MMSE与MoCA量表在脑血管病认知障碍筛查中的一致性回顾性研究

Retrospective Study on the Consistency of MMSE and MoCA Scales in Screening for Cognitive Impairment in Cerebrovascular Disease

摘要: 目的：探讨简易精神状态检查量表(MMSE)与蒙特利尔认知评估量表(MoCA)在脑血管病患者认知障碍筛查中的一致性，为临床筛查工具的选择与联合应用提供参考。方法：回顾性分析2024年1月~7月珠海市中西医结合医院收治的116例脑血管病患者的临床资料，所有患者均同期完成MMSE与MoCA评估。比较两量表总分及认知障碍检出率，采用Pearson相关分析、McNemar配对χ²检验及Kappa一致性检验评价两量表的相关性与一致性，并按年龄(<65岁/≥65岁)、受教育年限(<9年/≥9年)进行亚组分析。结果：116例患者MMSE总分为(20.19 ± 7.34)分，高于MoCA校正总分(15.49 ± 6.94)分，差异有统计学意义(t = 16.284, P < 0.001)；两量表总分呈强正相关(r = 0.907, P < 0.001)。MMSE认知障碍检出率为53.4% (62/116)，低于MoCA的92.2% (107/116)，差异有统计学意义(χ² = 43.022, P < 0.001)。两量表判定结果总符合率为61.2% (71/116)，Kappa值为0.176，一致性较差；以MoCA判定结果为参照，MMSE筛查认知障碍的灵敏度为57.9%、特异度为100.0%。亚组分析显示，各年龄、受教育程度及性别亚组MoCA检出率均显著高于MMSE (均P < 0.05)，两量表一致性均较差(Kappa = 0.000~0.358)。结论：脑血管病患者MMSE与MoCA评分相关性良好，但两量表对认知障碍的判定一致性较差；MoCA对脑血管病认知障碍尤其是轻度认知障碍的筛查敏感性显著高于MMSE，单独应用MMSE易造成漏诊。临床筛查脑血管病认知障碍时，建议优先选用MoCA或两量表联合应用，以提高早期识别率，为认知康复干预提供依据。

Abstract: Objective: To explore the consistency of the Mini-Mental State Examination Scale (MMSE) and Montreal Cognitive Assessment Scale (MoCA) in the screening of cognitive impairment in patients with cerebrovascular disease, and to provide a reference for the selection and combined application of clinical screening tools. Methods: The clinical data of 116 patients with cerebrovascular disease admitted to Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from January to July 2024 were retrospectively analyzed. All patients completed MMSE and MoCA evaluations during the same period. The total score and the detection rate of cognitive impairment of the two scales were compared. Pearson correlation analysis, McNemar paired χ² test, and Kappa consistency test were used to evaluate the correlation and consistency of the two scales, and subgroup analysis was made according to age (<65 years/≥65 years) and years of education (<9 years/≥9 years). Results: The total score of MMSE in 116 patients was (20.19 ± 7.34) points, which was higher than the corrected total score of MoCA (15.49 ± 6.94) points, with statistical significance (t = 16.284, P < 0.001). There was a strong positive correlation between the total scores of the two scales (r = 0.907, P < 0.001). The detection rate of MMSE cognitive impairment was 53.4% (62/116), which was lower than that of MoCA (92.2%, 107/116), and the difference was statistically significant (χ² = 43.022, P < 0.001). The total coincidence rate of the two scales was 61.2% (71/116), and the Kappa value was 0.176, indicating poor consistency. Based on the results of MoCA, the sensitivity and specificity of MMSE in screening cognitive impairment were 57.9% and 100.0%. Subgroup analysis showed that the detection rate of MoCA in all age groups, education levels, and gender subgroups was significantly higher than that in MMSE (all P < 0.05), and the consistency between the two scales was poor (kappa = 0.000~0.358). Conclusion: MMSE and MoCA scores in patients with cerebrovascular disease have a good correlation, but the consistency of the two scales in judging cognitive impairment is poor. MoCA is significantly more sensitive than MMSE in screening cognitive impairment in cerebrovascular disease, especially mild cognitive impairment, and MMSE alone can easily lead to missed diagnosis. In clinical screening of cognitive impairment in cerebrovascular disease, it is suggested that MoCA or the combination of the two scales should be preferred to improve the early recognition rate and provide a basis for cognitive rehabilitation intervention.