摘要： 目的 研究蒙特利尔认知评价量表（MoCA）中文版在轻度认知损害（MCI）诊断筛查中的作用，评价认知功能在疾病进展过程中的临床意义。方法 对年龄、性别、文化程度构成无统计学差异的两组受试者（正常对照组29 例、MCI 组28 例）进行MoCA 和简易智能状态检查量表（MMSE）测试，以其总成绩及各单项成绩作为基线成绩，观察MoCA 和MMSE 在筛查MCI 中的作用，并比较两种量表对筛查轻度认知损害的敏感性、特异性的差异。于初次筛查后12 个月对两组受试者进行再次测试，并与基线成绩进行配对t 检验，比较前后测试成绩间的差异及各单项成绩对预测疾病进展的作用。结果 MoCA和MMSE 对鉴别正常老龄化和轻度认知损害均具有初步筛查作用，MoCA 量表中的视空间执行功能（t =2.151，P = 0.036）、抽象（t = 2.787，P = 0.009）、定向（t = 3.162，P = 0.003）、记忆（t = 4.704，P = 0.000）等单项测试成绩，两组间差异具有统计学意义；以26 分为分界值，MoCA 和MMSE 诊断MCI 的敏感度分别为89.29%和10.71%，特异度为82.76%和100%，MoCA 诊断敏感性显著高于MMSE。MCI 组患者在12 个月后的随访测试中各项成绩均略有下降，其中MoCA 总成绩（t = 6.454，P = 0.000）、视空间执行功能（t =5.610，P = 0.000）、语言（t = 4.954，P = 0.000）测试成绩，复查前后差异有统计学意义。结论 MoCA 对轻度认知损害的诊断敏感性高于MMSE，其中视空间执行功能、抽象、定向、记忆各单项测试成绩具有诊断价值；MoCA 总评分、视空间执行功能、语言等项成绩复查后降低，对轻度认知损害向阿尔茨海默病转化具有提示作用。

关键词: 痴呆, 精神状态检查量表, 认知障碍, 诊断

Abstract: Objective To assess the effect of Montreal cognitive assessment (MoCA, Chinese version) in diagnosing and observing the cognitive changes of mild cognitive impairment (MCI). Methods The MoCA and Mini Mental State Examination (MMSE) were taken to all subjects (28 patients with MCI and 29 normal controls) to assess the effect and to compare the sensitivity and specificity of MMSE and MoCA in diagnosing MCI, and to compare the cognitive changes of the MCI patients at the beginning of study and 12 months later. Results The MoCA and MMSE are useful for differential diagnosis between normal control and MCI patients. MoCA was significant for the assessment of visuospacial/constructive abilities (t = 2.151, P = 0.036), memory (t = 4.704, P = 0.000), abstraction (t = 2.787, P = 0.009) and orientation (t = 3.162, P = 0.003) in comparison among groups. When the cut-off -point was 26, the sensitivity of MoCA and MMSE to diagnose MCI was 89.29% and 10.71% respectively, while the specificity was 82.76% and 100% respectively. The diagnostic sensitivity of MoCA was significantly higher than MMSE. In MCI patients, the score of MMSE and MoCA after 12 months were lower than baseline, the difference was significant in the MoCA total score (t = 6.454, P = 0.000), visuospacial/constructive abilities (t = 5.610, P = 0.000) and language (t = 4.954, P = 0.000). Conclusion Comparing with MMSE, the sensitivity of MoCA is higher. The decline of the score of MoCA and visuospacial/constructive abilities and language may be a predictor in the conversion of MCI to dementia.

Key words: Dementia, Metal status schedule, Cognition disorders, Diagnosis