Hensel Anke, Luck Tobias, Luppa Melanie, Glaesmer Heide, Angermeyer Matthias C, Riedel-Heller Steffi G
Department of Psychiatry, Public Health, University of Leipzig, Leipzig, Germany.
Dement Geriatr Cogn Disord. 2009;27(1):50-8. doi: 10.1159/000189267. Epub 2009 Jan 8.
BACKGROUND/AIM: Norms for change in Mini Mental State Examination (MMSE) total score suggest that only a decline of at least 2-4 points indicates a reliable change. However, it is unknown whether change norms (Reliable Change Indices, RCIs) of the MMSE total score are suitable to predict future dementia.
554 elderly individuals aged 75 and over without dementia at the first 2 visits were tested with the MMSE at a maximum of 6 visits with 1.5-year intervals. Two different RCIs for change in MMSE score (first to second visit) were computed - one RCI which corrects for practice and one RCI which corrects for regression to the mean. The main outcome measure was the diagnosis of dementia.
During the study, 88 persons developed dementia. RCIs were significantly associated with future dementia diagnosis. The best cutoff for raw change in MMSE total score to predict dementia was -1 point (sensitivity = 48%, specificity = 67%, relative risk = 1.6). With the RCI + regression to the mean, the diagnostic accuracy was moderate (sensitivity = 61%, specificity = 72%, relative risk = 3.2).
A change in MMSE total score is significantly associated with future dementia, but the diagnostic accuracy for dementia prediction is rather low.
背景/目的：简易精神状态检查表（MMSE）总分变化的标准表明，只有至少下降2 - 4分才表明有可靠的变化。然而，MMSE总分的变化标准（可靠变化指数，RCI）是否适用于预测未来痴呆尚不清楚。
554名75岁及以上的老年人在前两次就诊时无痴呆，最多进行6次MMSE测试，间隔为1.5年。计算了两种不同的MMSE分数变化（首次到第二次就诊）的RCI——一种校正练习效应的RCI和一种校正均值回归的RCI。主要结局指标是痴呆的诊断。
在研究期间，88人发展为痴呆。RCI与未来痴呆诊断显著相关。预测痴呆的MMSE总分原始变化的最佳临界值为 -1分（敏感性 = 48%，特异性 = 67%，相对风险 = 1.6）。采用RCI + 均值回归时，诊断准确性中等（敏感性 = 61%，特异性 = 72%，相对风险 = 3.2）。
MMSE总分的变化与未来痴呆显著相关，但痴呆预测的诊断准确性相当低。
