Diagnostic value of montreal cognitive assessment for mild cognitive impairment in Chinese middle-aged adults: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

HUANG Feiyun ¹ , WANG Yanhong ² , LI Juanjuan ¹ , WANG Li ² , JIANG Yu ¹ ,  LIAO Susu ²

1. Department of Epidemiology & Biostatistics, School of Public Health, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, P.R.China;
2. Department of Epidemiology & Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, Beijing, 100005, P.R.China;

Corresponding?author：

LIAO Susu, Email: susuliao@ibms.pumc.edu.cn

Keywords：

The Montreal Cognitive Assessment; Mild cognitive impairment; Chinese population; Diagnostic test; Meta-analysis

DOI：

10.7507/1672-2531.201609052

Video：

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Objective To evaluate diagnostic accuracy of several relevant cut-off points of Montreal cognitive assessment (MoCA) for mild cognitive impairment (MCI) in Chinese middle-aged adults. Methods Databases including PubMed, EMbase, Web of Science, The Cochrane Library (Issue 5, 2016), OVID, CBM, CNKI, VIP, WanFang Data were searched for diagnostic tests about MoCA for MCI from April 9^th 2005 to December 31^st 2015. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality by QUADAS-2 tool. Then, meta-analysis was performed by Stata 14.0 software. Results A total of 27 studies involving 5 755 participants were included with mean ages from 60 to 80 years old. Among them, 1 997 were diagnosed as MCI patients by Petersen criteria. Based on maximal area under the ROC curve as well as optimal pooled sensitivity and specificity, the optimal cutoff value of MoCA was 25/26, the pooled sensitivity was 0.96 with 95%CI 0.93 to 0.97, specificity was 0.83 with 95%CI 0.75 to 0.89, and DOR was 107 with 95%CI 61 to 188. The subgroup analysis with different research designs, different sources of study participants and different MoCA versions all indicated 25/26 as an optimal cut-off value. Conclusion The optimal cutoff value of MoCA in Chinese middle-aged adults for screening MCI by Petersen criteria was 25/26.

Citation： HUANG Feiyun, WANG Yanhong, LI Juanjuan, WANG Li, JIANG Yu, LIAO Susu. Diagnostic value of montreal cognitive assessment for mild cognitive impairment in Chinese middle-aged adults: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(4): 450-457. doi: 10.7507/1672-2531.201609052 Copy

