Duff Kevin, Spering Cynthia C, O'Bryant Sid E, Beglinger Leigh J, Moser David J, Bayless John D, Culp Kennith R, Mold James W, Adams Russell L, Scott James G
Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah 84108, USA.
Appl Neuropsychol. 2011 Jan;18(1):11-7. doi: 10.1080/09084282.2010.523354.
The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cutoff scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer's disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in three of the four clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.
RBANS的努力指数（EI）旨在帮助临床医生区分努力程度良好的患者和努力程度较差的患者。然而，有人担心老年人可能会因该使用未校正原始分数的指数而受到不公平的惩罚。利用五组具有广泛认知功能的老年患者独立样本（例如，认知功能正常、养老院居民、疑似阿尔茨海默病患者），计算了EI的失败基础率。在认知功能正常和轻度受损的样本中，很少有老年人被归类为努力程度较差（例如，认知功能正常者中为3%）。然而，在受损更严重的老年患者中，超过三分之一的患者EI分数高于建议的临界分数（例如，养老院居民中为37%，疑似阿尔茨海默病患者中为33%）。在认知功能正常的样本中，年龄较大和受教育程度较低的患者更有可能获得表明努力程度较差的分数。在四个临床样本中的三个样本中观察到了教育效应。总体认知功能与EI分数显著相关，认知功能越差，被怀疑努力程度低的可能性就越大。目前的结果表明，在解释EI结果时应考虑年龄、教育程度和认知功能水平，并且在检查疑似患有痴呆症的老年人的EI分数时应格外谨慎。
