CAJ | 학술논문

目的探讨蒙特利尔认知评估量表(MoCA)识别首次卒中后轻度血管性认知障碍(mVCI-FS)的作用,并与简易智能精神状态量表(MMSE)比较. 方法选取mVCI-FS患者60例.首次卒中后非血管性认知障碍(nVCI-FS)25例,于发病后(12+1)周由不知情的神经科医师进行MoCA及MMSE评估. 结果 MoCA总平均分为(19.78±4.573)分,MMSE为(25.48±3.148)分,偏相关分析间.r=9,P=0.000.MoCA除计算力和言语流畅性外,其余各项在mVCI-FS和nVCI-FS间差异均有统计学意义(P<0.05);MMSE的即刻记忆、计算力、命名和阅读理解在2组间差异无统计学意义(P>0.05).应用ROC曲线和Youden指数最大值初步确定MoCA识别mVCI-FS与nVCI-FS的最佳分界值为21分.以21分为分界值.MoCA筛查mVCI-FS的敏感度和特异度分别为84.6%和76.0%,明显优于MMSE(敏感度59.6%和特异度57.7%),差异有统计学意义(P<0.05). 结论初步确定MoCA识别mVCI-FS与nVCI-FS的最佳分界值为21分.MoCA筛查mVCI-FS的敏感度和特异度均高,是一种有效的mVCI.FS筛查量表;MMSE对mVCI.FS的敏感度低,识别mVCI-FS的作用有限.
목적 탐토몽특리이인지평고량표(MoCA)식별수차졸중후경도혈관성인지장애(mVCI-FS)적작용,병여간역지능정신상태량표(MMSE)비교. 방법 선취mVCI-FS환자60례.수차졸중후비혈관성인지장애(nVCI-FS)25례,우발병후(12+1)주유불지정적신경과의사진행MoCA급MMSE평고. 결과 MoCA총평균분위(19.78±4.573)분,MMSE위(25.48±3.148)분,편상관분석간.r=9,P=0.000.MoCA제계산력화언어류창성외,기여각항재mVCI-FS화nVCI-FS간차이균유통계학의의(P<0.05);MMSE적즉각기억、계산력、명명화열독리해재2조간차이무통계학의의(P>0.05).응용ROC곡선화Youden지수최대치초보학정MoCA식별mVCI-FS여nVCI-FS적최가분계치위21분.이21분위분계치.MoCA사사mVCI-FS적민감도화특이도분별위84.6%화76.0%,명현우우MMSE(민감도59.6%화특이도57.7%),차이유통계학의의(P<0.05). 결론 초보학정MoCA식별mVCI-FS여nVCI-FS적최가분계치위21분.MoCA사사mVCI-FS적민감도화특이도균고,시일충유효적mVCI.FS사사량표;MMSE대mVCI.FS적민감도저,식별mVCI-FS적작용유한.
Objective To determine the value of Montreal cognitive assessment (MoCA) in identifying the patients with mild vascular cognitive impairment after first stroke (mVCI-FS), and compare it's results with those of mini-mental state examination (MMSE). Methods MoCA and MMSE were performed on 60 patients with mVCI-FS and 25 with non mild vascular cognitive impairment after first stroke (nVCI-FS) by neurologists 12±1 w after the onset. Results Total mean scores of MoCA was 19.78±4.57 and that of MMSE was 25.48±3.14 with the partial correlation reaching r=0.779 and P=0.000. Significant differences in each sub-items of MoCA were found between mVCI-FS group and nVCI-FS group, except calculation and verbal fluency (P<0.05); no significant difference in immediate memory, calculation, naming and reading comprehension of MMSE was noted between the 2 groups (P>0.05). The initial optimal cut-off-point of MoCA was 21 in identifying mVCI-FS from nVCI-FS according to the ROC curve analyses as well as the largest youden's index. With the cut-off-point of 21,MoCA Can provided a sensitivity of 84.6% and a specificity of 76.0%,respectively,for screening mVCI-FS, which was much better than MMSE (sensitivity 59.6% and specificity 57.7%)Conclusions The initial optimal cut-off-point of MoCA is 21 in identifying mVCI-FS from nVCI-FS.MoCA, having high sensitivity and specificity in screening mVCI-FS, is a valid screening scale in screening mVCI-FS; however, MMSE, showing poor sensitivity in screening mVCI-FS, cannot be a reliable instrument in screening mVCI-FS.