Background: Dementia is one of the most distressing and burdensome health problems associated with Parkinson's Disease (PD). The Montreal Cognitive Assessment scale (MoCA) is widely used to screen for dementia in PD patients, but the appropriate diagnostic cutoff score when used with Chinese PD patients is not known.
Aim: Determine a diagnostic cutoff value of the Chinese version of the MoCA (MoCA-C) for Chinese PD patients and describe the characteristics of PD patients screened positive for dementia using the MoCA-C.
Methods: The presence of dementia in 616 PD patients and 85 community controls was determined using the Movement Disorder Society Task Force criteria (the gold standard diagnosis). We administered the MoCA-C to these individuals and used a receiver operating characteristic (ROC) curve to identify the cutoff score of the MoCA-C that most efficiently identified dementia in both PD patients and community controls. Demographic and clinical characteristics of PD patients who were screened positive or negative for dementia using the MoCA-C were compared.
Results: A MoCA-C score of 23 was the optimal cutoff score for dementia in both patients and controls. Using this cutoff score, the sensitivity and specificity of the MoCA-C in PD patients were 0.70 and 0.77, respectively; the positive and negative predictive values were 0.59 and 0.85, respectively; and the overall concordance (kappa [95% confidence interval]) was 0.45 (0.39-0.52). The corresponding kappa value (concordance) in community controls was only 0.25 (0.05-0.45). Compared to PD patients who screened negative for dementia, those who screened positive for dementia were significantly impaired in all cognitive domains, including visuospatial and executive functioning, naming, attention, language, abstraction, delayed recall and orientation (all p<0.001). Among the PD patients, screening positive for dementia was independently associated with old age, low educational attainment, female gender and more severe motor impairment.
Conclusions: The commonly recommended cutoff screening score for dementia of 26 on the MoCA it too high for PD patients in China; a cutoff score of 23 is more appropriate. Potential risk factors for dementia in Chinese PD patients include older age, less education, and more severe motor symptoms of PD.
背景: 痴呆是帕金森氏病(PD)相关的最痛苦和最繁重的健康问题之一。蒙特利尔认知评估量表(MOCA)被广泛用于帕金森氏症患者的痴呆筛查，但是不知道怎样的诊断划界分适用于中国的帕金森病患者。
目的: 确定中国版蒙特利尔认知评估量表(MoCA-C)在中国帕金森氏症患者中的诊断划界分和了解经MoCA-C筛查痴呆阳性的帕金森氏症患者的特征
方法: 采用运动障碍学会工作组标准(金标准诊断)确定616例 PD患者和85名社区对照中是否存在痴呆。我们对这些人进行了MoCA-C测试，并运用受试者工作特征(ROC)曲线来确定能够最有效地识别帕金森氏症患者和社区对照中痴呆的MoCA-C划界分。比较经MoCA-C筛查为痴呆阳性与阴性的PD患者的人口学和临床特征。
结果: MoCA-C 23分是诊断帕金森氏患者及对照组痴呆的最佳划界分。使用该划界分，PD患者的MoCA-C敏感性和特异性分别为0.70和0.77，阳性和阴性预测值分别为0.59和0.85，整体一致性(kappa [95% 可信区间])为0.45 (0.39-0.52)。社区对照相应的kappa值 (一致性)仅为0.25 (0.05-0.45)。与筛查为痴呆阴性的PD患者相比，筛查为痴呆阳性的PD患者所有认知功能都有显著受损，包括视觉空间和执行功能，命名，注意力，语言，抽象，延迟回忆和定向 (均P<0.001)。在帕金森氏症患者中，筛查为痴呆阳性与年老，文化程度低，女性以及严重运动障碍独立相关。
结论: 通常建议的痴呆划界分26对于中国帕金森病患者来说过高；23分划界分更加合适。中国的帕金森氏症患者发生痴呆的可能危险因素包括年龄，文化程度较低，以及PD严重的运动障碍症状。