长沙版蒙特利尔认知评估量表的信度、效度检测与血管性认知障碍理想划界分值

摘要

目的 在湖南地区缺血性脑血管病人群中进行长沙版蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)的信度、效度检测并初步探索其筛查血管性认知障碍(vascular cognitive impairment,VCI)的理想划界分值.方法 在长沙地区年龄≥40岁的159例缺血性脑血管病患者中进行长沙版MoCA、简易精神状态检查量表(mini-mental state examination,MMSE)、认知检测组合(包括中国修订韦氏成人智力量表中的计算、相似性、数字广度、木块图测验；中国修定韦氏记忆量表中的常识和定向、逻辑记忆、视觉再认；Stroop测试)及其他相关量表的评估.并于首次评估后的3～5周在随机选取的30例子样本中进行长沙版MoCA的复评.分别计算长沙版MoCA的内部一致性信度、重测信度、调查员信度、平行效度,并根据ROC曲线(receiver operator characteristic curve)分析探索其筛查VCI的理想划界分值.结果 长沙版MoCA的克朗巴赫系数(Cronbach's α)为0.846、重测信度为0.974、调查员信度为0.969;长沙版MoCA与MMSE及简式智商的Pearson相关系数分别为0.879及0.799;按照受教育年限≤6年者总分加1分,以26/27分作为诊断VCI的划界分(≤26分存在VCI),可得到最佳的灵敏度(90.0％)及特异度(70.9％).以该划界分进行诊断的结果与临床专家组的认知诊断结果间的Kappa一致性系数为0.610.结论 长沙版MoCA的信度、效度良好,适合在湖南地区缺血性脑血管病人群中进行VCI筛查；长沙版MoCA为一个适合中国大陆人群使用的中文版MoCA,有进一步向全国推广使用的潜力.%Objective To examine the reliability, validity of Montreal Cognitive Assessment (Changsha Version) (MoCA-CS) in patients with ischemic cerebrovascular disease in Hunan province and explore its optimal cutoff score for detecting vascular cognitive impairment (VCI). Methods MoCA-CS, Mini-Mental State Examination (MMSE), a detailed neuropsychological battery (including 4 sub-tests of Chinese revised Wechsler Adult Intelligence Scale: block design, digit span, similarities, and arithmetic; 3 sub-tests of Chinese revised Wechsler memory scale; logical memory test and 5 min delayed logical memory, experience and orientation, visual recognition; stroop tests) and several related scales were conducted in 159 patients with ischemic cerebrovascular disease (all 340 years old) to evaluate their cognitive function. MoCA-CS was then re-tested in a randomly selected sub-sample (contained 30 people) 3-5 weeks after the first time cognitive estimation. The internal consistency reliability, test-retest reliability, inter-rater reliability, concurrent validity of MoCA-CS were calculated. Based on receiver operator characteristic curve (ROC) analysis,rnwe explored MoCA-CS's optimal cutoff score for detecting VCI. Results The Cronbach's α of MoCA-CS was 0.846. The test-retest reliability and inter-rater reliability of MoCA-CS were 0.974 and 0.969, respectively. The concurrent validity of MoCA-CS was estimated by correlating its final scores with scores of MMSE and simplified intelligence quotient (S-IQ), both showed high correlation (r = 0.879 for MMSE and r = 0.799 for S-IQ). It was recommended adding 1 point to total scores of MoCA-CS for subjects with ≤6 years of education. 26/27 (sensitivity 90.0%, specificity 70.9%) was recommended as optimal cutoff score for detection VCI (≤526 indicates VCI). The consistency between diagnose results of clinical experts and MoCA-CS was good (Kappa = 0.610). Conclusions MoCA-CS has good reliability and validity, and is suitable for screening VCI in patients with ischemic cerebrovascular disease in Hunan province. MoCA-CS has the potential to further apply in the whole mainland China.