Gornemann I, Zunzunegui M V, Martínez C, Onís M D
Hospital Carlos Haya, Málaga, Spain.
Psychiatry Res. 1999 Dec 20;89(2):133-45. doi: 10.1016/s0165-1781(99)00089-x.
The objectives of this work are to assess the agreement in classifying the 10th percentile of the population with impaired cognitive function resulting from different combinations of items in the Short Portable Mental Status Questionnaire, to evaluate the effect of literacy status on the new reduced versions, and to propose items less biased by education. Three data sets of representative samples of non-institutionalized elderly (65-year-olds and older) living in urban and rural communities in Spain were analyzed. Cognitive function was assessed using either the original or a modified Spanish version of the Short Portable Mental Status Questionnaire (SPMSQ). Different combinations of items were excluded from the scale and for each resulting reduced scale the lower 10th percentile of the distribution assessed a cut-off score. Cohen's kappa was used to test the agreement between the whole scale and the reduced scales in identifying the lowest 10th percentile of people with cognitive impairment. To test the effect of literacy status, the three samples were combined. New distributions were obtained for reduced versions of the scale including the items with the highest correlation with cognitive impairment controlling for literacy status. All three samples follow a similar distribution of errors. Most kappa values obtained when excluding one or more items from the original scales were between 0.80 and 0.95, while proportion of agreement varied between 94.2% and 100%. Lack of agreement is highest when eliminating all items that represent one dimension. Shorter versions of the SPMSQ are as reliable as the complete 10-item version in identifying those at risk for cognitive dysfunction. Cut-off points differed by literacy status but remained stable regardless of the number of items included.
这项工作的目标是评估在使用简易便携式精神状态问卷中不同项目组合对认知功能受损人群的第十百分位数进行分类时的一致性，评估识字状态对新简化版本的影响，并提出受教育程度偏差较小的项目。分析了西班牙城市和农村社区中居住的非机构化老年人（65岁及以上）代表性样本的三个数据集。使用简易便携式精神状态问卷（SPMSQ）的原始版本或修改后的西班牙文版本评估认知功能。从量表中排除不同的项目组合，对于每个由此产生的简化量表，分布的下第十百分位数评估一个截止分数。使用科恩kappa检验全量表和简化量表在识别认知障碍人群最低第十百分位数方面的一致性。为了检验识字状态的影响，将三个样本合并。获得了量表简化版本的新分布，包括在控制识字状态的情况下与认知障碍相关性最高的项目。所有三个样本的误差分布相似。从原始量表中排除一个或多个项目时获得的大多数kappa值在0.80至0.95之间，而一致性比例在94.2%至100%之间变化。当消除代表一个维度的所有项目时，不一致性最高。SPMSQ的较短版本在识别认知功能障碍风险人群方面与完整的10项版本一样可靠。截止点因识字状态而异，但无论包含的项目数量如何都保持稳定。
