혈관성 인지장애 선별검사로서 Korean-Montreal Cognitive Assessment(K-MoCA)의 신뢰도, 타당도 및 규준 연구
A Reliability, Validity, and Normative Study of the Korean-Montreal Cognitive Assessment(K-MoCA) as an Instrument for Screening of Vascular Cognitive Impairment(VCI)
1
조회
0
다운로드
84
인용
0
참고문헌
키워드
초록
Montreal Cognitive Assessment(MoCA)는 원래 경도인지장애를 선별하는 검사로서 개발되었으나 NINDS-CSN 혈관성 인지장애 표준화 기준(VCIHS) 위원회(Hachinski et al., 2006)는 MoCA를 혈관성 인지장애(VCI)를 평가하는 표준 신경심리검사도구의 일부로 지정하였다. 본 연구는 “한국 VCIHS” 연구의 일환으로서 한국판 MoCA (K-MoCA)를 한국 문화와 언어적 특성을 고려한 문항들로 새롭게 구성하고, K-MoCA가 VCI의 선별검사로서 신뢰롭고 타당한지를 검증하기 위해서 수행되었다. 82명의 뇌졸중환자(평균나이 71.05±9.53세, 평균 교육년수 7.53±5.01년)와 나이와 학력이 대응이 되고 Christensen 등(1991)의 건강선별기준에 합당한 81명의 정상노인들이 본 연구에 참여하였다. 뇌졸중 환자들은 K-MoCA, K-MMSE 및 종합적인 신경심리학적 평가를 받았고 신경심리학적 평가결과와 일상생활기능척도의 결과를 종합하여 CDR이 0으로 평정된 2명을 제외한 후, CDR이 0.5로 평정된 36명을 “혈관성 인지장애가 있으나 치매가 아닌 집단(VCI-ND)”으로, CDR이 1.0이상인 44명을 혈관성치매집단(VD)으로 분류하였다. 정상노인들도 K-MoCA와 K-MMSE 검사를 받았고 검사-재검사 신뢰도를 평가하기 위하여 이들 중 29명에게는 4주 후에 K-MoCA를 다시 실시하였다. K-MoCA의 내적일치도(Cronbach's α=.84)와 검사-재검사 신뢰도는 매우 높았다(ICC=.85, p<.001). K-MoCA는 VD(r=.90, p<.001), VCI-ND(r=.84, p<.001) 및 정상노인집단(r=.79, p<.001) 모두에서 K-MMSE와 유의한 상관을 나타내었다. Receiver Operating Curve(ROC) 분석결과 K-MoCA는 VCI 집단과 정상집단을 잘 변별할 수 있음이 밝혀졌다(AUC=.80, p<.001). 더욱이 K-MoCA는 정상노인과 VD(AUC=.90, p<.001)뿐만 아니라 정상노인과 VCI-ND(AUC=.67, p<.01)도 잘 변별할 수 있고, K-MMSE보다 VCI-ND를 더 민감하게 탐지할 수 있음이 시사되었다. 본 연구의 결과들은 K-MoCA가 VCI-ND와 VD를 모두 포함하는 VCI를 선별하는데 있어 신뢰롭고 타당한 인지기능검사임을 입증하며 K-MoCA가 특히 뇌혈관질환으로 인한 경한 수준의 초기 인지기능장애를 선별하는데 유용하게 사용될 수 있을 것임을 시사한다. 끝으로, 교육수준과 나이에 따라 세분화된 K-MoCA의 정상인 규준을 제시하였고, 외국 규준과의 차이에 대하여 논의하였다.
Abstract
The Montreal Cognitive Assessment (MoCA) was originally developed as a brief screening tool for mild cognitive impairment. However, the NINDS-CSN Vascular Cognitive Impairment Harmonization Standardization working group (Hachinski et al., 2006) suggested that the MoCA would also be a useful instrument for vascular cognitive impairment (VCI). This study was conducted to examine the validity of the newly developed Korean version of the Montreal Cognitive Assessment (K-MoCA) as an instrument for screening of VCI. Eighty-two stroke patients (mean age=71.05±9.53 years, mean education=7.53±5.01 years) with confluent white matter lesions were given the K-MoCA and the K-MMSE with a comprehensive neuropsychological test battery. Among the patients, 36 had a CDR score of 0.5 (Vascular Cognitive Impairment No Dementia, VCI-ND), and 44 had a score of 1.0 or more (Vascular Dementia, VD). Eighty-one matched healthy normal controls (mean age=69.33±8.75 years, mean education =8.14±4.60 years) who met Christensen's health criteria (Christensen et al., 1991) were recruited from the community and were given the K-MoCA and K-MMSE. The K-MoCA was re-administered to 29 normal subjects with a 4-week interval for assessing the test-retest reliability. Strong correlations between the K-MoCA and the K-MMSE were found in VD (r=.90, p<.001), VCI-ND (r=.84, p<.001), and normal controls (r=.79, p<.001). Receiver Operating Curve (ROC) analysis showed that the K-MoCA effectively differentiated stroke (VCI) patients from normal controls (AUC=.80, p<.001). Moreover, it was found that the K-MoCA could differentiate the VCI-ND (AUC=.67, p<.01) as well as the VD (AUC=.90, p<.001) from normal controls, suggesting that the K-MoCA was more sensitive for detecting the VCI-ND than the K-MMSE (AUC=.63, p<.05). Both internal consistency and test-retest reliability of the K-MoCA were significantly high (Cronbach's α=.84; ICC=.85, p<.001). These results suggest that the K-MOCA can be used reliably for screening of VCI. The K-MoCA would help identify individuals in the early stage of cognitive impairment due to cerebrovascular problems. Finally, normative data for the elderly were also presented.
