Royall D R, Mahurin R K, Gray K F
Department of Psychiatry, University of Texas Health Science Center, San Antonio 78284-7792.
J Am Geriatr Soc. 1992 Dec;40(12):1221-6. doi: 10.1111/j.1532-5415.1992.tb03646.x.
This study is a pilot validation of the Executive Interview (EXIT), a novel instrument designed to assess executive cognitive function (ECF) at the bedside.
Inter-rater reliability testing and validation using inter-group comparisons across levels of care and measures of cognition and behavior.
Forty elderly subjects randomly selected across four levels of care.
Settings ranged from independent living apartments to designated Alzheimer's Special Care units in a single 537-bed retirement community.
The EXIT: a 10-minute, 25-item interview scored from 0-50 (higher scores = greater executive dyscontrol) was administered by a physician. Subjects were also administered the Mini-Mental State Exam (MMSE) and traditional tests of "frontal" executive function by a neuropsychologist, and the Nursing Home Behavior Problem Scale (NHBPS) by Licensed Vocational Nurses.
Interrater reliability was high (r = .90). EXIT scores correlated well with other measures of ECF. The interview discriminated among residents at each level of care. In contrast, the MMSE did not discriminate apartment-dwelling from residential care residents, or residential care from nursing home residents. The EXIT was highly correlated with disruptive behaviors as measured by the NHBPS (r = .79).
These preliminary findings suggest that the EXIT is a valid and reliable instrument for the assessment of executive impairment at the bedside. It correlates well with level of care and problem behavior. It discriminates residents at earlier stages of cognitive impairment than the MMSE.
本研究是对执行功能访谈（EXIT）的初步验证，EXIT是一种旨在在床边评估执行认知功能（ECF）的新型工具。
通过跨护理级别以及认知和行为测量的组间比较进行评分者间信度测试和验证。
从四个护理级别中随机选择40名老年受试者。
环境范围从独立生活公寓到一个拥有537张床位的退休社区内指定的阿尔茨海默病特殊护理单元。
EXIT：由医生进行一次10分钟、包含25个条目的访谈，评分范围为0至50分（分数越高 = 执行功能障碍越严重）。受试者还接受了神经心理学家进行的简易精神状态检查（MMSE）和传统的“额叶”执行功能测试，以及执业职业护士进行的养老院行为问题量表（NHBPS）评估。
评分者间信度很高（r = 0.90）。EXIT分数与其他ECF测量方法相关性良好。该访谈能够区分每个护理级别的居民。相比之下，MMSE无法区分居住在公寓的居民与接受机构护理的居民，也无法区分接受机构护理的居民与养老院居民。EXIT与NHBPS所测量的破坏性行为高度相关（r = 0.79）。
这些初步研究结果表明，EXIT是一种在床边评估执行功能损害的有效且可靠的工具。它与护理级别和问题行为相关性良好。与MMSE相比，它能够在认知损害的早期阶段区分居民。
