Department of Psychiatry and Langley Porter Psychiatric Institute, University of California, San Francisco, San Francisco, CA 94143, USA.
J Geriatr Psychiatry Neurol. 2010 Jun;23(2):94-9. doi: 10.1177/0891988709358589. Epub 2010 Jan 25.
Older adults with severe psychiatric illness are often treated at community mental health centers (CMHCs) and these individuals commonly have numerous risk factors for cognitive impairment (CI). Brief cognitive screening instruments are frequently used to evaluate cognitive functioning in CMHCs, but the validity of these measures for detecting CI has not been adequately evaluated in this patient population.
To determine the sensitivity and specificity of 2 cognitive screening measures (the Mini-Mental Status Examination [MMSE] and the Stroop Color and Word Test [SCWT]) for detecting CI in a sample of older adults with severe psychiatric illness.
Data were collected from 52 older adults receiving services at a CMHC. Diagnosis of CI was made by a neuropsychologist. Sensitivity and specificity coefficients for 2 cutoff scores for the MMSE and the SCWT were calculated.
A cutoff score of 25 on the MMSE yielded a sensitivity of 43.3% and a specificity of 90.4% for detecting CI, whereas a cutoff score of 21 yielded sensitivity of 13.1% and 100% specificity. Using an age- and education-corrected scaled score (SS) on the SCWT falling at or below 7 as the criterion the SCWT had 88.8% sensitivity and 36.8% specificity, whereas a cutoff score of 5 or below yielded sensitivity of 59.2% and specificity of 57.8%.
Overall, the MMSE was found to be the more clinically useful cognitive screening tool for use in CMHC. Yet, because of the poor sensitivity of the MMSE for detecting CI in this patient population, alternative screening methods should be explored.
患有严重精神疾病的老年人通常在社区心理健康中心（CMHC）接受治疗，这些人通常存在许多认知障碍（CI）的风险因素。简短的认知筛查工具常用于评估 CMHC 中的认知功能，但这些措施在该患者群体中检测 CI 的有效性尚未得到充分评估。
确定 2 种认知筛查工具（简易精神状态检查 [MMSE] 和 Stroop 颜色和文字测验 [SCWT]）在检测严重精神疾病老年患者 CI 中的灵敏度和特异性。
从接受 CMHC 服务的 52 名老年人中收集数据。由神经心理学家诊断 CI。计算 MMSE 和 SCWT 2 个截断分数的灵敏度和特异性系数。
MMSE 的截断分数为 25 时，检测 CI 的灵敏度为 43.3%，特异性为 90.4%，而截断分数为 21 时，灵敏度为 13.1%，特异性为 100%。使用 SCWT 的年龄和教育校正后的得分（SS）低于或等于 7 作为标准，SCWT 的灵敏度为 88.8%，特异性为 36.8%，而截断分数为 5 或更低时，灵敏度为 59.2%，特异性为 57.8%。
总体而言，MMSE 被认为是 CMHC 中更具临床价值的认知筛查工具。然而，由于 MMSE 在此患者群体中检测 CI 的灵敏度较差，因此应探索替代筛查方法。
