| Chief complaint of cognitive decline such as memory and computing problems in Middle-aged and elderly people increases with age. Daily life is impacted in varying degrees, with dementia in most severe cases, which is hard to deal with and may brought heavy burden to society and people's living conditions. Therefore, more research should be concentrated on early warning signals of cognitive decline. The concept of mild cognitive impairment(MCI)make up the limitations and delayed tendency in the treatment of dementia, and will become Entry point for researching recent years.Vascular factors are the most common factors leading to cognitive impairment. Most stroke patients can be accompanied by cognitive impairment, therefore, the prevention and treatment of VCI should be moved up to the time of stroke, and even prior to the occurrence of stroke to minimize the risk of cognitive impairment. Cognitive impairment caused by a variety of vascular risk factors, including: hypertension, coronary heart disease, diabetes, stroke, hyperlipidemia, obesity, metabolic syndrome, peripheral vascular disease and smoking can be distinguished and controlled. Early prevention, early intervention and prevention focus on governance, are the core of the concept of modern biology - psychology - social medicine model. Therefore, in order to reduce the serious harm of cognitive impairment, an early start of treatment is indispensable.The Mini-Mental Scale Examination(MMSE)designed by Folstein has been widely applied in clinical practice of cognitive impairment screening and assessment. However, with in-depth study, many scholars considered MMSE could only detecte serious cognitive dysfunction and dementia patients, and could not effectively distinguish MCI, normal aging and early AD patients because of the lack of sensitivity and specificity. The main reason is that MCI is characterized by malfunction of episodic memory, especially in verbal episodic memory of the earliest damage, followed by the visual episodic memory. Test that indicate the verbal episodic memory is comparatively less in MMSE, and level of education impacts the result significantly. Bad sensitivity for high culture, high rate of false-positive for the lower culture.Combined with Substantial clinical experience, MoCA is made by Nasreddine in reference to the cognition project settings and score criteria in MMSE. There has been multiple versions of different cultural backgrounds and languages at home and abroad aiming at screening for mild cognitive impairment in Middle-aged and elderly poeple. MoCA has a high sensitivity and specificity for MCI patients in assessing attention, executive function, memory, language, abstract thinking, calculation, orientation and other areas of cognitive. Compared with other dedicated instrument, MoCA has a full field of cognitive tests, a sensitivity and specificity of the ideal, a vivid image of the test screen, the advantages of a reasonable time, which has been reported in literature. MoCA includes more words in memory testing, and longer time delay in delayed recall. Moreover, it has advantages in the executive function, the use of advanced language ability and the processing of complex visual-spatial, being consistent with the patients of vascular cognitive impairment.The significance of the proposed concept of VCI and MCI are anchored at early detection and prevention of decline in cognitive function. Therefore, neuropsychological assessment of various types emphasis more on sensitivity rather than specificity.The treatment of ischemic cerebrovascular disease are roughly the same, of which the improvement in cognitive functions has been extensively studied in neurotrophic agents, neuroprotective agents, antioxidants, as well as circulation improving agent. However, most of them were empirical treatment and lack of high-level clinical evidences. Nimodipine is the only drug that can intervene from the view of vascular with the cognitive impairment, and it is recommended by by both at home and aboard guidance, consensus and evidence-based study.67 cases of patients with ischemic cerebrovascular disease accompanied by chief complaint of cognitive decline(such as cerebral ischemia, TIA, cerebral infarction, etc)in our hospital from June 2007 to December 2008 are chosen in our study. And 35 cases of individuals at the same period in the community without reference to chief complaint of cognitive decline are included as control group. All the subjects has been already screened by MMSE to exclude the ones of moderate and severe cognitive dysfunction and their gender, age, education are of the same level. The two groups are further examined by MoCA, and their scores in all areas are recorded. For patients with cognitive impairment which is confirmed by MoCA, admission to hospital for routine treatment, combined with the United Nimodipine oral treatment for two weeks, four weeks is needed before the next trip to MoCA. SPSS11.5 package is applied for statistical treatment with all the data we have acquired. x±s represents quantitative data, t test is applied in test of significance of mean and paired t test is used in the comparison of sth between before and after the treatment. Finally, X2 test for frequency distribution, and bivariate correlation analysis of Spearmem correlation coefficient for MMSE and MoCA.The Study shows MoCA scores and MMSE scores are significantly correlated(Rs=0.845,P<0.01).And the detection rate of MoCA, 74.5% is greater than the detection rate of MMSE, 33.3%(P<0.001).The patients confirmed with cognitive impairment by MoCA dose not include the ones confirmed normal by MMSE, whereas, 61.7% of normal patients confirmed by MMSE is considered to be with cognitive dysfuction (P<0.001).Overall scores of Hypertensive group, high glucose group in the control group is respectively lower than that of the normal blood pressure and blood sugar group(P<0.05).The score of recurrence group is lower than the initial issuance group in the patients with Ischemic cerebrovascular disease(Case group) (P<0.05). The average MMSE and MoCA score in groups with multiple lesions is lower than that in groups with one lesion or without lesion(P<0.05),and one lesion exceeds non-lesion(P < 0.05).The ratings of various cognitive areas of Ischemic cerebrovascular patients with cognitive impairment is lower than that with normal cognition,most significantly in areas such as Spaces executive function, language skills, memory, abstract thinking(P<0.05),and is lower than that of the control group too in areas such as Spaces executive function, especially in two aspect called alternate connection tests and delayed recall(P<0.05).Ratings of the group with routine treatment ,combined or combined not with Nimodipine for two weeks, four weeks in Ischemic cerebrovascular patients is higher than that before the treatment. But there is no statistical significance(P>0.05).In summary, MoCA scores and MMSE scores are significantly correlated, and the detection range of MoCA is wider than that of MMSE. MoCA has a higher sensitivity, and can detect patients with mild cognitive dysfunction including groups with no chief complaint of cognitive dysfunction. It also can provide a screening subject for early prevention. High blood pressure, high blood sugar, recurrence of ischemic cerebrovascular disease and the number of ischemic brain lesions correlates with the decline in cognitive function. Areas such as spaces executive function, language skills, memory, abstract thinking is significantly affected in Ischemic cerebrovascular patients with cognitive dysfunction. Decline in cognitive fuction such as spaces executive function, especially two aspects called Tests alternate connection and Delayed Memory is the Characteristic performance of Ischemic cerebrovascular patients with cognitive dysfunction. Scores of the group with routine treatment, combined or combined not with Nimodipine for two weeks, four weeks are tend to higher than that before the treatment. But there is no Statistical significance, small number of sample cases and short course of treatment may contribute to it.
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