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Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults

机译:蒙特利尔认知评估和迷你精神状态考试之间的关系,以评估老年人的轻度认知障碍

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摘要

BACKGROUND: The Montreal Cognitive Assessment (MoCA) was developed to enable earlier detection of mild cognitive impairment (MCI) relative to familiar multi-domain tests like the Mini-Mental State Exam (MMSE). Clinicians need to better understand the relationship between MoCA and MMSE scores.METHODS: For this cross-sectional study, we analyzed 219 healthy control (HC), 299 MCI, and 100 Alzheimer's disease (AD) dementia cases from the Alzheimer's Disease Neuroimaging Initiative (ADNI)-GO/2 database to evaluate MMSE and MoCA score distributions and select MoCA values to capture early and late MCI cases. Stepwise variable selection in logistic regression evaluated relative value of four test domains for separating MCI from HC. Functional Activities Questionnaire (FAQ) was evaluated as a strategy to separate dementia from MCI. Equi-percentile equating produced a translation grid for MoCA against MMSE scores. Receiver Operating Characteristic (ROC) analyses evaluated lower cutoff scores for capturing the most MCI cases.RESULTS: Most dementia cases scored abnormally, while MCI and HC score distributions overlapped on each test. Most MCI cases scored ≥ 17 on MoCA (96.3%) and ≥ 24 on MMSE (98.3%). The ceiling effect (28-30 points) for MCI and HC was less using MoCA (18.1%) versus MMSE (71.4%). MoCA and MMSE scores correlated most for dementia (r = 0.86; versus MCI r = 0.60; HC r = 0.43). Equi-percentile equating showed a MoCA score of 18 was equivalent to MMSE of 24. ROC analysis found MoCA ≥ 17 as the cutoff between MCI and dementia that emphasized high sensitivity (92.3%) to capture MCI cases. The core and orientation domains in both tests best distinguished HC from MCI groups, whereas comprehension/executive function and attention/calculation were not helpful. Mean FAQ scores were significantly higher and a greater proportion had abnormal FAQ scores in dementia than MCI and HC.CONCLUSIONS: MoCA and MMSE were more similar for dementia cases, but MoCA distributes MCI cases across a broader score range with less ceiling effect. A cutoff of ≥ 17 on the MoCA may help capture early and late MCI cases; depending on the level of sensitivity desired, ≥ 18 or 19 could be used. Functional assessment can help exclude dementia cases. MoCA scores are translatable to the MMSE to facilitate comparison.
机译:背景:蒙特利尔认知评估(MoCA)的开发是为了使轻度认知障碍(MCI)相对于熟悉的多领域测试(如迷你精神状态考试(MMSE))更早地得到检测。临床医生需要更好地了解MoCA和MMSE评分之间的关​​系。方法:对于本横断面研究,我们分析了219名健康对照(HC),299名MCI和100名阿尔茨海默氏病神经影像学倡议(Alzheimer's Disease Neuroimaging Initiative)的老年痴呆症病例( (ADNI)-GO / 2数据库来评估MMSE和MoCA分数分布,并选择MoCA值来捕获早期和晚期MCI病例。 Logistic回归中的逐步变量选择评估了将MCI与HC分离的四个测试域的相对值。对功能活动调查表(FAQ)进行了评估,以将痴呆症与MCI分开。等分百分位数等于针对MMSE得分的MoCA转换网格。接受者操作特征(ROC)分析评估了较低的截止分数,以捕获最多的MCI病例。结果:大多数痴呆病例得分异常,而每次测试的MCI和HC得分分布重叠。大多数MCI患者在MoCA上得分≥17(96.3%),而在MMSE上得分≥24(98.3%)。使用MoCA(18.1%)相对于MMSE(71.4%)对MCI和HC的上限效应(28-30点)较小。 MoCA和MMSE得分与痴呆症的相关性最高(r = 0.86; MCI r = 0.60; HC r = 0.43)。等分百分数表示,MoCA得分为18等于MMSE为24。ROC分析发现MoCA≥17是MCI和痴呆之间的分界点,强调了对MCI病例的高度敏感性(92.3%)。在这两个测试中,核心和方向域都将HC与MCI组最佳区分开,而理解/执行功能和注意力/计算无济于事。结论:MoCA和MMSE在痴呆症患者中的相似性更高,但MoCA将MCI病例分布在较宽的评分范围内,但上限影响较小。 MoCA的截止值≥17可能有助于捕获早期和晚期MCI病例;根据所需的灵敏度水平,可以使用≥18或19。功能评估可以帮助排除痴呆症病例。 MoCA分数可翻译为MMSE,以方便比较。

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