1.	?Juebin H, John SM, Zhen ZX,et al. Progression of mild cognitive impairment to Alzheimer's or vascular dementia versus normative aging among elderly Chinese. Curr Alzheimer Res, 2005, 2(5): 571-578.
2.	Li H, Li J, Li N,et al. Cognitive intervention for persons with mild cognitive impairment: A meta-analysis. Ageing Res Rev, 2011, 10(2): 285-296.
3.	Michael V, Perminder S. Can cognitive exercise prevent the onset of dementia? Systematic review of randomized clinical trials with longitudinal follow-up. Am J Geriatr Psychiatry, 2009, 17(17): 179-187.
4.	Simon SS, Yokomizo JE, Bottino CMC. Cognitive intervention in amnestic Mild Cognitive Impairment: A systematic review. Neurosci Biobehav Rev, 2012, 36(4): 1163-1178.
5.	Nasreddine ZS, Phillips NA, Bedirian V,et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc, 2005, 53(4): 695-699.
6.	王煒, 王魯寧. " 蒙特利爾認知評估量表”在輕度認知損傷患者篩查中的應用. 中華內科雜志, 2007, 46(5): 414-416.
7.	Zhao S, Guo C, Wang M,et al. A clinical memory battery for screening for amnestic mild cognitive impairment in an elderly chinese population. J Clin Neurosci, 2011, 18(6): 774-779.
8.	易剛, 肖軍, 唐娟娟. 蒙特利爾認知評估量表在成都市社區老年人輕度認知功能障礙篩查中的應用分析. 中國臨床心理學雜志, 2011, 19(2): 203-204.
9.	Ciesielska N. Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol, 2016, 50(5): 1039-1052.
10.	Petersen RC, Smith GE, Waring SC,et al. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol, 1999, 56(3): 303-308.
11.	Petersen RC, Stevens JC, Ganguli M,et al. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2001, 56(9): 1133-1142.
12.	Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med, 2004, 256(3): 183-194.
13.	Whiting PF, Rutjes AW, Westnood ME,et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
14.	鄔蘭, 張永, 曾憲濤. QUADAS-2 在診斷準確性研究的質量評價工具中的應用. 湖北醫藥學院學報, 2013, 32(3): 201-208.
15.	Reitsma JB, Glas AS, Rutjes AWS,et al. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol, 2005, 58(10): 982-990.
16.	Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol, 2005, 58(9): 882-893.
17.	沈銀, 駱雄, 唐牟尼, 等. 簡明精神狀態檢查和蒙特利爾認知評估量表篩查社區老年人中輕度認知功能障礙及癡呆的應用分析. 中華精神科雜志, 2014, 47(5): 293-297.
18.	張雪晴, 曾慧. 蒙特利爾認知評估量表在老年人輕度認知功能障礙篩查中的截斷值分層研究. 中國全科醫學, 2014, 17(26): 3046-3051.
19.	姚燕, 楊芳, 王麗娟, 等. 蒙特利爾認知評估量表在輕度認知功能障礙診斷中的應用. 吉林大學學報（醫學版）, 2012, 38(4): 730-735.
20.	沈銀. 廣州地區城鄉 65 歲及以上老人輕度認知障礙和癡呆的流行病學調查. 廣州: 廣州醫學院, 2011.
21.	溫洪波, 張振馨, 牛富生, 等. 北京地區蒙特利爾認知量表的應用研究. 中華內科雜志, 2008, 47(1): 36-39.
