蒙特利尔认知评估量表在中国社区老人中的应用

doi:10.3969/j.issn.1674-8115.2021.12.017

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (12): 1662-1667.doi: 10.3969/j.issn.1674-8115.2021.12.017

• 论著 · 临床研究 • 上一篇

蒙特利尔认知评估量表在中国社区老人中的应用

夏安琪¹^,²(), 李军³(), 岳玲¹^,², 洪波¹^,², 严峰¹^,², 苏宁¹^,², 肖世富¹^,², 刘园园¹^,²(), 王涛¹^,²()

^1.上海交通大学医学院附属精神卫生中心老年精神科，上海 200030
^2.上海交通大学阿尔茨海默病诊治中心，上海 200030
^3.安徽医科大学附属巢湖医院，合肥 238000

收稿日期:2021-07-29 出版日期:2021-12-28 发布日期:2022-01-28
通讯作者: 刘园园,王涛 E-mail:xiaanqi349@foxmail.com;shangeryilyy@163.com;wtshhwy@163.com
作者简介:夏安琪（1995—），女，住院医师，硕士生；电子信箱：xiaanqi349@foxmail.com
夏安琪（1995—），女，住院医师，硕士生；电子信箱：xiaanqi349@foxmail.com
基金资助:
国家科技部科技支撑计划项目(2009BAI77B03);上海市卫生系统优秀人才培养计划（优秀学科带头人）(2017BR054);上海市教育委员会高原学科建设计划(20172029);上海交通大学医学院转化医学协同创新中心合作研究项目(TM201728)

Application of Montreal Cognitive Assessment Scale to the elderly in Chinese community

An-qi XIA¹^,²(), Jun LI³(), Ling YUE¹^,², Bo HONG¹^,², Feng YAN¹^,², Ning SU¹^,², Shi-fu XIAO¹^,², Yuan-yuan LIU¹^,²(), Tao WANG¹^,²()

^1.Department of Geriatric Psychiatry, Shanghai Mental health center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
^2.Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai 200030, China
^3.Chaohu Hospital of Anhui Medical University, Hefei 238000, China

Received:2021-07-29 Online:2021-12-28 Published:2022-01-28
Contact: Yuan-yuan LIU,Tao WANG E-mail:xiaanqi349@foxmail.com;shangeryilyy@163.com;wtshhwy@163.com
Supported by:
China Ministry of Science and Technology Grants(2009BAI77B03);Shanghai Health System Excellent Talent Training Program (Excellent Subject Leader)(2017BR054);Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support(20172029);Collaborative Innovation Center for Translational Medicine of Shanghai Jiao Tong University School of Medicine Project(TM201728)

摘要/Abstract

摘要：

目的·更新蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）区分中国城市社区正常老人（normal elderly，NE）与轻度认知功能损害（mild cognitive impairment，MCI）老人的最佳分界值，分析分量表得分。方法·采用横断面研究，对来自中国10个城市随机抽样的60岁以上老人采用简明精神状态检查（Mini-Mental State Examination，MMSE）和MoCA（北京版）评定其认知功能。数据采用SPSS 19.0进行分析。结果·共有2 367例NE和553例MCI患者。其中，男性1 319例，女性1 601例，平均年龄为（70.6±7.5）岁，平均受教育年限为（8.7±5.2）年。MCI组和NE组在年龄和教育水平上的差异具有统计学意义（t=12.3，P=0.000；t=-13.5，P=0.000）。女性更易患MCI（χ²＝13.5，P=0.000）。通过对NE组MoCA得分分析，发现男性、高文化程度和低年龄组的MoCA得分较高。命名中的犀牛和骆驼，延迟记忆中的教堂和面孔，交替连线测验及画钟实验中的指针位置难度较大。各分量表得分显示，受试者在定向力和注意力测试中表现较好，而视空间功能、延迟回忆、句子重复和抽象能力得分较低。MoCA区分NE与MCI的最佳分界值为20（敏感度为63.7%，特异度为75.7%），曲线下面积为0.76。结论·MoCA（北京版）对NE与MCI区分度良好，最佳分界值为20。MoCA得分受年龄、性别、受教育程度影响；基于难度分析，可将评估记忆部分词语进行替换（用“手”替换“面孔”，用“工厂”替换“教堂”）。

关键词: 蒙特利尔认知评估量表, 难度分析, 轻度认知功能损害, 分界值

Abstract:

Objective·To update the cut-off value of the normal elderly (NE) and mild cognitive impairment (MCI) elderly in urban areas of China according to the Montreal Cognitive Assessment (MoCA) scores and analyze the sections of MoCA.

