認知機能低下の鑑別における日本語版Montoreal Cognitive Assessment（MoCA-J）の特性
認知症診療において臨床検査技師も積極的に神経心理学的検査を行うようになっている。その中に，軽度認知障害（mild cognitive impairment; MCI）の評価スケールとして開発された日本語版Montoreal Cognitive Assessment（MoCA-J）がある。今回，MoCA-Jの特性を検証するため，当院外来でMoCA-Jを施行した患者75名を対象とし，リスク因子との関連を頭部MRI所見を含めて後方視的に解析した。また認知症疾患ごとにMoCA-Jサブスコアでの検討を行った。平均年齢74.6 ± 9.1歳，MoCA-J中央値21（最小値8，最大値30）であった。認知機能...
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| Published in | 医学検査 Vol. 69; no. 4; pp. 527 - 533 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本臨床衛生検査技師会
25.10.2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0915-8669 2188-5346 |
| DOI | 10.14932/jamt.20-8 |
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| Abstract | 認知症診療において臨床検査技師も積極的に神経心理学的検査を行うようになっている。その中に，軽度認知障害（mild cognitive impairment; MCI）の評価スケールとして開発された日本語版Montoreal Cognitive Assessment（MoCA-J）がある。今回，MoCA-Jの特性を検証するため，当院外来でMoCA-Jを施行した患者75名を対象とし，リスク因子との関連を頭部MRI所見を含めて後方視的に解析した。また認知症疾患ごとにMoCA-Jサブスコアでの検討を行った。平均年齢74.6 ± 9.1歳，MoCA-J中央値21（最小値8，最大値30）であった。認知機能正常者においてMoCA-Jと関連する因子の多変量解析を行ったところ，脳室周囲高信号域（periventricular hyperintensity; PVH）は有意に独立した相関因子であった。疾患毎のMoCA-Jサブスコアの比較を行ったところ，血管性認知症では注意・遂行において正答率の低値が認められた。また，記憶の正答率は認知機能正常者も含めてすべての群で低かったが，認知機能正常者，MCI，認知症の順で 顕著に低下していた。MoCA-Jは特に前頭葉機能を反映する注意・遂行の配点が高いことが特徴である。その点を踏まえて脳画像所見との比較や認知機能低下の鑑別に活用する意義は大きいと考えられた。 |
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| AbstractList | 認知症診療において臨床検査技師も積極的に神経心理学的検査を行うようになっている。その中に，軽度認知障害（mild cognitive impairment; MCI）の評価スケールとして開発された日本語版Montoreal Cognitive Assessment（MoCA-J）がある。今回，MoCA-Jの特性を検証するため，当院外来でMoCA-Jを施行した患者75名を対象とし，リスク因子との関連を頭部MRI所見を含めて後方視的に解析した。また認知症疾患ごとにMoCA-Jサブスコアでの検討を行った。平均年齢74.6 ± 9.1歳，MoCA-J中央値21（最小値8，最大値30）であった。認知機能正常者においてMoCA-Jと関連する因子の多変量解析を行ったところ，脳室周囲高信号域（periventricular hyperintensity; PVH）は有意に独立した相関因子であった。疾患毎のMoCA-Jサブスコアの比較を行ったところ，血管性認知症では注意・遂行において正答率の低値が認められた。また，記憶の正答率は認知機能正常者も含めてすべての群で低かったが，認知機能正常者，MCI，認知症の順で 顕著に低下していた。MoCA-Jは特に前頭葉機能を反映する注意・遂行の配点が高いことが特徴である。その点を踏まえて脳画像所見との比較や認知機能低下の鑑別に活用する意義は大きいと考えられた。 |
| Author | 福田, 雅子 西野, 真佐美 今村, 栄次 若林, 伸一 平田, 明子 小川, 加菜美 中森, 正博 |
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| References | 2) Fujiwara Y et al.: “Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive Assessment,” Geriatr Gerontol Int, 2010; 10: 225–232. 8) McKhann GM et al.: “The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease,” Alzheimers Dement, 2011; 7: 263–269. 19) Roalf DR et al.: “Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging,” Alzheimers Dement, 2013; 9: 529–537. 14) Wardlaw JM et al.: “Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia?” Stroke, 2003; 34: 806–812. 18) Kandiah N et al.: “Montreal Cognitive Assessment for the screening and prediction of cognitive decline in early Parkinson’s disease,” Parkinsonism Relat Disord, 2014; 20: 1145–1148. 16) Bolandzadeh N et al.: “The association between cognitive function and white matter lesion location in older adults: A systematic review,” BMC Neurol, 2012; 12: 126. 11) Pantoni L et al.: “Pathogenesis of leukoaraiosis: A review,” Stroke, 1997; 28: 652–659. 17) Ghafar MZAA et al.: “Cognitive screening instruments to identify vascular cognitive impairment: A systematic review,” Int J Geriatr Psychiatry, 2019; 34: 1114–1127. 5) Staekenborg SS et al.: “Behavioural and psychological symptoms are not related to white matter hyperintensities and medial temporal lobe atrophy in Alzheimer’s disease,” Int J Geriatr Psychiatry, 2008; 23: 387–392. 7) Hirata Y et al.: “Voxel-based morphometry to discriminate early Alzheimer’s disease from controls,” Neurosci Lett, 2005; 382: 269–274. 1) 西野, 真佐美，他：「MMSEと時計描画テストのスコアリングは認知症診断精度を向上させる」，医学検査，2019; 68: 424–429. 4) Fazekas F et al.: “MR signal abnormalities at 1.5T in Alzheimer’s dementia and normal aging,” AJNR, 1987; 8: 421–426. 15) Yao H et al.: “Leukoaraiosis and dementia in hypertensive patients,” Stroke, 1992; 23: 1673–1677. 12) Pantoni L: “Cerebral small vessel disease: From pathogenesis and clinical characteristics to therapeutic challenges,” The Lancet Neurology, 2010; 9: 689–701. 