Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Nutr Health Aging. 2010 Oct;14(8):697-702. doi: 10.1007/s12603-010-0038-5.
The need for recognition of mild cognitive impairment (MCI) in primary care is increasingly discussed because MCI is a risk factor for dementia. General Practitioners (GPs) could play an important role in the detection of MCI since they have regular and long-term contact with the majority of the elderly population. Thus the objective of this study is to find out how well GPs recognize persons with MCI in their practice population.
Cross-sectional study.
Primary care chart registry sample.
3,242 non-demented GP patients aged 75-89 years.
GPs assessed the cognitive status of their patients on the Global Deterioration Scale (GDS). Thereafter, trained interviewers collected psychometric data by interviewing the patients at home. The interview data constitute the basis for the definition of MCI cases (gold standard).
The sensitivity of GPs to detect MCI was very low (11-12%) whereas their specificity amounts to 93-94%. Patients with MCI with a middle or high level of education more often got a false negative assignment than patients with a low educational level. The risk of a false positive assignment rose with the patients' degree of comorbidity. GPs were better at detecting MCI when memory or two and more MCI-domains were impaired.
The results show that GPs recognise MCI in a very limited number of cases when based on clinical impression only. A further development of the MCI concept and its operationalisation is necessary. Emphasis should be placed on validated, reliable and standardised tests for routine use in primary care encompassing other than only cognitive domains and on case finding approaches rather than on screening. Then a better attention and qualification of GPs with regard to the recognition of MCI might be achievable.
由于轻度认知障碍 (MCI) 是痴呆的一个危险因素，因此越来越多地讨论在初级保健中识别 MCI 的必要性。全科医生 (GP) 可以在 MCI 的检测中发挥重要作用，因为他们与大多数老年人口保持定期和长期的联系。因此，本研究的目的是了解 GP 在其就诊人群中识别 MCI 患者的能力如何。
横断面研究。
初级保健图表登记样本。
3242 名年龄在 75-89 岁的非痴呆 GP 患者。
GP 使用全球衰退量表 (GDS) 评估患者的认知状态。然后，经过培训的访谈员通过在家中对患者进行访谈来收集心理计量数据。访谈数据是定义 MCI 病例的基础（金标准）。
GP 检测 MCI 的敏感性非常低（11-12%），而特异性达到 93-94%。与低教育水平的患者相比，中等或高教育水平的 MCI 患者更有可能被误诊为阴性。患者的共病程度越高，误诊的风险就越高。当记忆或两个及以上 MCI 域受损时，GP 更有可能检测到 MCI。
结果表明，仅基于临床印象，GP 识别 MCI 的病例非常有限。需要进一步发展 MCI 概念及其操作化。应强调在初级保健中常规使用经过验证、可靠和标准化的测试，涵盖认知领域以外的其他领域，并强调病例发现方法而不是筛查。然后，可能会更好地关注和培训 GP 识别 MCI。
