Harvan Jennifer R, Cotter Valeriet
School of Nursing, University of Pennsylvania, Philadelphia, USA.
J Am Acad Nurse Pract. 2006 Aug;18(8):351-60. doi: 10.1111/j.1745-7599.2006.00137.x.
To evaluate current screening methods for dementia to determine the most accurate and efficient tools for use in primary care.
Search included the following: Medline, CINAHL, BIOSIS, PsycINFO, ISI Web of Science, and Health & Psychosocial Instruments (1840-2005). The following search terms were used: screen, screening, tools, Mini Mental, MMSE, clock drawing, subjective memory, assessment, diagnosis, primary care, outpatient, community based, ambulatory care, dementia, cognitive impairment, and memory impairment. There was no limit to publication year. Articles excluded were those not published in English and those which used screening tools as part of diagnostic evaluation. The search revealed 581 relevant articles, which were narrowed to 20.
The Mini Mental State Examination (MMSE) has high sensitivity and specificity in outpatients older than 65 years when age- and education-specific cutoffs are used. The clock drawing test has lower sensitivity and specificity when used alone; however, in combination with the MMSE, its sensitivity is higher than that of the MMSE while specificity is slightly lower. Subjective memory complaints contribute diagnostic information; however, objective memory performance is a stronger predictor of future dementia. All measures are subject to influence by age, education, and other physical factors. The body of evidence regarding dementia screening methods has increased in recent years. The studies have been well conducted, of large sample size, in various geographic locations and populations, and by numerous investigators.
Dementing illnesses will become a common presentation in primary care. Currently, routine screening is not conducted although acceptable instruments, such as the MMSE, are available. Additional research on routine screening in primary care to bolster the current evidence, use of nurses as evaluators of cognition, and utilization of specialists is needed.
评估当前用于痴呆症的筛查方法，以确定在初级保健中使用的最准确、高效的工具。
检索包括以下内容：医学索引数据库（Medline）、护理学与健康领域数据库（CINAHL）、生物学文摘数据库（BIOSIS）、心理学文摘数据库（PsycINFO）、科学引文索引数据库（ISI Web of Science）以及健康与心理社会测量工具数据库（Health & Psychosocial Instruments，1840 - 2005）。使用了以下检索词：筛查、筛选工具、简易精神状态检查表、MMSE、画钟试验、主观记忆、评估、诊断、初级保健、门诊病人、基于社区的、非卧床护理、痴呆症、认知障碍和记忆障碍。对发表年份没有限制。排除的文章包括非英文发表的文章以及将筛查工具用作诊断评估一部分的文章。检索共发现581篇相关文章，最终筛选出20篇。
当使用针对年龄和教育程度的特定临界值时，简易精神状态检查表（MMSE）在65岁以上门诊患者中具有较高的敏感性和特异性。单独使用画钟试验时，其敏感性和特异性较低；然而，与MMSE联合使用时，其敏感性高于MMSE，而特异性略低。主观记忆主诉有助于提供诊断信息；然而，客观记忆表现是未来患痴呆症的更强预测指标。所有测量指标均受年龄、教育程度和其他身体因素的影响。近年来，关于痴呆症筛查方法的证据量有所增加。这些研究开展得很好，样本量大，涉及不同地理位置和人群，且由众多研究者进行。
痴呆症将成为初级保健中的常见病症。目前，尽管有像MMSE这样可接受的工具，但尚未进行常规筛查。需要对初级保健中的常规筛查进行更多研究，以加强现有证据，利用护士作为认知评估者，并利用专科医生的资源。
