Li Minglei, Ng Tze Pin, Kua Ee Heok, Ko Soo Meng
Gerontological Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore.
Dement Geriatr Cogn Disord. 2006;21(5-6):392-402. doi: 10.1159/000092808. Epub 2006 Apr 25.
BACKGROUND/AIMS: Recent research has attempted combinations of instruments to improve screening accuracy for mild cognitive impairment (MCI) and early Alzheimer's disease (AD). We compared Mini-Mental State Examination (MMSE), Immediate and Delayed Recall (Logical Memory I and II; LM-I and LM-II, respectively), a single-item informant report of memory problem (IRMP), and a four-item Instrumental Activities of Daily Living (4IADL) scale, and combinations of these tests.
The tests were administered together with Clinical Dementia Rating (CDR) to subjects who were cognitively intact (CDR = 0, n = 88), and with diagnoses of MCI (CDR = 0.5, n = 37) and early AD (CDR = 1-2, n = 19).
Screening accuracy (receiver operating characteristic area under curve, AUC) for identifying MCI or MCI-AD was lowest for MMSE (AUC 67.6% for MCI or 77.9% for MCI-AD), and better for IRMP (79.5 or 83.2%), 4IADL (76.9 or 84.7%), LM-I (81.2 or 87.1%) and LM-II (86.1 or 90.8%). Combining IRMP, 4IADL and LM-II was most accurate (AUC 91.7% for MCI or 94.5% for MCI-AD); sensitivity: 86.5 or 89.3%; specificity: 86.4 or 88.6%. However, combining IRMP and 4IADL gave nearly as good accuracy (AUC 87.2 or 91.6%); sensitivity: 86.5 or 85.7%; specificity: 79.5 or 85.2%.
A brief instrument combining an IRMP and 4IADL items is potentially useful in screening for MCI and early AD.
背景/目的：最近的研究尝试联合使用多种工具，以提高对轻度认知障碍（MCI）和早期阿尔茨海默病（AD）的筛查准确性。我们比较了简易精神状态检查表（MMSE）、即时与延迟回忆（分别为逻辑记忆I和II；LM-I和LM-II）、关于记忆问题的单项 informant 报告（IRMP）以及四项日常工具性活动（4IADL）量表，以及这些测试的组合。
将这些测试与临床痴呆评定量表（CDR）一起施用于认知功能正常的受试者（CDR = 0，n = 88），以及被诊断为MCI（CDR = 0.5，n = 37）和早期AD（CDR = 1 - 2，n = 19）的受试者。
用于识别MCI或MCI-AD的筛查准确性（曲线下面积，AUC），MMSE最低（MCI时AUC为67.6%，MCI-AD时为77.9%），而IRMP（79.5%或83.2%）、4IADL（76.9%或84.7%）、LM-I（81.2%或87.1%）和LM-II（86.1%或90.8%）的准确性更高。联合使用IRMP、4IADL和LM-II最为准确（MCI时AUC为91.7%，MCI-AD时为94.5%）；敏感性：86.5%或89.3%；特异性：86.4%或88.6%。然而，联合使用IRMP和4IADL的准确性几乎与之相当（AUC为87.2%或91.6%）；敏感性：86.5%或85.7%；特异性：79.5%或85.2%。
一种结合IRMP和4IADL项目的简短工具在筛查MCI和早期AD方面可能有用。
