The Preliminary Application Of Montreal Cognitive Assessment In Vascular Cognitive Impairment

Background and objective:The term 'vascular cognitive impairment' was first proposed by Hachinski and Bowler in 1993, that is caused by or associated with vascular factors.VCI can occur either alone or in association with Alzheimer's disease(AD).It includes vascular cognitive impairment with no dementia (VCIND),vascular dementia(VaD) and Mixed AD with VaD.The data are drawn from the Canadian Study of Health and Aging(CSHA),a representative cohort study of older(＞65 years) Canadians undertaken chiefly to estimate the prevalence and incidence of dementia,indicated that the morbidity rate of VCI is 5%,increasing with aging.A 5-year follow-up study found that,in VCIND 46%progress into dementia,52%were dead.The high morbidity rate,high disabled rate and high mortality rate of VCI are destroying human's healthy and life.But the early cognitive impairment is mild,that is difficult to discover.It is too early to diagnose dementia.The Mini-mental State Examination(MMSE) is most popular screening tool for cognitive impairment,but its sensitivity is too low and rate of missed diagnosis is too high.Therefore,we need a better screening tool for VCI.To address this problem,the Montreal Cognitive Assessment(MoCA) was developed by Nasreddine as a tool to screen patients who present with mild cognitive complaints and usually perform in the normal range on the MMSE.There are only a few articles about the relationship between MoCA and VCI.In this article,we study the application of Montreal Cognitive Assessment in vascular cognitive impairment,and make a benchmark for a cutoff score.Method: VCI group:During 2008.11-2009.3,50 patients,who have the complains of cognitive impairment,psychological test proof,and definite diagnosis according to Rockwood diagnostic criteria and.exclude severe and acute conditions.Control group:2008.11-2009.3,60 health people,who have normal MMSE and ADL scores.Statistics method:Apply SPSS16.0 statistical package,Pearson correlation analysis,t test,One-Way ANOVA, Mann-Whitney U,chi square test,Screening validity evaluation.Results:1.MoCA and MMSE totle scores are correlated1.1 VCI group,MoCA and MMSE totle scores,r=0.858,p＜0.05;1.2 Control group,MoCA and MMSE totle scores,r=0.318,p＜0.05.2.MoCA subitems and totle score are correlated2.1 VCI group,MoCA subitems and totle score are correlated;Visuopatial/Executive subitem and totle score,r=0.779,P＜0.05;Naming subitem and totle score,r=0.679,P＜0.05;Attention subitem and totle score,r=0.832,P＜0.05;Language subitem and totle score,r=0.541,P＜0.05;Abstraction subitem and totle score,r=0.42,P＜0.05;Delayed recall subitem and totle score,r=0.64,P＜0.05;Orientation subitem and totle score,,r=0.755,P＜0.05.2.2 Control group,MoCA subitems and totle score correlation.Visuopatial/Executive subitem and totle score,r=0.678,P＜0.05;Naming subitem and totle score,r=0.369,P＜0.05;Attention subitem and totle score,r=0.699,P＜0.05;Language subitem and totle score,r=0.552,P＜0.05;Abstraction subitem and totle score,r=0.731,P＜0.05;Delayed recall subitem and totle score,r=0.805,P＜0.05; Orientation subitem and totle score,,r=-0.01,P＞0.05.3.Control group,VCI group,VCIND group,dementia group MoCA totle scores,subitems, MMSE totale scores have statistics differences.3.1 Control group,VCI group,MoCA totle scores,subitems,MMSE totle score have statistics differences;3.2 Control group,VCIND group,MoCA totle scores,subitems,MMSE totle scores have statistics differences,P＜0.05;3.3 Control group,VCIND group,exclude Naming subitem,other subitems have statistics differences;3.4 VCIND group,dementia group,exclude Language and Abstraction subitem,other subitems have statistics differences;4.Age and sex have no statistics differences for MoCA.5.Education(junior high school for cutpoint) has statistics differences for MoCA.and MMSE.6.Work(mental,physical work) have statistics differences for MoCA.and MMSE.7.HCY,BP,BS,blood fat,cerebrovascular disease history,heart disease;smoking,alcohol lhave no statistics differences for MoCA and MMSE.8.MoCA screening sensitivity is better than MMSE.8.1 Below junior high school,MoCA≥22,sensitivity 83.3%,specificity 70%,MMSE≥20分, sensitivity 46.7%,specificity 100%;8.2 Above junior high school,MoCA≥25,sensitivity85%,specificity75%,MMSE≥26, sensitivity50%,specificity 100%;Conclusion:1.MoCA and MMSE totle scores,subitems,have correlations,exclude orientation subitem and MoCA totle score.2.Control group,VCI group,VCIND group,dementia group MoCA totle score,subitems, MMSE totle score have statistics differences.Exclude Control group,VCIND group,Naming subitem,other subitems have no statistics differences,Exclude VCIND group,dementia group, Language and Abstraction subitem,other subitems have no statistics differences. 3.Education(junior high school for cutpoint) and Work(mental,physical work) has statistics differences for MoCA.and MMSE.4.Age and sex,HCY,BP,BS,blood fat,cerebrovascular disease history,heart disease;smoking, alcohol lhave no statistics differences for MoCA and MMSE.5.MoCA screening sensitivity is better than MMSE.Significance:MoCA Screening sensitivity is better than MMSE,can use as a good screening tool for VCI.