Methods·A cross-sectional study was conducted to investigate the elderly over 60 years old in ten cities of China. Mini-Mental State Examination (MMSE) and MoCA (Beijing version) were used to assess cognitive function. Data was statistically analyzed by SPSS 19.0.

Results·There were 2 367 NE, 553 MCI patients, 1 319 males and 1 601 females, with an average age of (70.6±7.5) years and an average length of education of (8.7±5.2) years. There were significant difference in age and length of education between MCI and NE groups (t=12.3, P=0.000; t=-13.5, P=0.000). Female was more likely to have MCI (χ²＝13.5, P=0.000). By analyzing the score of MoCA of the NE, it was found that the MoCA score of males, high education level and low age group were higher. Rhinoceros and camel in naming, church and face in delayed memory, alternating connection test and pointer position in clock drawing were more difficult. The sections' scores of MoCA showed that the subjects performed better in the orientation and attention tests, while the scores of visuospatial functions, delayed recalling, sentence repetition and abstract ability were lower. The best cut-off value of MoCA was 20 (sensitivity = 63.7%, specificity = 75.7%). The area under the curve was 0.76.

Conclusion·MoCA (Beijing version) has a good distinction between NE and MCI, and 20 can be used as a cut-off value in MCI subjects screening in urban areas of China. MoCA score is influenced by age, gender and education level. Based on difficulty analysis, some words that evaluate memory could be replaced (replacing “face” with “hand” and replacing “church” with “factory”).

Key words: Montreal Cognitive Assessment Scale (MoCA), difficulty assessment, mild cognitive impairment, cut-off value

中图分类号:

R749.1+6

夏安琪, 李军, 岳玲, 洪波, 严峰, 苏宁, 肖世富, 刘园园, 王涛. 蒙特利尔认知评估量表在中国社区老人中的应用[J]. 上海交通大学学报(医学版), 2021, 41(12): 1662-1667.

An-qi XIA, Jun LI, Ling YUE, Bo HONG, Feng YAN, Ning SU, Shi-fu XIAO, Yuan-yuan LIU, Tao WANG. Application of Montreal Cognitive Assessment Scale to the elderly in Chinese community[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(12): 1662-1667.

图/表 6

参考文献 27

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Characteristic	MCI （n=553）	NE （n=2 367）	P value
Gender/n（%）			0.000
Male	205 （37.1）	1 114 （47.1）
Female	348 （62.9）	1 253 （52.9）
Age/year
60-64	62.2±1.5	62.0±1.4	0.235
65-69	67.0±1.6	66.9±1.4	0.473
70-74	72.2±1.4	71.9±1.4	0.063
75-79	77.1±1.4	76.8±1.4	0.051
80-84	81.8±1.3	81.7±1.4	0.544
≥85	88.4±3.1	87.8±2.6	0.318
Length of education/year
>12	14.1±2.3	14.4±2.2	0.283
7-12	7.8±1.5	8.2±1.4	0.000
1-6	3.1±1.3	3.3±1.3	0.265
0	0.0±0.0	0.0±0.0	-

Characteristic	MCI （n=553）	NE （n=2 367）	P value
Gender/n（%）			0.000
Male	205 （37.1）	1 114 （47.1）
Female	348 （62.9）	1 253 （52.9）
Age/year
60-64	62.2±1.5	62.0±1.4	0.235
65-69	67.0±1.6	66.9±1.4	0.473
70-74	72.2±1.4	71.9±1.4	0.063
75-79	77.1±1.4	76.8±1.4	0.051
80-84	81.8±1.3	81.7±1.4	0.544
≥85	88.4±3.1	87.8±2.6	0.318
Length of education/year
>12	14.1±2.3	14.4±2.2	0.283
7-12	7.8±1.5	8.2±1.4	0.000
1-6	3.1±1.3	3.3±1.3	0.265
0	0.0±0.0	0.0±0.0	-