13) Kalaria RN: “Cerebrovascular disease and mechanisms of cognitive impairment: Evidence from clinicopathological studies in humans,” Stroke, 2012; 43: 2526–2534. 6) Gregoire SM et al.: “The Microbleed Anatomical Rating Scale (MARS),” Neurology, 2009; 73: 1759–1766. 9) Albert MS et al.: “The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease,” Alzheimers Dement, 2011; 7: 270–279. 10) Roman GC et al.: “Vascular dementia: Diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop,” Neurology, 1993; 43: 250–260. 3) Murakami H et al.: “Usefulness differs between the visual assessment and specific binding ratio of 123I-ioflupane SPECT in assessing clinical symptoms of drug-naïve Parkinson’s disease patients,” Front Aging Neurosci, 2018; 10: 412. |
| References_xml | – reference: 10) Roman GC et al.: “Vascular dementia: Diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop,” Neurology, 1993; 43: 250–260. – reference: 18) Kandiah N et al.: “Montreal Cognitive Assessment for the screening and prediction of cognitive decline in early Parkinson’s disease,” Parkinsonism Relat Disord, 2014; 20: 1145–1148. – reference: 7) Hirata Y et al.: “Voxel-based morphometry to discriminate early Alzheimer’s disease from controls,” Neurosci Lett, 2005; 382: 269–274. – reference: 14) Wardlaw JM et al.: “Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia?” Stroke, 2003; 34: 806–812. – reference: 4) Fazekas F et al.: “MR signal abnormalities at 1.5T in Alzheimer’s dementia and normal aging,” AJNR, 1987; 8: 421–426. – reference: 13) Kalaria RN: “Cerebrovascular disease and mechanisms of cognitive impairment: Evidence from clinicopathological studies in humans,” Stroke, 2012; 43: 2526–2534. – reference: 1) 西野, 真佐美，他：「MMSEと時計描画テストのスコアリングは認知症診断精度を向上させる」，医学検査，2019; 68: 424–429. – reference: 9) Albert MS et al.: “The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease,” Alzheimers Dement, 2011; 7: 270–279. – reference: 19) Roalf DR et al.: “Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging,” Alzheimers Dement, 2013; 9: 529–537. – reference: 2) Fujiwara Y et al.: “Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive Assessment,” Geriatr Gerontol Int, 2010; 10: 225–232. – reference: 5) Staekenborg SS et al.: “Behavioural and psychological symptoms are not related to white matter hyperintensities and medial temporal lobe atrophy in Alzheimer’s disease,” Int J Geriatr Psychiatry, 2008; 23: 387–392. – reference: 8) McKhann GM et al.: “The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease,” Alzheimers Dement, 2011; 7: 263–269. – reference: 16) Bolandzadeh N et al.: “The association between cognitive function and white matter lesion location in older adults: A systematic review,” BMC Neurol, 2012; 12: 126. – reference: 15) Yao H et al.: “Leukoaraiosis and dementia in hypertensive patients,” Stroke, 1992; 23: 1673–1677. – reference: 17) Ghafar MZAA et al.: “Cognitive screening instruments to identify vascular cognitive impairment: A systematic review,” Int J Geriatr Psychiatry, 2019; 34: 1114–1127. – reference: 11) Pantoni L et al.: “Pathogenesis of leukoaraiosis: A review,” Stroke, 1997; 28: 652–659. – reference: 6) Gregoire SM et al.: “The Microbleed Anatomical Rating Scale (MARS),” Neurology, 2009; 73: 1759–1766. – reference: 12) Pantoni L: “Cerebral small vessel disease: From pathogenesis and clinical characteristics to therapeutic challenges,” The Lancet Neurology, 2010; 9: 689–701. – reference: 3) Murakami H et al.: “Usefulness differs between the visual assessment and specific binding ratio of 123I-ioflupane SPECT in assessing clinical symptoms of drug-naïve Parkinson’s disease patients,” Front Aging Neurosci, 2018; 10: 412. |
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| SubjectTerms | 日本語版Montoreal Cognitive Assessment 神経心理学的検査 認定認知症領域検査技師制度 認知症スクリーニング |
| Title | 認知機能低下の鑑別における日本語版Montoreal Cognitive Assessment（MoCA-J）の特性 |
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