The Formation Of Montreal Cognitive Assessment (Changsha Version) And Application In Ischemic Cerebrovascular Disease Patients Of Hunan Province, China

Background:Montreal Cognitive Assessment (MoCA) is the most widely used cognitive screen tool for mild cognitive impairment (MCI) in the world at present. Vascular cognitive impairment (VCI) may involve all cognitive domains, however, the earliest and most prominent cognitive impairment of VCI often locates in frontal executive function domain. Because MoCA involving nearly all cognitive domains (including executive function), which makes it has special advantages in screening VCI. The National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS/CNS) vascular cognitive impairment harmonization standards had introduced MoCA as 5 minute protocol of VCI neuropsychological test. So far, there are three main problems in MoCA related researches in mainland China:Firstly, There is no unified Chinese version of MoCA (including Beijing version, introduced version of Beijing Xiehe hospital, Hong Kong version, etc.), which make different research results lack of comparability; Secondly, there are some insufficiencies in each version which make it unsuitable to apply in population of mainland China; Thirdly, no version has large sample norms and reliable analysis of reliability and validity. Therefore, developing a Chinese version of MoCA which is really suitable to apply in population of mainland China is the most urgent, important MoCA related research orientation in mainland China. This work has important realistic and social significance.Objective:Exploring the feasibility, insufficiencies and potential revision points of MoCA (Beijing Version); After translating and adapting the original MoCA (English Version), determining the final version of MoCA (Changsha Version); Examing the reliability, validity of MoCA (Changsha Version) in ischemic cerebrovascular disease patients of Hunan province and formulating its ideal cutoff score.Methods:1. Pilot study:Applying MoCA (Beijing Version), Mini-Mental State Examination (MMSE), etc. in 56 ischemic cerebrovascular disease patients and 32 normal controls (all(?)40 years old) to evaluate their cognition. Discussing feasibility, insufficiencies of MoCA (Beijing Version) and exploring its potential adapting points.2. The formation of MoCA (Changsha Version):After several processes such as obtaining the translation and revising right of MoCA (English Version) from it's original author, translation, experts evaluation, adaption, small sample trial, etc., the final version of the MoCA (Changsha Version) was determined.3. Validation study:Applying MoCA (Changsha Version), Mini-Mental State Examination (MMSE), and several detailed neuropsychological testings in 159 ischemic cerebrovascular disease patients (all(?)40 years old) to evaluate their cognition. Examing reliability and validity of MoCA (Changsha Version), exploring its ideal cutoff score for detecting vascular cognitive impairment no dementia (V-CIND).Results:1. Pilot study:MoCA (Beijing Version) is an effective and feasible cognitive screening scale, however, it still has several insufficiencies which make it unsuitable for applying in population of mainland China: Such as several items weren't suitable for culture background of mainland China, the educational limit for adding point and cutoff point for cognitive impairment were too high, etc.2. The formation of MoCA (Changsha Version):There were 8 relevant experts involved in the translation quality evaluation and adaption guidance.3 sub-items had entered the small sample trial. The final version of MoCA (Changsha Version) was determined in July 2010, and been approved by MoCA's original author and published on website (http://www.mocatest.org).3. Validation study:The Cronbach's alpha of MoCA (Changsha Version) was 0.846. The test-retest reliability and inter-rater reliability of MoCA (Changsha Version) was 0.974 and 0.969 respectively. Adding 1 point in subjects with(?)6 years of education. Using 26/27 as cutoff score ((?)27 means cognitive normal,(?)26 means V-CIND) could get the most ideal sensitivity (90.0%) and specificity (70.9%). The Kappa coefficient of agreement between cognitive diagnosis results of MoCA (Changsha) and results of clinical expert panel was 0.610.Conclusion:1. The reliability and validity of MoCA (Changsha Version) is good. It is suitable to apply in population with ischemic cerebrovascular disease in Hunan province for V-CIND screening.2. MoCA (Changsha Version) is developed especially for applying in population of mainland China. It is suitable to further apply in other areas of the whole country of China.