蒙特利尔认知评估量表在轻度认知功能障碍诊断中的应用

目的:应用Meta分析法综合评价采用25/26为蒙特利尔认知评估量表（MoCA）诊断界值对轻度认知功能障碍（MCI）的诊断价值。方法:检索PubMed、Medline、中文科技期刊全文数据库（VIP）、中国期刊全文数据库（CNKI）和万方等数据库，检索时间为各数据库2006年1月-2011年12月发表的相关文献，收集关于MoCA诊断MCI的相关文献并进行信息统计和文献质量评估；采用Meta-Disc 1.4 软件随机效应模型进行数据分析，计算合并敏感度、特异度及似然比指标。结果:本研究共纳入13篇文章，其中英文2篇，中文11篇，共9 684例研究对象，其中经金标准诊断的MCI患者6 859例，非患者2 825例。异质性检验显示，纳入研究存在异质性，通过随机效应模型计算合并敏感度为0.98（95% CI：0.97~0.98），合并特异度为0.55（95% CI：0.53~0.57），合并阳性似然比为3.67（95% CI：2.67~5.05），合并阴性似然比为0.08（95% CI：0.03~0.18）。结论:采用25/26为MoCA界值诊断MCI时，敏感度较高，特异度较低，但是总体诊断效能较强，尚可以考虑作为我国人群MCI筛查使用的工具。鉴于其较低的特异度，建议今后针对量表本土化及界值制定进行进一步深入研究。

Diagnostic value of Montreal Cognitive Assessment in mild cognitive impairment

Objective To evaluate the diagnostic value of the Montreal Cognitive Assessment(MoCA) in mild cognitive impairment(MCI) by using 25/26 cut-off value with Meta-analysis.Methods PubMed,Medline,VIP,CNKI and WANFANG databases(from January 1 2006 to December 31 2011) were searched to collect studies which evaluated the diagnostic value of MoCA in MCI.The statistical information and quality of science were assessed and classified.The data was analyzed using Meta-Disc1.4 software.The diagnostic value of MoCA in MCI was evaluated by the pooled sensitivity,specificity,and the likelihood ratio.Results Thirteen literatures were collected including 2 in English and 11 in Chinese,and 9 684 subjects were included in the review which were grouped with 6 859 MCI patients and 2 825 cognitive normal individuals,all diagnosed by gold standard.Heterogeneity test showed that the heterogeneity was existed among the study.By using random effects models to analyze the data,the value of the weighted sensitivity was 0.98(95% CI:0.97-0.98),the specificity was 0.55(95% CI:0.53-0.57),the positive likelihood ratio was 3.67(95% CI:2.67-5.05),and the negative likelihood ratio was 0.08(95% CI:0.03-0.18).Conclusion The diagnostic ability of MoCA is good.High sensitivity and low specificity are found by using 25/26 as cut-off value.MoCA could be used as a screening test for MCI screening in Chinese population.Considering its low specificity,more detailed researches should be performed to localize this tool,and focus on its cut-off value establishment.