참고문헌 (30)
- 강연욱, "K-MMSE(Korean-Mini Mental State Examination)의 노인 규준 연구", 한국심리학회지:일반, 25(2), pp.1~12 (2006), 한국심리학회
- 강연욱, "서울신경심리검사(SNSB)" (2003), Human Brain Research & Consulting Co.
- 강연욱, "치매환자들을 대상으로 한 K-MMSE의 타당도 연구", 대한신경과학회지, 15, pp.300~307 (1997)
- 김향희, "파라다이스․한국판 웨스턴 실어증검사" (2001), 파라다이스복지재단
- 서상규, "현대한국어의 어휘빈도" (1998), 연세대학교 언어정보개발연구원
- 이관용, "우리말 범주규준조사: 본보기 산출빈도, 전형성, 그리고 세부특징 조사", 한국심리학회지: 실험 및 인지, 3, pp.131~160 (1991)
- 통계청, "사망원인통계연보(전국편)" (2008), 통계청
- Bowler, J. V., "Vascular cognitive impairment: A new concept", pp.321~337 (2002), Oxford: Oxford University Press
- Canadian Study on Health and Aging Working Group, "The incidence of dementia in Canada. Neurology", 66~73 (2000)
- Christensen, K. J., "A cognitive battery for dementia: Development and measurement characteristics", Psychological Assessment, 3, pp.168~174 (1991)
- DeCarli, C., "Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease", Journal of the Neurological Sciences, 257, pp.185~193 (2007)
- Elias, M. F., "Framingham stroke risk profile and lowered cognitive performance", Stroke, 35, pp.404~409 (2004)
- Folstein, M. F., "Mini-Mental State Examination: Clinical guide" (2001), Lutz, FL: PAR
- Folstein, M. F., "“Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician", Journal of Psychiatric Research, 12, pp.189~198 (1975)
- Fernando, M. S., "Vascular pathologies and cognition in a population- based cohort of elderly people", Journal of the Neurological Sciences, 226, pp.13~17 (2004)
- Hachinski, V., "National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards", Stroke, 37, pp.2220~2241 (2006)
- Knopman, D. S., "Vascular dementia in a population -based autopsy study", Archives of Neurology, 60, pp.569~575 (2003)
- Manly, J. J., "Literacy and cognitive decline among ethnically diverse elders", pp.219~249 (2007), New York: Taylor & Francis
- Morris,J.C, "Clinical Dementia Rating (CDR): Current version and scoring rules", Neurology, 43, pp.2412~2414 (1993)
- Nazem, S., "Montreal Cognitive Assessment Performance in Patients with Parkinson's Disease with “Normal” Global Cognition According to Mini-Mental State Examination Score", Journal of the American Geriatrics Society, 57, pp.304~308 (2009)
- Nasreddine, Z. S., "The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment", Journal of the American Geriatrics Society, 53, pp.695~699 (2005)
- Pauker, J. D, "Constructing overlapping cell tables to maximize the clinical usefulness of normative data: Rationale and an example from neuropsychology", Journal of Clinical Psychology, 44, pp.930~933 (1988)
- Petersen,R.C, "Mild cognitive impairment", Journal of Internal Medicine, 256, pp.183~194 (2004)
- Pohjasvaara, T., "Dementia three months after stroke: Baseline frequency and effect of different definitions of dementia in the Helsinki Stroke Aging Memory Study (SAM) cohort", Stroke, 28, pp.785~792 (1997)
- Popovic, I. M., "Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease", Journal of the Neurological Sciences, 257, pp.185~193 (2007)
- Rasquin, S. M. C., "Vascular mild cognitive impairment is highly prevalent after lacunar stroke but does not increase over time: A 2-year follow-up study", Dementia and Geriatric Cognitive Disorders, 24, pp.396~401 (2007)
- Román, G.. C., "Vascular cognitive disorder: A new diagnostic category updating vascular cognitive impairment and vascular dementia", Journal of the Neurological Sciences, 226, pp.81~87 (2004)
- Sachdev,P, "Vascular cognitive disorder", International Journal of Geriatric Psychiatry, 14, pp.402~403 (1999)
- Tatemichi, T. K., "Prevalence of dementia after stroke depends on diagnostic criteria", Neurology, 42, pp.413~ (1992)
- Zadikoff, C., "A comparison of the mini mental state exam to the Montreal cognitive assessment in identifying cognitive deficits in Parkinson's disease", Movement Disorders, 23, pp.297~299 (2008)