Lorentz Wendy J, Scanlan James M, Borson Soo
University of Washington School of Medicine, Seattle, Washington, USA.
Can J Psychiatry. 2002 Oct;47(8):723-33. doi: 10.1177/070674370204700803.
To compare brief dementia screening tests as candidates for routine use in primary care practice.
We selected screening tests that met 2 criteria: 1) administration time of 10 minutes or less in studies including individuals with, and without, dementia; and 2) performance characteristics evaluated in at least 1 community or clinical sample of older adults. We compared tests for face validity, sensitivity, and specificity in a clearly defined subject sample; for vulnerability to sociodemographic biases unrelated to dementia; for direct comparison with an accepted standard; for acceptability to patients and doctors; and for brevity and ease of administration, scoring, and interpretation by nonspecialists.
Thirteen instruments met our inclusion criteria. Very short tests (1 minute or less) proved unacceptable by several criteria. Standard instruments requiring more than 5 minutes to complete, including the best-studied Mini-Mental State Examination (MMSE), were found to be too long for routine application. Several failed other performance tests or could not be adequately assessed. Short tests taking between 2 and 5 minutes that can be administered by nonspecialists with little or no training and are relatively unbiased by language and education level appear to be superior to both shorter and longer instruments.
Three tests showed the most promise for broad application in primary care settings: the Mini-Cog, the Memory Impairment Screen, and the General Practitioner Assessment of Cognition (GPCOG). Formal practice intervention trials are now needed to validate the utility of short screens with regard to implementation, effect on rates of diagnosis and treatment of dementia patients, and outcomes for patients, families, and health care systems.
比较用于基层医疗实践中常规使用的简易痴呆筛查测试。
我们选择了符合两个标准的筛查测试：1）在包括有和没有痴呆症个体的研究中，测试用时为10分钟或更短；2）在至少一个老年人社区或临床样本中评估了其性能特征。我们在一个明确界定的受试者样本中比较了测试的表面效度、敏感性和特异性；比较了它们对与痴呆症无关的社会人口统计学偏差的易感性；比较了与公认标准的直接对比情况；比较了患者和医生对其的接受程度；还比较了其简洁性以及非专业人员进行测试、评分和解读的难易程度。
十三种工具符合我们的纳入标准。极短的测试（1分钟或更短）在几个标准方面被证明不可接受。需要超过5分钟才能完成的标准工具，包括研究最多的简易精神状态检查表（MMSE），被发现对于常规应用来说太长了。有几种工具在其他性能测试中失败，或者无法得到充分评估。用时在2到5分钟之间的简短测试，非专业人员几乎无需培训或稍加培训即可进行，并且相对不受语言和教育水平的影响，似乎优于更短和更长的工具。
三种测试在基层医疗环境中广泛应用最具潜力：简易认知测试（Mini-Cog）、记忆损害筛查测试（Memory Impairment Screen）和全科医生认知评估（GPCOG）。现在需要进行正式的实践干预试验，以验证简短筛查在实施、对痴呆症患者诊断和治疗率的影响以及对患者、家庭和医疗保健系统的结局方面的效用。
