Saxton Judith, Morrow Lisa, Eschman Amy, Archer Gretchen, Luther James, Zuccolotto Anthony
Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Postgrad Med. 2009 Mar;121(2):177-85. doi: 10.3810/pgm.2009.03.1990.
Many older individuals experience cognitive decline with aging. The causes of cognitive dysfunction range from the devastating effects of Alzheimer's disease (AD) to treatable causes of dysfunction and the normal mild forgetfulness described by many older individuals. Even mild cognitive dysfunction can impact medication adherence, impair decision making, and affect the ability to drive or work. However, primary care physicians do not routinely screen for cognitive difficulties and many older patients do not report cognitive problems. Identifying cognitive impairment at an office visit would permit earlier referral for diagnostic work-up and treatment. The Computer Assessment of Mild Cognitive Impairment (CAMCI) is a self-administered, user-friendly computer test that scores automatically and can be completed independently in a quiet space, such as a doctor's examination room. The goal of this study was to compare the sensitivity and specificity of the CAMCI and the Mini Mental State Examination (MMSE) to identify mild cognitive impairment (MCI) in 524 nondemented individuals > 60 years old who completed a comprehensive neuropsychological and clinical assessment together with the CAMCI and MMSE. We hypothesized that the CAMCI would exhibit good sensitivity and specificity and would be superior compared with the MMSE in these measures. The results indicated that the MMSE was relatively insensitive to MCI. In contrast, the CAMCI was highly sensitive (86%) and specific (94%) for the identification of MCI in a population of community-dwelling nondemented elderly individuals.
许多老年人随着年龄增长会出现认知能力下降。认知功能障碍的原因多种多样，从阿尔茨海默病（AD）的毁灭性影响到可治疗的功能障碍原因，以及许多老年人描述的正常轻度健忘。即使是轻度认知功能障碍也会影响药物依从性、损害决策能力，并影响驾驶或工作能力。然而，初级保健医生通常不会常规筛查认知困难，许多老年患者也不会报告认知问题。在门诊就诊时识别认知障碍将有助于更早地转诊进行诊断检查和治疗。轻度认知障碍计算机评估（CAMCI）是一种自我管理、用户友好的计算机测试，可自动评分，并且可以在安静的空间（如医生检查室）独立完成。本研究的目的是比较CAMCI和简易精神状态检查表（MMSE）在524名60岁以上非痴呆个体中的敏感性和特异性，这些个体完成了全面的神经心理学和临床评估以及CAMCI和MMSE。我们假设CAMCI将表现出良好的敏感性和特异性，并且在这些指标上优于MMSE。结果表明MMSE对轻度认知障碍（MCI）相对不敏感。相比之下，在社区居住的非痴呆老年人群体中，CAMCI对MCI的识别具有高度敏感性（86%）和特异性（94%）。
