Montreal Cognitive Assessment Validation Study for Mild Cognitive Impairment and Alzheimer Disease
Montreal Cognitive Assessment Validation Study for Mild Cognitive Impairment and Alzheimer Disease
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DOI：
10.1097/wad.0b013e3182420bfe
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发表时间：
2013-01-01
影响因子：
2.1
通讯作者：
Santana, Isabel
中科院分区：
文献类型：
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作者：
Freitas, Sandra;Simoes, Mario Rodrigues;Santana, Isabel
蒙特利尔认知评估（MoCA）最近被提议作为一种轻度认知障碍的认知筛查测试，已经超越了众所周知的迷你精神状态检查（MMSE）的局限性。本研究旨在通过分析MoCA对轻度认知障碍（Mild Cognitive Impairment， MCI）和阿尔茨海默病（Alzheimer disease， AD）的诊断准确性和提出截断值，验证MoCA对轻度认知障碍（Mild Cognitive Impairment， MCI）和阿尔茨海默病（Alzheimer disease， AD）的筛查效果。根据标准标准将患者分为两组：MCI （n = 90）和AD （n = 90）。2个对照组（C-MCI: n = 90; C-AD: n = 90）由认知健康的社区居民组成，选择与患者性别、年龄和教育程度相匹配的患者。与MMSE相比，MoCA表现出一贯优越的心理测量特性，对MCI（曲线下面积= 0.856,95%可信区间为0.796-0.904）和AD（曲线下面积= 0.980,95%可信区间为0.947-0.995）患者的诊断准确率更高。在MCI低于22、AD低于17的最佳临界值下，MoCA在敏感性、特异性、阳性预测值、阴性预测值和分类准确性方面明显优于MMSE。此外，在纵向监测中，MoCA对认知能力下降的敏感性更高。这项研究提供了强有力的证据，证明MoCA是一种比广泛使用的MMSE更好的认知工具，用于筛查和监测临床环境中的MCI和AD。
The Montreal Cognitive Assessment (MoCA) was recently proposed as a cognitive screening test for milder forms of cognitive impairment, having surpassed the well-known limitations of the Mini-Mental State Examination (MMSE). This study aims to validate the MoCA for screening Mild Cognitive Impairment (MCI) and Alzheimer disease (AD) through an analysis of diagnostic accuracy and the proposal of cut-offs. Patients were classified into 2 clinical groups according to standard criteria: MCI (n = 90) and AD (n = 90). The 2 control groups (C-MCI: n = 90; C-AD: n = 90) consisted of cognitively healthy community dwellers selected to match patients in sex, age, and education. The MoCA showed consistently superior psychometric properties compared with the MMSE, and higher diagnostic accuracy to discriminate between MCI (area under the curve = 0.856; 95% confidence interval, 0.796-0.904) and AD patients (area under the curve = 0.980; 95% confidence interval, 0.947-0.995). At an optimal cut-off of below 22 for MCI and below 17 for AD, the MoCA achieved significantly superior values in comparison with MMSE for sensitivity, specificity, positive predictive value, negative predictive value, and classification accuracy. Furthermore, the MoCA revealed higher sensitivity to cognitive decline in longitudinal monitoring. This study provides robust evidence that the MoCA is a better cognitive tool than the widely used MMSE for the screening and monitoring of MCI and AD in clinical settings.