of increased MoCA score (3.1, 95% confidence interval [CI] 1.5–4.7), whereas cerebrovascular accidents and chronic kidney disease were independent predictors of decreased score (−3.3, 95% CI −5.7 to −0.97 and −3.2, 95% CI −6.2 to −0.11, respectively). When analysis was restricted to patients with SCD, increased education (3.7, 95% CI −2.2–5.2) and a history of hydroxyurea therapy (2.0, 95% CI 0.022 to 4.0) were independent predictors of a higher score, whereas chronic kidney disease ( −3.3, 95% CI −6.4 to −0.24) and increased aspartate transaminase ( −0.045, 95% CI −0.089 to −0.0010) were independent predictors of a decreased score. The MoCA showed promise by identifying important cognitive deficits and associations with chronic complications and therapy.