四种认知测试在预测老年人无法学会使用计量吸入器方面的比较。

A comparison of four tests of cognition as predictors of inability to learn to use a metered dose inhaler in old age.

机构信息

The Royal Bournemouth Hospital, Castle Lane East, Bournemouth, Dorset, UK.

出版信息

Int J Clin Pract. 2009 Aug;63(8):1150-3. doi: 10.1111/j.1742-1241.2009.02060.x.

DOI:10.1111/j.1742-1241.2009.02060.x

PMID:19624784

Abstract

BACKGROUND

Previous studies have shown that a Mini Mental State Examination (MMSE) score of < 24/30 and inability to copy intersecting pentagons (IP) predict inability to learn to use inhaler devices. We hypothesised that clock drawing tests (CLOX 1 and 2), being validated tests of cognitive executive function, might predict competent inhaler acquisition with a higher sensitivity and specificity than the MMSE or IP.

METHODS

We studied 80 (63 women) inhaler-naïve inpatients, mean age 83 years (range 75-97 years). All performed the MMSE, IP, CLOX 1 and 2, before receiving standardised demonstration, instruction and assessment in the use of a metered dose inhaler (MDI).

RESULTS

A total of 28/80 (35%) patients were able to acquire a satisfactory MDI technique. Using normative thresholds for impairment, the sensitivity and specificity (% with 95% confidence intervals) of the cognitive scores in predicting inability were: MMSE < 24 sensitivity 57 (42-71), specificity 76 (57-88), p = 0.04; IP sensitivity 75 (60-85), specificity 79 (59-91), p = 0.0000; CLOX1 < 10 sensitivity 83 (69-91), specificity 57 (37-75), p = 0.0004; CLOX2 < 12 sensitivity 58 (43-71), specificity 64 (44-81), p = 0.05.

CONCLUSION

CLOX tests did not perform better than MMSE and IP, to identify patients who are unlikely to be able to acquire MDI technique from a single episode of training. In clinical practice, most patients with an MMSE < 24 or negative IP will not be able to learn MDI technique. In this study, IP had the best overall predictive value.

摘要

背景

先前的研究表明，简易精神状态检查（MMSE）得分<24/30 和无法复制交叉五角星（IP）可预测无法学习使用吸入器装置。我们假设，作为认知执行功能验证测试的时钟绘图测试（CLOX 1 和 2），其预测有能力获得吸入器的灵敏度和特异性可能高于 MMSE 或 IP。

方法

我们研究了 80 名（63 名女性）初次使用吸入器的住院患者，平均年龄为 83 岁（75-97 岁）。所有患者在接受标准化的计量吸入器（MDI）使用演示、指导和评估之前，均进行了 MMSE、IP、CLOX 1 和 2 测试。

结果

共有 28/80（35%）名患者能够获得满意的 MDI 技术。使用认知评分的正常阈值来预测无法获得 MDI 技术的能力，其灵敏度和特异性（95%置信区间的%）如下：MMSE<24 灵敏度 57（42-71），特异性 76（57-88），p=0.04；IP 灵敏度 75（60-85），特异性 79（59-91），p=0.0000；CLOX1<10 灵敏度 83（69-91），特异性 57（37-75），p=0.0004；CLOX2<12 灵敏度 58（43-71），特异性 64（44-81），p=0.05。