摘要： 目的·更新蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）区分中国城市社区正常老人（normal elderly，NE）与轻度认知功能损害（mild cognitive impairment，MCI）老人的最佳分界值，分析分量表得分。方法·采用横断面研究，对来自中国10个城市随机抽样的60岁以上老人采用简明精神状态检查（Mini-Mental State Examination，MMSE）和MoCA（北京版）评定其认知功能。数据采用SPSS 19.0进行分析。结果·共有2 367例NE和553例MCI患者。其中，男性1 319例，女性1 601例，平均年龄为（70.6±7.5）岁，平均受教育年限为（8.7±5.2）年。MCI组和NE组在年龄和教育水平上的差异具有统计学意义（
t=12.3，
P=0.000；
t=-13.5，
P=0.000）。女性更易患MCI（
χ2＝13.5，
P=0.000）。通过对NE组MoCA得分分析，发现男性、高文化程度和低年龄组的MoCA得分较高。命名中的犀牛和骆驼，延迟记忆中的教堂和面孔，交替连线测验及画钟实验中的指针位置难度较大。各分量表得分显示，受试者在定向力和注意力测试中表现较好，而视空间功能、延迟回忆、句子重复和抽象能力得分较低。MoCA区分NE与MCI的最佳分界值为20（敏感度为63.7%，特异度为75.7%），曲线下面积为0.76。结论·MoCA（北京版）对NE与MCI区分度良好，最佳分界值为20。MoCA得分受年龄、性别、受教育程度影响；基于难度分析，可将评估记忆部分词语进行替换（用“手”替换“面孔”，用“工厂”替换“教堂”）。
关键词: 蒙特利尔认知评估量表, 难度分析, 轻度认知功能损害, 分界值 Abstract: Objective·To update the cut-off value of the normal elderly (NE) and mild cognitive impairment (MCI) elderly in urban areas of China according to the Montreal Cognitive Assessment (MoCA) scores and analyze the sections of MoCA.
Methods·A cross-sectional study was conducted to investigate the elderly over 60 years old in ten cities of China. Mini-Mental State Examination (MMSE) and MoCA (Beijing version) were used to assess cognitive function. Data was statistically analyzed by SPSS 19.0.
Results·There were 2 367 NE, 553 MCI patients, 1 319 males and 1 601 females, with an average age of (70.6±7.5) years and an average length of education of (8.7±5.2) years. There were significant difference in age and length of education between MCI and NE groups (t=12.3, P=0.000; t=-13.5, P=0.000). Female was more likely to have MCI (χ2＝13.5, P=0.000). By analyzing the score of MoCA of the NE, it was found that the MoCA score of males, high education level and low age group were higher. Rhinoceros and camel in naming, church and face in delayed memory, alternating connection test and pointer position in clock drawing were more difficult. The sections' scores of MoCA showed that the subjects performed better in the orientation and attention tests, while the scores of visuospatial functions, delayed recalling, sentence repetition and abstract ability were lower. The best cut-off value of MoCA was 20 (sensitivity = 63.7%, specificity = 75.7%). The area under the curve was 0.76.
Conclusion·MoCA (Beijing version) has a good distinction between NE and MCI, and 20 can be used as a cut-off value in MCI subjects screening in urban areas of China. MoCA score is influenced by age, gender and education level. Based on difficulty analysis, some words that evaluate memory could be replaced (replacing “face” with “hand” and replacing “church” with “factory”).
Key words: Montreal Cognitive Assessment Scale (MoCA), difficulty assessment, mild cognitive impairment, cut-off value PDF全文下载地址:
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