Vascular Cognitive Impairment No Dementia In Patients With MMSE And MoCA Score Comparison And Correlation Of C-reactive Protein, Folic Acid, Vitamin B12

Background Vascular cognitive impairment(VCI) include all levels of cognitivedecline resulting from cerebrovascular disease (CVD) or risk factors for CVD, rangingfrom mild deficits in one or more cognitive domains to a broad dementia-likesyndrome.Three broad clinical subtypes are included: vascular cognitive impairment nodementia(VCIND), vascular dementia (VD) and mixed dementia (MD). VCI cases that donot meet the criteria for dementia can also be labeled as vascular cognitive impairment nodementia(VCIND). With the time and progression of disease,the most patients of VCINDmay develop to vascular dementia (VD).In the stage of VCIND there are many risk factorswhich can be intervened, so to early discover cognitive impairment before daily life iseffected and to interfere in it may avoid the late stage of VD.MMSE (Mini-menta1State Examination, MMSE) is the most widely used screeningscale of cognitive function disorder for clinician. A lot of patients have reached theVCI,but the MMSE score is in the normal range. The sensitivity of MMSE is low, the rateof misdiagnosis is high.MoCA have high sensitivity for screening and assessing patientswith mild cognitive impairment (MCI), but MOCA used for patients with VCIND is less.This study investigates the differences, advantages and disadvantages of the two scales, toselect a higher degree of sensitivity and specificity of neuropsychological assessment scaleas a rapid screening tool of vascular cognitive impairment no dementia(VCIND).Currently,VCI disease may be caused by the combined effect of a variety ofmechanism, and the inflammatory factor play an important role. Some inflammatoryfactors may have some relevance in the cerebrospinal fluid and blood levels with VCI.C-reactive protein (CRP) is the acute phase proteins of inflammation，and it is the mostsignificant clinical markers of inflammation.Therefor,detecting the inflammatory markers and learning more about its role in the cognitive impairment, contribute to prevent andtreat the patients with VCI early. The recent studies have found that folic acid, VitaminB12have relation with VCI. The relations and role of folic acid and Vitamin B12with VCIreported in the literature is less,the results and conclusions is inconsistent. This article aimsto explore the relevance of the CRP, folic acid and Vitamin B12with VCI.Objective To investigate the characteristics of MOCA and MMSE, select the highersensitivity and specificity scale as a screening tool for VCIND; to explore the relevance ofCRP, folic acid and Vitamin B12with VCIND.Method December2011to December2012, the Second Affiliated Hospital ofSoochow University Department of Neurology, inpatient and outpatient patients with80cases, including39cases of patients with VCIND41cases and gender, age andeducation-matched normal control (NC) completed a series of neuropsychological tests,including the overall level of cognitive, memory, attention, naming, differences invisual-spatial ability, executive function and other cognitive domains were comparedcognitive function.Neuropsychological tests, including the Mini-Mental State Examination(MMSE) and Montreal Cognitive Assessment (MoCA).Patients in both groups fastingblood samples in the morning were sent to our hospital clinical laboratory testing inpatients with C-reactive protein, serum folate and vitamin B12level. All selected objectson the pilot program, informed consent, and approved by the Ethics Committee.Results (1)Totle scores of MoCA were correlated with that of MMSE,(VCINDgroup r=0.897，p<0.01;NC group r=0.883, p<0.01); The scores of MoCA’s subitems werecorrelated with totle scores of MoCA; The totle scores of MMSE in VCIND group werelower than the NC group,(22.57±4.21vs27.32±3.66);The totle scores of MoCA inVCIND group were lower than the NC group (20.12±4.17vs25.08±4.41);Some sub-itemscore of MoCA in VCIND group were lower than the NC group.In VCIND group,the scoreof Visuospatial/Executive,Abstraction subitem,Delayed recall and Orientation were lowerthan the NC group.(p<0.05)(2) Compared with NC group,C-reactive protein of NCIND group increased,folateand vitamin B12reduced.Conclusion1.The sensitivity and Specificity of MOCA is higher than MMSE forscreening patients with VCIND, it can be used as a good scale for screening patients withVCIND. 2.C-reactive protein, folic acid and vitamin B12have a correlation with the VCIND,ithas a reference value for the diagnosis of patients with VCIND.