Abstract
To investigate the relationship between Silent Cerebral Infarction (SCI) and cognitive impairment to testify that Montreal Cognitive Assessment (MoCA) is a more sensitive screening tool than the Mini Mental State Examination (MMSE) to identify cognitive deficits in patients with SCI. We recruited 196 individuals in Shanghai of China and divided them into 2 groups: the SCI group including 112 individuals (45 men and 67 women; aged from 43 to 70 years old) and the control group including 84 individuals (43 men and 41 women; aged from 42 to 79 years old). We collected information including participants’ gender, age, blood glucose, kidney function, blood lipids, blood pressure, Electrocardiogram (ECG), carotid artery ultrasound, MMSE score, and MoCA score. SAS software (version 9.1) was used to perform statistical analysis on physical examinations outcomes from 196 participants. Furthermore, multiple logistic regression model was built up to screen out the independent risk factors of SCI. Besides, Receiver Operator Characteristic (ROC) analysis was also used. Multivariate logistic regression analysis showed that abnormal ECG and existence of carotid artery plaques were independent risk factors of SCI occurrence, while MoCA scores was negatively associated with SCI risk. Moreover, MoCA might be more valuable in predicting vascular cognitive impairment (VCI) than MMSE (0.667 vs 0.626). We found that the MMSE was generally insensitive to detect cognitive impairment; but the MoCA has a good balance of sensitivity and specificity at the cut-score of 26. We found that the patients with SCI might accompany with VCI and the MoCA appeared to be an excellent screening test for patients with SCI, worthy of being promoted in the clinical practitioning on Chinese population.
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References
Gill DJ, Freshman A, Blender JA, Ravina B (2008) The Montreal cognitive assessment as a screening tool for cognitive impairment in Parkinson’s disease. Mov Disord 23(7):1043–1046
Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148(3):839–843
Katzman R, Zhang MY, Ouang-Ya-Qu, Wang ZY, Liu WT, Yu E et al (1988) A Chinese version of the Mini-Mental State Examination; impact of illiteracy in a Shanghai dementia survey. J Clin Epidemiol 41(10):971–978
Koga H, Takashima Y, Murakawa R, Uchino A, Yuzuriha T, Yao H (2009) Cognitive consequences of multiple lacunes and leukoaraiosis as vascular cognitive impairment in community-dwelling elderly individuals. J Stroke Cerebrovasc Dis 18(1):32–37
Lee SC, Park SJ, Ki HK, Gwon HC, Chung CS, Byun HS et al (2000) Prevalence and risk factors of silent cerebral infarction in apparently normal adults. Hypertension 36(1):73–77
Lee JY, Dong Woo Lee, Cho SJ, Na DL, Hong Jin Jeon, Kim SK et al (2008) Brief screening for mild cognitive impairment in elderly outpatient clinic: validation of the Korean version of the Montreal Cognitive Assessment. J Geriatr Psychiatry Neurol 21(2):104–110.
Luis CA, Keegan AP, Mullan M (2009) Cross validation of the Montreal Cognitive Assessment in community dwelling older adults residing in the Southeastern US. Int J Geriatr Psychiatry 24(2):197–201
Nasreddine ZS, Phillips NA, Bédirian V et al (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699
National Institute of Neurological Disorders and Stroke Ad Hoc Committee (1990) Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. Stroke 21(4):637–676
Nazem S, Siderowf AD, Duda JE, Have TT, Colcher A, Horn SS et al (2009) Montreal cognitive assessment performance in patients with Parkinson’s disease with “normal” global cognition according to mini-mental state examination score. J Am Geriatr Soc 57(2):304–308
O’Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L et al (2003) Vascular cognitive impairment. Lancet Neurol 2(2):89–98
Olson RA, Chhanabhai T, McKenzie M (2008) Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases. Support Care Cancer 16(11):1273–1278
Popović IM, Serić V, Demarin V (2007) Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. J Neurol Sci 257(1–2):185–193
Smith T, Gildeh N, Holmes C (2007) The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. Can J Psychiatry 52(5):329–332
The group of consensus on vascular cognitive impairments (2007) Consensus on vascular cognitive impairments. Chinese J Intern Med (in Chinese) 12:24–30
Tombaugh TN, McIntyre NJ (1992) The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40(9):922–935
Trenkle DL, Shankle WR, Azen SP (2007) Detecting cognitive impairment in primary care: performance assessment of three screening instruments. J Alzheimers Dis 11(3):323–335
Vermeer SE, Koudstaal PJ, Oudkerk M, Hofman A, Breteler MM (2002) Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke 33(1):21–25
Vermeer SE, Longstreth WT Jr, Koudstaal PJ (2007) Silent brain infarcts: a systematic review. Lancet Neurol 6(7):611–619
Wong A, Xiong YY, Kwan PW, Chan AY, Lam WW, Wang K et al (2009) The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dement Geriatr Cogn Disord 28(1):81–87
Yatsu FM, Shaltoni HM (2004) Implications of silent strokes. Curr Atheroscler Rep 6(4):307–313
Zadikoff C, Fox SH, Tang-Wai DF, Thomsen T, de Bie RM, Wadia P et al (2008) A comparison of the mini mental state exam to the Montreal cognitive assessment in identifying cognitive deficits in Parkinson’s disease. Mov Disord 23(2):297–299
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This study was granted by Shanghai Key Discipline Program (No.S30202), Shanghai Key Project of Basic Science Research (No.09DZ1950400), Shanghai Natural Scientific Fund (No.09JC1416402, 09ZR1419100), and Program for Outstanding Medical Academic Leader (No.LJ 06003).
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Jing Zhao and Huidong Tang contributed equally to this work.
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Zhao, J., Tang, H., Sun, J. et al. Analysis of cognitive dysfunction with silent cerebral infarction: a prospective study in Chinese patients. Metab Brain Dis 27, 17–22 (2012). https://doi.org/10.1007/s11011-011-9275-5
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DOI: https://doi.org/10.1007/s11011-011-9275-5