比较MoCA和MMSE在卒中后认知功能筛查中的应用

目的：比较蒙特利尔认知评估量表（Montreal Cognitive Assessment,MoCA）和简易智能量表（mini-mental state examination,MMSE）在急性缺血性脑卒中后认知损害筛查中的应用。方法：对65例缺血性脑卒中患者在发病14天内应用简易精神状态检查量表（Mini-mental State Examination,MMSE）和MoCA进行神经心理评估。其中12例患者在发病3-6个月后应用MMSE、MoCA和神经心理成套测验进行神经心理评估。以MMSE〈23分、MoCA〈21为分界值,受教育年限小于12年加1分,文盲加2分。结果：MMSE的平均分值为25.2±4.3,MoCA的平均分值为18.6±5.7。37例患者MoCA评分显示有认知损害,但其中19例患者（29%）MMSE评分显示正常。28例MoCA评估显示认知正常的患者的MMSE评分均显示认知正常。视空间与执行功能、注意和语言重复测试受损最常见,定向和命名受损较少。在3-6个月的随访期内,12例患者中1例诊断为血管性痴呆患者的MoCA的分值上升1分,MMSE分值无变化;5例认知正常患者、3例轻度认知损害无痴呆的患者和3例中度认知损害无痴呆的患者MMSE和MoCA平均分值均有不同程度的上升,视空间与执行功能平均得分值在2次检测中无明显变化。结论：MoCA较MMSE检出血管性认知功能障碍患者敏感性更高,对认知变化更为敏感。

To Compare the Effect of Screening Cognitive Impairment of Post-Stroke Patients by MoCA and MMSE

Objective：To compare the application of the MoCA（Montreal Cognitive Assessment,MoCA）and MMSE（mi-ni-mental state examination,MMSE）in screening cognitive impairment of post-stroke patients.Methods：Neuropsychological assessment was conducted to 65 patients with ischemic stroke within 14 days of the onset by MMSE and MoCA.12 of 65 patients were assessed by MoCA and MMSE within 14 days and after 3 to 6 months of onset respectively.With MMSE 23 points,MoCA 21 as the cut off value,the level of education less than 12 years added 1 point,illiteracy added 2 points.Results：The average score of MMSE was 25.2 ± 4.3,while that of MoCA was 18.6 ± 5.7 for 65 patients.37 patients showed cognitive impairment according to the assessment results by MoCA,but 19 of 37 patients（29%）showed normal score by MMSE.28 of 37 patients with normal score by MoCA also showed normal cognition by MMSE.Visual spatial,executive function,attention,and word repeating test impaired most;orientation and naming damaged less.In the 3 to 6 months follow-up period,1 patient with vascular dementia increased 1 point by MoCA,but did not change by MMSE.There were different rising up of the assessment score by MoCA and MMSE for the 5 patients with normal cognition,3 patients with mild cognitive impairment without dementia and 3 patients with moderate cognitive impairment without dementia.The average scores of executive and visual spatial in the two tests had no significant change.Conclusion：The sensitivity of MoCA is better than MMSE in screening the vas-cular cognitive impairment from the patients with acute cerebral infarction.The sensitivity of MoCA is higher than MMSE in detecting cognitive fluctuation.