[痴呆综合征筛查：匈牙利7分钟测试的经验]

Kálmán János, Boda Krisztina, Bende Zsuzsanna, Janka Zoltán

Szegedi Tudományegyetem, Altalános Orvostudományi Kar, Szent Györgyi Albert Orvos- és Gyógyszerésztudományi Centrum, Pszichiátriai Klinika.

Orv Hetil. 2003 Sep 28;144(39):1929-38.

INTRODUCTION

The screening and recognition of dementing disorders are considered as important tasks of general practitioners. Despite of the recent progress made in the treatment of cognitive, behavioral symptoms and slowing down the rate of progression, difficulties are still existing in the early detection, and the most frequent dementia forms such as Alzheimer's disease (AD) and vascular dementia (VD) are underdiagnosed in Hungary. Any rapid, easy-to-use dementia screening method therefore could be of great value in the community.

AIMS

The Hungarian standardisation of a new dementia screening tool, the 7 Minute Test (7MT) has been reported here. Accuracy, sensitivity and specificity were calculated. The authors provide new data regarding the discriminative power of this test in a variety of dementing and dementia related conditions.

METHODS

The test results of 339 probands, referred to the local memory clinic, were evaluated in all subtests, where orientation in time, memory, verbal fluency, and visuoconstructive skills are assessed. The patients were clustered into seven groups according to their clinical diagnosis, such as: Control (CNT), Mild Cognitive Impairment (MCI), AD, VD, mixed AD-VD, depression (D) and Organic Amnestic Syndrome (OAS).

RESULTS

In overall, the test successfully discriminated 77% of the CNT and all disease cases (sensitivity 85%, specificity 55%). When the AD and CNT groups were compared separately, the highest values: 91% sensitivity, 86% specificity have been found. A total score of 139 has been suggested as a cutoff value to separate CNT and dementia cases. These results suggest that the test is suitable to classify CNT and "real" dementia cases (AD, VD, mixed AD-VD), but not valid within the real dementia groups. Furthermore, it is not helpful for the identification of MCI, pseudodementia cases (D) and OAS as well.

CONCLUSION

The 7MT could be a valuable dementia screening tool in the primary care, but it is not specific for any form of dementia.

引言

痴呆症的筛查与识别被视为全科医生的重要任务。尽管在认知、行为症状治疗以及减缓疾病进展速度方面取得了最新进展，但早期检测仍存在困难，在匈牙利，最常见的痴呆症类型，如阿尔茨海默病（AD）和血管性痴呆（VD），仍未得到充分诊断。因此，任何快速、易用的痴呆症筛查方法在社区中都可能具有重要价值。

目的

本文报道了一种新的痴呆症筛查工具——7分钟测试（7MT）在匈牙利的标准化情况。计算了该测试的准确性、敏感性和特异性。作者提供了有关此测试在各种痴呆症及与痴呆症相关病症中的鉴别能力的新数据。

方法

对转诊至当地记忆诊所的339名受试者的测试结果进行了所有子测试的评估，这些子测试评估了时间定向、记忆、语言流畅性和视觉构建技能。根据临床诊断将患者分为七组，例如：对照组（CNT）、轻度认知障碍（MCI）、AD、VD、AD-VD混合型、抑郁症（D）和器质性遗忘综合征（OAS）。

结果

总体而言，该测试成功区分了77%的对照组和所有疾病病例（敏感性85%，特异性55%）。当分别比较AD组和对照组时，发现最高值：敏感性91%，特异性86%。建议以总分139作为区分对照组和痴呆症病例的临界值。这些结果表明，该测试适用于区分对照组和“真正的”痴呆症病例（AD、VD、AD-VD混合型），但在真正的痴呆症组内无效。此外，它对识别MCI、假性痴呆病例（D）和OAS也没有帮助。