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.
강연욱 (2006). K-MMSE(Korean-Mini Mental State Examination)의 노인 규준 연구. 한국심리학회지: 일반, 25, 1-12.
강연욱, 나덕렬 (2003). 서울신경심리검사(SNSB). 인천: Human Brain Research & Consulting Co.
강연욱, 나덕렬, 한승혜. (1997). 치매환자들을 대상으로 한 K-MMSE의 타당도 연구. 대한신경과학회지, 15, 300-307.
김향희, 나덕렬 (2001). 파라다이스․한국판 웨스턴 실어증검사. 서울: 파라다이스복지재단.
서상규 (1998). 현대한국어의 어휘빈도. 서울: 연세대학교 언어정보개발연구원
이관용 (1991). 우리말 범주규준조사: 본보기 산출빈도, 전형성, 그리고 세부특징 조사. 한국심리학회지: 실험 및 인지, 3, 131-160.
통계청 (2008). 사망원인통계연보(전국편). 서울: 통계청.
Bowler, J. V., & Hachinski, V. (2002). Vascular cognitive impairment: A new concept. In J. V. Bowler & V. Hachinski (Eds.), Vascular cognitive impairment (pp.321-337). Oxford: Oxford University Press.
Canadian Study on Health and Aging Working Group (2000). The incidence of dementia in Canada. Neurology, 55, 66-73.
Christensen, K. J., Multhaup, K. S., Nordstrom, S., & Voss, K. (1991). A cognitive battery for dementia: Development and measurement characteristics. Psychological Assessment, 3, 168-174.
DeCarli, C., Miller, B. L., Swan, G. E., Reed, T., Wolf, P. A., & Carmelli, D. (2007). Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. Journal of the Neurological Sciences, 257, 185-193.
Elias, M. F., Sullivan, L. M., D’Agostino, R. B., Elias, P. K., Beiser, A., Au, R. et al. (2004). Framingham stroke risk profile and lowered cognitive performance. Stroke, 35, 404–409.
Folstein, M. F., Folstein, S. E., & Fanjiang, G. (2001). Mini-Mental State Examination: Clinical guide. Lutz, FL: PAR.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.
Fernando, M. S., & Ince, P. G. (2004). Vascular pathologies and cognition in a population- based cohort of elderly people. Journal of the Neurological Sciences, 226, 13–17.
Hachinski, V., Iadecola, C., Petersen, R. C., Breteler, M. M., Nyenhuis, D. L., Black, S. E. et al. (2006). National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards. Stroke, 37, 2220-2241.
Knopman, D. S., Parisi, J. E., Boeve, B. F., Cha, R. H., Apaydin, H., Salviati, A., et al. (2003). Vascular dementia in a population -based autopsy study. Archives of Neurology. 60, 569-575.
Manly, J. J., Schupf, N., Tang, M., Weiss, C. C., & Stern, Y. (2007). Literacy and cognitive decline among ethnically diverse elders. In Y. Stern (Ed.), Cognitive reserve (pp. 219-249). New York: Taylor & Francis.
Morris, J. C. (1993). Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology, 43, 2412-2414.
Nazem, S., Siderowf, A. D., Duda, J. E., Have, T. T., Colcher, A., Horn, S. S. et al. (2009). 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, 304-308.
Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I. et al. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695-699.
Pauker, J. D. (1988). Constructing overlapping cell tables to maximize the clinical usefulness of normative data: Rationale and an example from neuropsychology. Journal of Clinical Psychology, 44, 930-933.
Petersen, R. C. (2004). Mild cognitive impairment. Journal of Internal Medicine, 256, 183-194.
Pohjasvaara, T., Erkinjuntti, T., Vataja, R., & Kaste, M. (1997). 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, 785–792.
Popovic, I. M., Seric, V., & Demarin, V. (2007). Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. Journal of the Neurological Sciences, 257, 185-193.
Rasquin, S. M. C., van Oostenbrugge, R. J., Verhey, F. R. J., & Lodder, J. (2007). 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, 396-401.
Román, G.. C., Sachdev, P., Royall, D. R., Bullock, R. A., Orgogozo, J. M., López-Pousa, S. et al. (2004). Vascular cognitive disorder: A new diagnostic category updating vascular cognitive impairment and vascular dementia. Journal of the Neurological Sciences, 226, 81-87.
Sachdev, P. (1999). Vascular cognitive disorder. International Journal of Geriatric Psychiatry, 14, 402-403.
Tatemichi, T. K.., Desmond, D. W., Stern, Y., Sano, M., Mayeux, R., & Andrews, H. (1992). Prevalence of dementia after stroke depends on diagnostic criteria. Neurology, 42, 413.
Zadikoff, C., Fox, S. H., Tang-Wai, D. F., Thomsen, T., de Bie, R. M., 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. Movement Disorders, 23, 297-299.