Jitapunkul Sutthichai, Chansirikanjana Sirintorn, Thamarpirat Jittima
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Geriatr Gerontol Int. 2009 Mar;9(1):47-53. doi: 10.1111/j.1447-0594.2008.00501.x.
We conducted a population-based prospective study in 420 older persons to examine the prevalence of undiagnosed dementia and validity of the Chula Mental Test (CMT) as well as value of serial administration of the CMT and its score evolution over 2 years.
The CMT score was obtained in 1997 and 1999 surveys. In 1999, all participants were evaluated by a geriatrician to make diagnoses of dementia according to the 4th edn of the Diagnostic and Statistical Manual criteria. Information on previous diagnosis of dementia by physicians was collected. Validity of the CMT was determined by the receiver-operator curve. The pattern of cognitive evolution over 2 years was analyzed.
Of 420 subjects, 23 had dementia, of which 22 (95.6%) were undiagnosed. The prevalence (95% confidence interval) of dementia and undiagnosed dementia were 5.5% (3.3-7.7%) and 5.3% (4.1-6.3%), respectively. With original cut-off (15/14) of the CMT, the sensitivity and specificity were 0.74 and 0.86, respectively. The best cut-off found in this study was 16/15 which provided better sensitivity (0.91) but worse specificity (0.76) than those of the original cut-off. Pattern of cognitive evolution was heterogeneous. The heterogeneous change was substantial in subjects with mild low CMT score. Cognitive evolution pattern showed that serial administration of the CMT could reduce workload of primary care physicians and might be useful in a screening protocol.
The prevalence of undiagnosed dementia in community-dwelling Thai older persons was high. The CMT was valid for use in a community. Heterogeneous evolution of cognitive function and value of serial cognitive impairment screening was found.
我们对420名老年人进行了一项基于人群的前瞻性研究，以调查未诊断出的痴呆症的患病率、朱拉精神测试（CMT）的有效性，以及CMT连续施用的价值及其在2年中的分数变化。
在1997年和1999年的调查中获得CMT分数。1999年，所有参与者由一名老年病医生根据《诊断和统计手册》第4版标准进行痴呆症诊断评估。收集有关医生先前诊断痴呆症的信息。CMT的有效性由接受者操作曲线确定。分析了2年中的认知演变模式。
420名受试者中，23人患有痴呆症，其中22人（95.6%）未被诊断出。痴呆症和未诊断出的痴呆症的患病率（95%置信区间）分别为5.5%（3.3-7.7%）和5.3%（4.1-6.3%）。以CMT的原始临界值（15/14），敏感性和特异性分别为0.74和0.86。本研究中发现的最佳临界值为16/15，其敏感性（0.91）比原始临界值更好，但特异性（0.76）更差。认知演变模式是异质性的。在CMT分数轻度偏低的受试者中，异质性变化很大。认知演变模式表明，连续施用CMT可以减轻初级保健医生的工作量，并且可能在筛查方案中有用。
泰国社区居住的老年人中未诊断出的痴呆症患病率很高。CMT可有效用于社区。发现了认知功能的异质性演变和连续认知障碍筛查的价值。
