Application of Screening Scale for Mild Cognitive Impairment in screening mild cognitive impairment of the elderly in rural communities in Hangzhou, Zhejiang

Abstract

Objective To investigate the prevalence of mild cognitive impairment (MCI) among the elderly in rural communities in Hangzhou, Zhejiang, and to explore the screening accuracy of Screening Scale for Mild Cognitive Impairment (sMCI) in the elderly with low education. Methods From April 2010 to September 2010, 360 elderly people in Sijiqing street, Jianggan district (now Shangcheng district), Hangzhou, Zhejiang were recruited. Dementia and MCI were judged by Mini⁃Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), sMCI and Clinical Dementia Rating Scale (CDR). Draw receiver operating characteristic (ROC) curve and calculate the area under the curve (AUC), and compare the accuracy of sMCI, MoCA and CDR scores in screening MCI. Results Finally, 171 cases completed all investigations. 1) 55 cases (32.16%) were diagnosed as MCI, including 25 cases (14.62%) of amnestic MCI (aMCI) and 30 cases of non⁃aMCI, 11 cases (6.43%) of dementia, 10 cases (5.85%) of depression, 4 cases (2.34%) of anxiety disorder, one case (0.58%) of bipolar disorder, one case (0.58%) of schizophrenia and one case (0.58%) of mental retardation. Among 154 patients with cognitive impairment, 25 cases (16.23%) were screened for dementia by MMSE, 8 cases (5.19%) were screened for dementia by CDR, and 11 cases (7.14%) were clinically confirmed; 138 cases (89.61%) of MCI were screened by MoCA, 117 cases (75.97%) by sMCI, 70 cases (45.45%) by CDR, and 55 cases (32.16%) were clinically confirmed. 2) Taking clinical diagnosis as reference standard, the ROC curve showed CDR score had the highest accuracy in screening MCI, and the AUC was 0.90 ± 0.03 (95%CI: 0.844-0.957, P=0.000); the AUC of MoCA score was 0.53 ± 0.05 (95%CI: 0.430-0.621, P=0.603); when the cut⁃off value of sMCI score was 23, the AUC was 1.00 ± 0.00 (95%CI: 1.000-1.000, P=0.000). The cut⁃off value of subjects with education level of 0-3 years was adjusted to 22, and the AUC was 0.67 ± 0.05 (95%CI: 0.578-0.756, P=0.001). 3) According to education level, they were divided into 0-3 years group (113 cases) and 4-6 years group (47 cases). Taking CDR score as the reference standard, ROC curve showed the AUC of MoCA score in screening MCI in 4-6 years group was 0.49 ± 0.17 (95%CI: 0.157-0.824, P=0.955), the cut⁃off value of sMCI score was 23, the AUC of sMCI score was 0.50 ± 0.17 (95%CI: 0.161-0.839, P=1.000); the AUC of MoCA score in the 0-3 years group was 0.51 ± 0.06 (95%CI: 0.402-0.617, P=0.858), and the cut⁃off value of sMCI score was adjusted to 22, and the AUC was 0.64 ± 0.05 (95%CI: 0.535-0.744, P=0.011). Conclusions It is more common for the elderly in the rural communities with low education to have MCI, the accuracy of sMCI in screening MCI is higher than MoCA, and the cut⁃off value is 23 (education level 4-6 years) and 22 (education level 0-3 years), which is worthy of clinical application.

doi：10.3969/j.issn.1672⁃6731.2021.12.006