蒙特利尔认知评估在筛查初住院COVID-19患者认知功能障碍中的诊断准确性:来自前瞻性多中心NeNeSCo研究的结果

IF 2.6 4区 心理学 Q2 CLINICAL NEUROLOGY Journal of the International Neuropsychological Society Pub Date : 2025-01-03 DOI:10.1017/S1355617724000675
Simona Klinkhammer, Esmée Verwijk, Gert Geurtsen, Annelien A Duits, Georgios Matopoulos, Johanna M A Visser-Meily, Janneke Horn, Arjen J C Slooter, Caroline M van Heugten
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引用次数: 0

摘要

目的:探讨重症COVID-19患者认知功能障碍的患病率和性质,以及蒙特利尔认知评估(MoCA)检测认知功能障碍的有效性。方法:采用综合多领域神经心理测试系统,对荷兰6家医院第一波(2020年3月至6月)住院的COVID-19患者出院后9个月的认知能力进行评估。测试成绩根据性别、年龄和教育程度的差异进行了校正,并转化为z分数。每个认知领域内的得分被平均并分为平均以上(z-score≥-0.84)、低平均(z-score -1.28至-0.84)、低于平均(z-score -1.65至-1.28)和极低(z-score < -1.65)。如果至少有一个域的z-score低于-1.65,则将患者分类为认知障碍。结果:12.1%(24/199)的患者存在认知障碍,言语记忆和思维速度受到的影响最大(分别为6.5%和7%,低于-1.65)。MoCA曲线下面积为0.84。原始临界值显示敏感性为83%,特异性为66%。结论:首次住院的COVID-19患者认知功能障碍患病率低于最初预期。言语记忆和处理速度主要受到影响。MoCA是一种有价值的筛查工具,可以将MoCA的截止值降低到
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Diagnostic accuracy of the Montreal Cognitive Assessment in screening for cognitive impairment in initially hospitalized COVID-19 patients: Findings from the prospective multicenter NeNeSCo study.

Objective: This study aimed to investigate the prevalence and nature of cognitive impairment among severely ill COVID-19 patients and the effectiveness of the Montreal Cognitive Assessment (MoCA) in detecting it.

Method: We evaluated cognition in COVID-19 patients hospitalized during the first wave (March to June 2020) from six Dutch hospitals, nine months post-discharge, using a comprehensive multi-domain neuropsychological test battery. Test performance was corrected for sex, age, and education differences and transformed into z-scores. Scores within each cognitive domain were averaged and categorized as average and above (z-score ≥ -0.84), low average (z-score -1.28 to -0.84), below average (z-score -1.65 to -1.28), and exceptionally low (z-score < -1.65). Patients were classified with cognitive impairment if at least one domain's z-score fell below -1.65. We assessed the MoCA's accuracy using both the original cutoff (<26) and an "optimal" cutoff determined by Youden's index.

Results: Cognitive impairment was found in 12.1% (24/199) of patients, with verbal memory and mental speed most affected (6.5% and 7% below -1.65, respectively). The MoCA had an area under the curve of 0.84. The original cutoff showed sensitivity of 83% and specificity of 66%. Using the identified optimal cutoff of <24, maintained sensitivity while improving specificity to 81%.

Conclusions: Cognitive impairment prevalence in initially hospitalized COVID-19 patients is lower than initially expected. Verbal memory and processing speed are primarily affected. The MoCA is a valuable screening tool for these impairments and lowering the MoCA cutoff to <24 improves specificity.

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来源期刊
CiteScore
5.40
自引率
3.80%
发文量
185
审稿时长
4-8 weeks
期刊介绍: The Journal of the International Neuropsychological Society is the official journal of the International Neuropsychological Society, an organization of over 4,500 international members from a variety of disciplines. The Journal of the International Neuropsychological Society welcomes original, creative, high quality research papers covering all areas of neuropsychology. The focus of articles may be primarily experimental, applied, or clinical. Contributions will broadly reflect the interest of all areas of neuropsychology, including but not limited to: development of cognitive processes, brain-behavior relationships, adult and pediatric neuropsychology, neurobehavioral syndromes (such as aphasia or apraxia), and the interfaces of neuropsychology with related areas such as behavioral neurology, neuropsychiatry, genetics, and cognitive neuroscience. Papers that utilize behavioral, neuroimaging, and electrophysiological measures are appropriate. To assure maximum flexibility and to promote diverse mechanisms of scholarly communication, the following formats are available in addition to a Regular Research Article: Brief Communication is a shorter research article; Rapid Communication is intended for "fast breaking" new work that does not yet justify a full length article and is placed on a fast review track; Case Report is a theoretically important and unique case study; Critical Review and Short Review are thoughtful considerations of topics of importance to neuropsychology and include meta-analyses; Dialogue provides a forum for publishing two distinct positions on controversial issues in a point-counterpoint format; Special Issue and Special Section consist of several articles linked thematically; Letter to the Editor responds to recent articles published in the Journal of the International Neuropsychological Society; and Book Review, which is considered but is no longer solicited.
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