22.	Hu JB, Zhou WH, Hu SH,et al. Cross-cultural difference and validation of the Chinese version of Montreal Cognitive Assessment in older adults residing in Eastern China: Preliminary findings. Arch Gerontol Geriatr, 2013, 56(1): 38-43.
23.	孟曉梅, 于逢春, 尹靜, 等. 蒙特利爾認知評估量表用于輕度認知功能障礙患者評估的初步研究. 中華老年心腦血管病雜志, 2012, 14(11): 1173-1175.
24.	Yu K, Zhang S, Wang Q,et al. Development of a computerized tool for the chinese version of the montreal cognitive assessment for screening mild cognitive impairment. Int Psychogeriatr, 2015, 27(2): 213-219.
25.	王曉飛, 郁可, 李余霞, 等. 蒙特利爾認知評估中文計算機軟件的臨床應用. 神經疾病與精神衛生, 2014, 14(4): 353-355.
26.	孔伶俐, 孫忠國, 周田田, 等. 蒙特利爾認知評估量表在輕度認知功能障礙診斷中的應用. 中國健康心理學雜志, 2015, 23(8): 1212-1215.
27.	Tsai CF, Lee WJ, Wang SJ,et al. Psychometrics of the Montreal Cognitive Assessment (MoCA) and its subscales: Validation of the Taiwanese version of the MoCA and an item response theory analysis. Int Psychogeriatr, 2012, 24(4): 651-658.
28.	邵榮, 韓伯軍. 蒙特利爾認知評估量表在老年輕度認知功能障礙篩查中的應用. 職業與健康, 2014, 30(20): 2916-2918.
29.	王琦, 毛禮煒, 劉娟, 等. 蒙特利爾認知評估量表在老年輕度認知損害中的應用. 蘇州大學學報（醫學版）, 2011, 31(4): 655-657.
30.	孫云闖, 秦斌. 中文版 MoCA 和 MMSE 在診斷遺忘型輕度認知功能障礙中的應用. 中國神經免疫學和神經病學雜志, 2011, 18(2): 91-93.
31.	何曉燕, 朱沂, 李紅燕, 等. 癡呆評估量表與事件相關電位 p300 對輕度認知功能障礙患者認知功能的評價. 中國老年學雜志, 2011, 31(16): 3041-3043.
32.	王盼, 張熙, 周波, 等. 蒙特利爾認知評價量表(中文版)在輕度認知損害診斷及進展過程中的作用. 中國現代神經疾病雜志, 2012, 12(2): 193-197.
33.	尹立勇. 輕度認知障礙調查與診斷研究. 石家莊: 河北醫科大學, 2010.
34.	林錦波, 張云鳳, 巫偉忠, 等. 蒙特利爾認知評估量表篩查老年輕度認知功能障礙的價值. 廣西醫學, 2015, 37(7): 967-968.
35.	袁正洲, 李作孝, 馬勛泰, 等. 長沙版蒙特利爾認知評估量表在老年輕度認知障礙篩查中的應用. 西部醫學, 2014, 26(6): 741-744.
36.	Chu LW, Ng KHY, Law ACK,et al. Validity of the Cantonese Chinese Montreal cognitive assessment in Southern Chinese. Geriatr GerontolInt, 2015, 15(1): 96-103.
37.	張立秀, 劉雪琴. 蒙特利爾認知評估量表中文版廣州市老人院人群劃界分探討. 中國心理衛生雜志, 2008, 22(2): 123-125.
38.	Yeung PY, Wong LL, Chan CC,et al. A validation study of the Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) in Chinese older adults in Hong Kong. Hong Kong Med J, 2014, 20(6): 504-510.
39.	高欣, 鄒晨雙, 段春波, 等. 蒙特利爾認知評估量表在北京社區老年人遺忘型輕度認知障礙篩查中的應用. 中國神經免疫學和神經病學雜志, 2014, 21(4): 250-253.
40.	朱文佳, 高中寶, 楊磊, 等. 蒙特利爾認知評估量表篩查輕度認知功能障礙分界值的研究. 中華老年心腦血管病雜志, 2012, 14(5): 500-502.
41.	王煒, 劉丹丹, 高中寶, 等. 蒙特利爾認知評估量表(中文版)在駐京軍隊離退休干部中界值劃分的初步研究. 中華保健醫學雜志, 2010, 12(4): 271-273.
42.	邢建麗, 董艷娟, 何躍, 等. 蒙特利爾認知評估量表在軍隊老年人群中應用的研究. 人民軍醫, 2011, 54(S1): 38-40.
43.	李海員. 輕度認知功能障礙患者的神經心理學及其血漿 Hcy 水平的研究. 廣州: 廣州醫學院, 2009.
44.	李蘭芳, 肖勁松, 章軍建, 等. 輕度認知功能障礙常用篩查量表的比較分析. 醫學新知雜志, 2011, 21(6): 420-423.
45.	戴海濤. 認知功能量表在輕度認知損害中的應用. 天津: 南開大學, 2010.

