北京版MoCA在长沙地区缺血性脑血管病人群中的应用及长沙版MoCA的形成

摘要

Objective To validate Beijing version Montreal Cognitive Assessment (MoCA) and develop Changsha version MoCA through further modifications of MoCA. Methods MoCA (Beijing Version) and Mini-Mental State Examination (MMSE) were employed to evaluate their cognition, daily life, mood, and psychiatric situation in 56 patients with ischemic cerebrovascular disease and 32 normal controls in Changsha area (all ≥40 years old) Regression and receiver operator characteristic curve (ROC curve) analyses were used to analyze every sub-item of Beijing version MoCA to validate and explore its potential modifications of Beijing version MoCA. Results The correlation between MoCA (Beijing Version) and MMSE was high ( γ = 0. 926) . The areas under the receiver operator characteristic curve ( ROC curve) for the cognitive impairment group versus normal group by MoCA (Beijing Version) were 0.907 (95％ confidence interval, 0.848 ±0. 966). When cutoff score was 25/26, its sensitivity and specificity for distinguishing cognitive impairment were 95. 35％ and 55. 56％ , respectively. When cutoff score was 23/24, its sensitivity and specificity for distinguishing cognitive impairment were 86. 04％ and 82. 22％ , respectively. 3 disputed sub-items had entered small sample trial. After repeated discussion and modification, the final version of Changsha MoCA was developed in July, 2010. Conclusions Beijng version Mo-CA is an effective and feasible cognitive screening scale. However, it still has several insufficiencies which reslricl its utility in population of mainland China. In contrast, Changsha version MoCA is a cognitive screen scale especially for population of mainland China.%目的 探讨北京版蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)的可行性及潜在修订点.通过翻译及修订英文原版MoCA,形成长沙版MoCA.方法 在长沙地区年龄≥40岁的56例缺血性脑血管患者及32名对照人群中应用北京版MoCA、简易精神状态检查量表(MMSE)等进行认知及日常生活、情绪、精神评估.通过相关、ROC曲线(receiver operator characteristic curve)分析及比较北京版MoCA各子测试项目在对照组人群中的得分率及受教育程度的影响等,探讨北京版MoCA的可行性及潜在修订点.进而通过申请英文版MoCA的翻译修订权、翻译、专家评议、修订、小样本临床试验等步骤,最终确定长沙版MoCA.结果 北京版MoCA与MMSE的总分高度相关(r=0.926).北京版MoCA诊断认知障碍的ROC曲线下面积为0.907(95%可信区间为0.848～0.966).按照推荐划界分值(25/26分),其诊断认知障碍的灵敏度及特异度分别为95.35%及55.56%.如果将划界分值调整为23/24分可得到最理想的灵敏度(86.04%)和特异度(82.22%).3个存在修订争议的子测试项目进入小样本试验,经反复评议及修订,于2010年7月确定长沙版MoCA.结论 北京版MoCA为一种有效、可行的认知筛查量表,但尚存在一些不适用于我国大陆人群的不足.长沙版MoCA为一种适合中国大陆人群使用的认知筛查量表.