Rosenman S
NH & MRC Social Psychiatry Research Unit, Australian National University, Canberra.
Psychol Med. 1991 Nov;21(4):923-34. doi: 10.1017/s0033291700029913.
Five operational methods for clinical diagnosis of mild dementia were compared to find out their diagnostic concordance when applied to a single group of seventy-five subjects. The clinical validity of the diagnoses was assessed in terms of their capacity to predict continued cognitive deterioration over three years after diagnosis and their capacity to reject the diagnostic influence of 'non-dementia' factors (that is, the cognitive consequences of depression, poor intellect, limited education and non-neurological physical illness). By all criteria of clinical validity the diagnostic methods for mild dementia performed poorly. Kappas measuring agreement between methods averaged only 0.15 and up to 57% of diagnostic deviance was explained by 'non-dementia' factors. Prediction of continued deterioration was poor, with a false positive rate which was too high for the diagnoses to be clinically usable. By no criterion of validity did the diagnostic methods exceed the performance of a clinician's judgement of the presence of pathological cognitive impairment or diagnosis by a cutpoint on the Mini-Mental State Examination.
对轻度痴呆临床诊断的五种操作方法进行了比较，以找出将其应用于一组75名受试者时的诊断一致性。根据诊断预测诊断后三年内持续认知衰退的能力以及排除“非痴呆”因素（即抑郁症、智力低下、教育程度有限和非神经性身体疾病的认知后果）的诊断影响的能力，评估诊断的临床有效性。按照所有临床有效性标准，轻度痴呆的诊断方法表现不佳。衡量方法之间一致性的卡帕值平均仅为0.15，高达57%的诊断偏差可由“非痴呆”因素解释。对持续衰退的预测很差，假阳性率过高，以至于这些诊断在临床上无法使用。按照任何有效性标准，这些诊断方法都没有超过临床医生对病理性认知障碍存在情况的判断或通过简易精神状态检查表的切点进行诊断的表现。
