中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (09): 451-454.doi: 10.3969/j.issn.1671-4091.2016.09.002

• 临床研究 • 上一篇    下一篇

MMSE与MoCA在维持性血液透析患者认知损害诊断中灵敏性的比较分析

高小玲1,石艳1,张明昊2,廖元江1   

  1. 1. 重庆市第九人民医院肾内科

    2.  重庆医科大学实验教学管理中心
  • 收稿日期:2016-03-03 修回日期:2016-04-13 出版日期:2016-09-12 发布日期:2016-09-12
  • 通讯作者: 廖元江 78743099@qq.com E-mail:lyj730225@163.com
  • 基金资助:

    重庆市卫计委2015MSXM117 号项目, 重庆市科委cstc2015shmszx120069号项目

Comparison of the sensitivity of mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) for the diagnosis of cognitive impairment in maintenance hemodialysis patients

  • Received:2016-03-03 Revised:2016-04-13 Online:2016-09-12 Published:2016-09-12

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摘要： 目的  比较简易精神状态检查量表(mini-mental state examination,MMSE)与蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)对维持性血液透析患者(maintenance hemodialysis patients,MHP)认知损害诊断的灵敏性，并分析其认知损害的特点。方法2015 年10 月～2016 年1 月间对89 例MHP 进行MMSE 和MoCA 的横断面测试，由神经科医生对这部分患者进行认知损害诊断，比较MMSE 和MoCA 对MHP 认知损害诊断的特异性和灵敏性。并进一步使用独立样本t 检验比较认知损害诊断为阳性/阴性的患者在MMSE 和MoCA 分量上的具体差异。结果MMSE 对认知损害筛查的敏感性为30.23%，特异性为100%；MoCA 对认知损害筛查的敏感性为97.67%，特异性为76.32%。认知损害诊断为阳性的患者在MMSE 量表的注意力与计算力(t=-4.995，P=0.000)、复述能力(t=-2.284，P= 0.021), 阅读能力(t=-2.322，P=0.023)、书写能力(t=-4.156，P＜0.001)以及结构能力(t=-3.921，P＜0.001)与诊断为阴性的患者相比有显著差异；在MoCA 的视空间与执行能力(t=- 4.636，P＜0.001)、注意及计算能力(t=-5.654，P＜0.001)、言语能力(t=-9.214，P＜0.001)、抽象能力(t=-4.910，P＜0.001)以及延迟回忆能力(t=-2.306, P =0.024)上与诊断为阴性的患者相比都有显著差异。结论MoCA 量表对MHP 患者认知损害诊断的敏感性更高。认知损害诊断为阳性的患者在执行能力、注意能力、结构能力和抽象能力等具体认知执行能力都显著低于认知损害为阴性的患者。

关键词: MHP, 认知损害, 简易精神状态检查量表, 蒙特利尔认知评估量表, 诊断敏感性

Abstract: Objective To compare the sensitivity of mini-mental state examination (MMSE), and Montreal cognitive assessment (MoCA) for the diagnosis of cognitive impairment in maintenance hemodialysis (MHD) patients, and to explore the characteristics of cognitive impairment in MHD patients. Methods A total of 89 MHD patients were examined with MMSE and MoCA between Oct. 2015 to Jan. 2016, and at the same time their cognitive impairment was assessed by neurologists. We then evaluated the specificity and sensitivity of MMSE and MoCA for the diagnosis of cognitive impairment in these patients. Results For the diagnosis of cognitive impairment, the sensitivity was 30.23% and the specificity was 100% by MMSE, and the sensitivity was 97.67% and the specificity was 76.32% by MoCA. The patients diagnosed with cognitive impairment had lower scores in attention and calculation (t=- 4.995, P=0.000), retelling ability (t=- 2.284, P=0.021), reading ability (t=-2.322, P=0.023), writing ability (t=-4.156,P＜0.001), and construction (t=-3.921, P＜0.001) by MMSE, and had lower scores in visual-spatial and executive capacities (t=-4.636, P＜0.001), attention and calculation (t=-5.654, P＜0.001), language (t=-9.214, P＜0.001), abstract ability (t=-4.910, P＜
0.001), and delayed recall ability (t=-2.306, P=0.024) by MoCA, as compared those with the patients without cognitive impairment. Conclusions The sensitivity of MoCA was higher than that of MMSE for the diagnosis of cognitive impairment in MHD patients. The patients diagnosed with cognitive impairment had lower
scores in some specific executive abilities such as executive capacity,attention,construction,and abstract ability.

Key words: cognitive impairment,  Mini-mental state examination,  Montreal cognitive assessment, diagnosis sensitivity