1. ?Juebin H, John SM, Zhen ZX,et al. Progression of mild cognitive impairment to Alzheimer's or vascular dementia versus normative aging among elderly Chinese. Curr Alzheimer Res, 2005, 2(5): 571-578.
2. Li H, Li J, Li N,et al. Cognitive intervention for persons with mild cognitive impairment: A meta-analysis. Ageing Res Rev, 2011, 10(2): 285-296.
3. Michael V, Perminder S. Can cognitive exercise prevent the onset of dementia? Systematic review of randomized clinical trials with longitudinal follow-up. Am J Geriatr Psychiatry, 2009, 17(17): 179-187.
4. Simon SS, Yokomizo JE, Bottino CMC. Cognitive intervention in amnestic Mild Cognitive Impairment: A systematic review. Neurosci Biobehav Rev, 2012, 36(4): 1163-1178.
5. Nasreddine ZS, Phillips NA, Bedirian V,et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc, 2005, 53(4): 695-699.
6. 王煒, 王魯寧. " 蒙特利爾認知評估量表”在輕度認知損傷患者篩查中的應用. 中華內科雜志, 2007, 46(5): 414-416.
7. Zhao S, Guo C, Wang M,et al. A clinical memory battery for screening for amnestic mild cognitive impairment in an elderly chinese population. J Clin Neurosci, 2011, 18(6): 774-779.
8. 易剛, 肖軍, 唐娟娟. 蒙特利爾認知評估量表在成都市社區老年人輕度認知功能障礙篩查中的應用分析. 中國臨床心理學雜志, 2011, 19(2): 203-204.
9. Ciesielska N. Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol, 2016, 50(5): 1039-1052.
10. Petersen RC, Smith GE, Waring SC,et al. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol, 1999, 56(3): 303-308.
11. Petersen RC, Stevens JC, Ganguli M,et al. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2001, 56(9): 1133-1142.
12. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med, 2004, 256(3): 183-194.
13. Whiting PF, Rutjes AW, Westnood ME,et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
14. 鄔蘭, 張永, 曾憲濤. QUADAS-2 在診斷準確性研究的質量評價工具中的應用. 湖北醫藥學院學報, 2013, 32(3): 201-208.
15. Reitsma JB, Glas AS, Rutjes AWS,et al. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol, 2005, 58(10): 982-990.
16. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol, 2005, 58(9): 882-893.
17. 沈銀, 駱雄, 唐牟尼, 等. 簡明精神狀態檢查和蒙特利爾認知評估量表篩查社區老年人中輕度認知功能障礙及癡呆的應用分析. 中華精神科雜志, 2014, 47(5): 293-297.
18. 張雪晴, 曾慧. 蒙特利爾認知評估量表在老年人輕度認知功能障礙篩查中的截斷值分層研究. 中國全科醫學, 2014, 17(26): 3046-3051.
19. 姚燕, 楊芳, 王麗娟, 等. 蒙特利爾認知評估量表在輕度認知功能障礙診斷中的應用. 吉林大學學報（醫學版）, 2012, 38(4): 730-735.
20. 沈銀. 廣州地區城鄉 65 歲及以上老人輕度認知障礙和癡呆的流行病學調查. 廣州: 廣州醫學院, 2011.
21. 溫洪波, 張振馨, 牛富生, 等. 北京地區蒙特利爾認知量表的應用研究. 中華內科雜志, 2008, 47(1): 36-39.
22. Hu JB, Zhou WH, Hu SH,et al. Cross-cultural difference and validation of the Chinese version of Montreal Cognitive Assessment in older adults residing in Eastern China: Preliminary findings. Arch Gerontol Geriatr, 2013, 56(1): 38-43.
