蒙特利尔认知评估表在老年轻度认知障碍评估中的应用

摘要

目的 在我国老年人群中初步使用蒙特利尔认知评估表(the Montreal Cognitive Assessment,MOCA),探讨老年认知功能改变的特点,评价蒙特利尔认知评估表的筛查可行性.方法 采用MOCA对275例60岁以上老年人进行测试,其中正常组(NC组)85例、轻度认知功能损害组(MCI组)117例,痴呆组(AD组)73例.结果 3组人群的MOCA总体差异有显著性(F=258.66,P＜0.01);各项分测验得分在控制文化、年龄、性别、职业等影响因素后,仍差异有显著性(视空间F=54.86,P＜0.01;命名F=17.30,P＜0.01;注意F=82.50,P＜0.01;语言F=25,88,P＜0.01;抽象思维F=15.00,P＜0.01;延迟记忆F=130.49,P＜0.01;定向力F=176.09,P＜0.01);两两比较,MCI组与NC组和AD组间均有显著性差异(除AD与MCI组的抽象思维项 (P＜0.05,其余各项均为P＜0.01);其中三组的定向力、延迟记忆分项测试得分差异最大(F=176.09,P＜0.01;F=130.49,P＜0.01.)以26分为截断点,MOCA筛查MCI的结果与临床诊断的观察符合率为0.93,机遇符合率0.61,Kappa指数0.85.结论 MOCA能很好地鉴别MCI与NC和AD ,具有很好的区分效度.其筛查MCI结果与临床诊断完全符合,具有很高的筛查价值.老年认知损害是以记忆、定向力为明显改变的认知损害.%Objective To explore the cognitive changes of patients with MCI using the Montreal Cognitive Assessment(MOCA) for elderly preliminarily.Methods 85 normal controls (NC),117 subjects with mild cognitive impairment (MCI) and 73 patients with Alzheimer's disease (AD) were assessed with the MOCA.Results There were significant differences among the three groups in all items of MOCA(F=258.66,P＜0.01).Significant differences were observed in almost all the sub-tests between MCI group and NC group or MCI group and AD group(visuopatial F=54.86,P＜0.01;naming F=17.30,P＜0.01;attention F=82.50,P＜0.01;language F=25,88,P＜0.01;abstraction F=15.00 ,P＜0.01;delayed recall F=130.49,P＜0.01;orientation F=176.09,P＜0.01.).The most significant differences were found in delayed recall and orientation among three groups(F=176.09,P＜0.01;F=130.49,P＜0.01.).At 26 cut-point,The results of screening of the MOCA agree with the gold standard of clinical diagnose for the patient with MCI.The agreement rate for observation was 0.93.The agreement rate by chance was 0.61.The Kappa was 0.85.Conclusions The MOCA appropriately define MCI,NC and AD in their cognitive function,it has good discriminant validity.The test of delayed recall and orientation may be more sensitive in the detection of the older people.The MOCA is a useful screening instrument for the patient with MCI.