在初级保健中检测认知障碍：三种筛查工具的性能评估
Detecting cognitive impairment in primary care: performance assessment of three screening instruments.
作者信息
Trenkle Douglas L, Shankle William R, Azen Stanley P
机构信息
Maine Coast Memorial Hospital, Ellsworth, ME 04605, USA.
出版信息
J Alzheimers Dis. 2007 Jun;11(3):323-35. doi: 10.3233/jad-2007-11309.
Early detection of Alzheimer's disease and related disorders (ADRD) is important, especially in primary care settings. We compared performances of two common screening tests, the Mini-Mental State Exam (MMSE) and Clock Drawing Test (CDT), with that of the MCI Screen ({MCIS}) in 254 patients over 65. None had previous diagnosis of ADRD, and 81% were asymptomatic by Functional Assessment Staging Test ({FAST}) (FAST=1). 215 patients completed all screening tests - 141 had >or= 1 abnormal result, 121/141 completed standardized diagnostic assessment, and the remaining 74/215 (34%) screened entirely normally and weren't further evaluated. Potential bias due to unevaluated cases was statistically adjusted. Among diagnosed cases: AD=43%, cerebrovascular disease=36%, other causes=21%. Bias-adjusted MCI prevalence for FAST stages 1 and 1-3 were 13.9-20.3% and 23.0-28.3%. Bias-adjusted results for the CDT, MMSE and MCIS were: clinical diagnosis validity (kappa statistic)={-0.02 (p=0.61), 0.06 (p=0.23), 0.92 (p< 0.0001)}; sensitivity={59%, 71%, 94%}; specificity={39%, 36%, 97%}; overall accuracy={54%, 62%, 96%}; positive predictive value={16%, 17%, 86%}; and negative predictive value={83%, 87%, 96%}. The MMSE and CDT were not valid for early detection, while the MCIS had high validity and accuracy in the primary care cohort.
早期发现阿尔茨海默病及相关疾病（ADRD）很重要，尤其是在初级保健环境中。我们比较了两种常见筛查测试——简易精神状态检查表（MMSE）和画钟测试（CDT），与MCI筛查（{MCIS}）在254名65岁以上患者中的表现。这些患者之前均未被诊断为ADRD，且81%通过功能评估分期测试（{FAST}）（FAST = 1）无症状。215名患者完成了所有筛查测试——141名有≥1项异常结果，121/141名完成了标准化诊断评估，其余74/215名（34%）筛查完全正常且未作进一步评估。对未评估病例造成的潜在偏倚进行了统计学调整。在确诊病例中：阿尔茨海默病占43%，脑血管疾病占36%，其他病因占21%。FAST 1期和1 - 3期经偏倚调整后的MCI患病率分别为13.9 - 20.3%和23.0 - 28.3%。CDT、MMSE和MCIS经偏倚调整后的结果为：临床诊断效度（kappa统计量）={-0.02（p = 0.61），0.06（p = 0.23），0.92（p < 0.0001）}；敏感度={59%，71%，94%}；特异度={39%，36%，97%}；总体准确率={54%，62%，96%}；阳性预测值={16%，17%，86%}；阴性预测值={83%，87%，96%}。MMSE和CDT对于早期检测无效，而MCIS在初级保健队列中具有较高的效度和准确率。
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