Group	Length of education/year
Group	>12	7-12	1-6	0	Total
Male
60-64 year	25.5±2.9	24.4±3.5	21.4±3.4	21.0±5.6	24.6±3.5
65-69 year	25.2±4.1	24.0±3.5	20.8±5.4	18.8±5.9	24.3±4.2
70-74 year	24.8±3.1	23.0±3.9	20.4±3.9	14.8±3.4	23.6±3.9
75-79 year	24.4±3.3	22.0±4.9	19.5±4.1	17.5±4.4	22.4±4.6
80-84 year	23.1±3.5	21.8±4.5	17.5±4.3	14.3±3.7	20.2±5.0
≥85 year	19.4±4.7	20.7±5.0	17.7±4.2	18.3±3.6	19.2±4.5
Female
60-64 year	25.7±3.1	24.2±3.8	20.4±3.8	17.7±5.9	24.1±4.1
65-69 year	25.7±3.5	23.0±4.0	18.5±4.3	16.0±5.0	23.1±4.8
70-74 year	24.4±4.2	22.0±4.6	19.8±4.3	14.7±5.5	22.1±5.3
75-79 year	24.2±3.5	20.4±4.4	17.2±5.1	14.7±4.5	19.1±5.7
80-84 year	21.7±4.7	21.6±4.2	16.4±5.5	13.3±5.2	17.1±6.2
≥85 year	23.7±7.1	17.8±5.1	19.9±6.8	11.5±6.6	15.3±7.7

Group	Length of education/year
Group	>12	7-12	1-6	0	Total
Male
60-64 year	25.5±2.9	24.4±3.5	21.4±3.4	21.0±5.6	24.6±3.5
65-69 year	25.2±4.1	24.0±3.5	20.8±5.4	18.8±5.9	24.3±4.2
70-74 year	24.8±3.1	23.0±3.9	20.4±3.9	14.8±3.4	23.6±3.9
75-79 year	24.4±3.3	22.0±4.9	19.5±4.1	17.5±4.4	22.4±4.6
80-84 year	23.1±3.5	21.8±4.5	17.5±4.3	14.3±3.7	20.2±5.0
≥85 year	19.4±4.7	20.7±5.0	17.7±4.2	18.3±3.6	19.2±4.5
Female
60-64 year	25.7±3.1	24.2±3.8	20.4±3.8	17.7±5.9	24.1±4.1
65-69 year	25.7±3.5	23.0±4.0	18.5±4.3	16.0±5.0	23.1±4.8
70-74 year	24.4±4.2	22.0±4.6	19.8±4.3	14.7±5.5	22.1±5.3
75-79 year	24.2±3.5	20.4±4.4	17.2±5.1	14.7±4.5	19.1±5.7
80-84 year	21.7±4.7	21.6±4.2	16.4±5.5	13.3±5.2	17.1±6.2
≥85 year	23.7±7.1	17.8±5.1	19.9±6.8	11.5±6.6	15.3±7.7

Factor	Unstandardized β	Standardized β	t value
Age	-0.265	-0.311	-23.196
Year of education	0.631	0.510	37.1
Gender	-0.977	-0.074	-5.61

蒙特利尔认知评估量表在中国社区老人中的应用

Application of Montreal Cognitive Assessment Scale to the elderly in Chinese community

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Metrics

Item	Edu≤6 year	Edu>6 year	t value
Visuospatial function	2.8±2.1	3.9±1.2	10.5
Naming	1.0±0.9	2.6±0.7	9.0
Delayed recalling	1.6±1.6	2.8±1.6	8.7
Attention	4.8±1.4	5.6±0.8	10.0
Sentence repetition	0.7±0.8	1.1±0.8	6.5
Fluency	0.3±0.4	0.5±0.5	6.2
Abstract ability	0.4±0.6	1.1±0.8	9.7
Orientation	5.5±1.1	5.8±0.7	5.1

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