23. 孟曉梅, 于逢春, 尹靜, 等. 蒙特利爾認知評估量表用于輕度認知功能障礙患者評估的初步研究. 中華老年心腦血管病雜志, 2012, 14(11): 1173-1175.
24. Yu K, Zhang S, Wang Q,et al. Development of a computerized tool for the chinese version of the montreal cognitive assessment for screening mild cognitive impairment. Int Psychogeriatr, 2015, 27(2): 213-219.
25. 王曉飛, 郁可, 李余霞, 等. 蒙特利爾認知評估中文計算機軟件的臨床應用. 神經疾病與精神衛生, 2014, 14(4): 353-355.
26. 孔伶俐, 孫忠國, 周田田, 等. 蒙特利爾認知評估量表在輕度認知功能障礙診斷中的應用. 中國健康心理學雜志, 2015, 23(8): 1212-1215.
27. Tsai CF, Lee WJ, Wang SJ,et al. Psychometrics of the Montreal Cognitive Assessment (MoCA) and its subscales: Validation of the Taiwanese version of the MoCA and an item response theory analysis. Int Psychogeriatr, 2012, 24(4): 651-658.
28. 邵榮, 韓伯軍. 蒙特利爾認知評估量表在老年輕度認知功能障礙篩查中的應用. 職業與健康, 2014, 30(20): 2916-2918.
29. 王琦, 毛禮煒, 劉娟, 等. 蒙特利爾認知評估量表在老年輕度認知損害中的應用. 蘇州大學學報（醫學版）, 2011, 31(4): 655-657.
30. 孫云闖, 秦斌. 中文版 MoCA 和 MMSE 在診斷遺忘型輕度認知功能障礙中的應用. 中國神經免疫學和神經病學雜志, 2011, 18(2): 91-93.
31. 何曉燕, 朱沂, 李紅燕, 等. 癡呆評估量表與事件相關電位 p300 對輕度認知功能障礙患者認知功能的評價. 中國老年學雜志, 2011, 31(16): 3041-3043.
32. 王盼, 張熙, 周波, 等. 蒙特利爾認知評價量表(中文版)在輕度認知損害診斷及進展過程中的作用. 中國現代神經疾病雜志, 2012, 12(2): 193-197.
33. 尹立勇. 輕度認知障礙調查與診斷研究. 石家莊: 河北醫科大學, 2010.
34. 林錦波, 張云鳳, 巫偉忠, 等. 蒙特利爾認知評估量表篩查老年輕度認知功能障礙的價值. 廣西醫學, 2015, 37(7): 967-968.
35. 袁正洲, 李作孝, 馬勛泰, 等. 長沙版蒙特利爾認知評估量表在老年輕度認知障礙篩查中的應用. 西部醫學, 2014, 26(6): 741-744.
36. Chu LW, Ng KHY, Law ACK,et al. Validity of the Cantonese Chinese Montreal cognitive assessment in Southern Chinese. Geriatr GerontolInt, 2015, 15(1): 96-103.
37. 張立秀, 劉雪琴. 蒙特利爾認知評估量表中文版廣州市老人院人群劃界分探討. 中國心理衛生雜志, 2008, 22(2): 123-125.
38. Yeung PY, Wong LL, Chan CC,et al. A validation study of the Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) in Chinese older adults in Hong Kong. Hong Kong Med J, 2014, 20(6): 504-510.
39. 高欣, 鄒晨雙, 段春波, 等. 蒙特利爾認知評估量表在北京社區老年人遺忘型輕度認知障礙篩查中的應用. 中國神經免疫學和神經病學雜志, 2014, 21(4): 250-253.
40. 朱文佳, 高中寶, 楊磊, 等. 蒙特利爾認知評估量表篩查輕度認知功能障礙分界值的研究. 中華老年心腦血管病雜志, 2012, 14(5): 500-502.
41. 王煒, 劉丹丹, 高中寶, 等. 蒙特利爾認知評估量表(中文版)在駐京軍隊離退休干部中界值劃分的初步研究. 中華保健醫學雜志, 2010, 12(4): 271-273.
42. 邢建麗, 董艷娟, 何躍, 等. 蒙特利爾認知評估量表在軍隊老年人群中應用的研究. 人民軍醫, 2011, 54(S1): 38-40.
43. 李海員. 輕度認知功能障礙患者的神經心理學及其血漿 Hcy 水平的研究. 廣州: 廣州醫學院, 2009.
44. 李蘭芳, 肖勁松, 章軍建, 等. 輕度認知功能障礙常用篩查量表的比較分析. 醫學新知雜志, 2011, 21(6): 420-423.
45. 戴海濤. 認知功能量表在輕度認知損害中的應用. 天津: 南開大學, 2010.

Chinese Journal of Evidence-Based Medicine

Diagnostic value of montreal cognitive assessment for mild cognitive impairment in Chinese middle-aged adults: a meta-analysis

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