Crooks Valerie C, Clark Linda, Petitti Diana B, Chui Helena, Chiu Vicki
Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, Pasadena, CA91101, USA.
BMC Neurol. 2005 Apr 13;5(1):8. doi: 10.1186/1471-2377-5-8.
Many types of research on dementia and cognitive impairment require large sample sizes. Detailed in-person assessment using batteries of neuropyschologic testing is expensive. This study evaluates whether a brief telephone cognitive assessment strategy can reliably classify cognitive status when compared to an in-person "gold-standard" clinical assessment.
The gold standard assessment of cognitive status was conducted at the University of Southern California Alzheimer Disease Research Center (USC ADRC). It involved an examination of patients with a memory complaint by a neurologist or psychiatrist specializing in cognitive disorders and administration of a battery of neuropsychologic tests. The method being evaluated was a multi-staged assessment using the Telephone Interview of Cognitive Status-modified (TICSm) with patients and the Telephone Dementia Questionnaire (TDQ) with a proxy. Elderly male and female patients who had received the gold standard in-person assessment were asked to also undergo the telephone assessment. The unweighted kappa statistic was calculated to compare the gold standard and the multistage telephone assessment methods. Sensitivity for classification with dementia and specificity for classification as normal were also calculated.
Of 50 patients who underwent the gold standard assessment and were referred for telephone assessment, 38 (76%) completed the TICS. The mean age was 78.1 years and 26 (68%) were female. When comparing the gold standard assessment and the telephone method for classifying subjects as having dementia or no dementia, the sensitivity of the telephone method was 0.83 (95% confidence interval 0.36, 1.00), the specificity was 1.00 (95% confidence interval 0.89,1.00). Kappa was 0.89 (95% confidence interval 0.69, 1.000). Considering a gold-standard assessment of age-associated memory impairment as cognitive impairment, the sensitivity of the telephone approach is 0.38 (95% confidence interval 0.09, 0.76) specificity 0.96 (CI 0.45, 0.89) and kappa 0.61 (CI 0.37, 0.85).
Use of a telephone interview to identify people with dementia or cognitive impairment is a promising and relatively inexpensive strategy for identifying potential participants in intervention and clinical research studies and for classifying subjects in epidemiologic studies.
许多关于痴呆症和认知障碍的研究类型都需要大样本量。使用一系列神经心理学测试进行详细的面对面评估成本很高。本研究评估了与面对面的“金标准”临床评估相比，简短的电话认知评估策略是否能可靠地对认知状态进行分类。
认知状态的金标准评估在南加州大学阿尔茨海默病研究中心（USC ADRC）进行。这包括由专门从事认知障碍的神经科医生或精神科医生对有记忆问题的患者进行检查，并进行一系列神经心理学测试。所评估的方法是对患者使用改良的认知状态电话访谈（TICSm）以及对代理人使用电话痴呆问卷（TDQ）进行多阶段评估。接受了金标准面对面评估的老年男性和女性患者也被要求接受电话评估。计算未加权kappa统计量以比较金标准和多阶段电话评估方法。还计算了痴呆分类的敏感性和正常分类的特异性。
在50名接受了金标准评估并被转介进行电话评估的患者中，38名（76%）完成了TICSm。平均年龄为78.1岁，26名（68%）为女性。当比较金标准评估和电话方法将受试者分类为患有痴呆症或未患有痴呆症时，电话方法的敏感性为0.83（95%置信区间0.36，1.00），特异性为1.00（95%置信区间0.89，1.00）。Kappa为0.89（95%置信区间0.69，1.000）。将与年龄相关的记忆损害的金标准评估视为认知障碍时，电话方法的敏感性为0.38（95%置信区间0.09，0.76），特异性为0.96（CI 0.45，0.89），kappa为0.61（CI 0.37，0.85）。
使用电话访谈来识别患有痴呆症或认知障碍的人是一种有前景且相对便宜的策略，可用于识别干预和临床研究中的潜在参与者，以及在流行病学研究中对受试者进行分类。
