Cognitive Behavioral Neurology Unit, Service of Neurology, Virgen de las Nieves University Hospital, Carretera de Jaen s/n, 18013-Granada, Spain.
BMC Neurol. 2011 Jul 29;11:92. doi: 10.1186/1471-2377-11-92.
To assess and compare the effectiveness and costs of Phototest, Mini Mental State Examination (MMSE), and Memory Impairment Screen (MIS) to screen for dementia (DEM) and cognitive impairment (CI).
A phase III study was conducted over one year in consecutive patients with suspicion of CI or DEM at four Primary Care (PC) centers. After undergoing all screening tests at the PC center, participants were extensively evaluated by researchers blinded to screening test results in a Cognitive-Behavioral Neurology Unit (CBNU). The gold standard diagnosis was established by consensus of expert neurologists. Effectiveness was assessed by the proportion of correct diagnoses (diagnostic accuracy [DA]) and by the kappa index of concordance between test results and gold standard diagnoses. Costs were based on public prices and hospital accounts.
The study included 140 subjects (48 with DEM, 37 with CI without DEM, and 55 without CI). The MIS could not be applied to 23 illiterate subjects (16.4%). For DEM, the maximum effectiveness of the MMSE was obtained with different cutoff points as a function of educational level [k = 0.31 (95% Confidence interval [95%CI], 0.19-0.43), DA = 0.60 (95%CI, 0.52-0.68)], and that of the MIS with a cutoff of 3/4 [k = 0.63 (95%CI, 0.48-0.78), DA = 0.83 (95%CI, 0.80-0.92)]. Effectiveness of the Phototest [k = 0.71 (95%CI, 0.59-0.83), DA = 0.87 (95%CI, 0.80-0.92)] was similar to that of the MIS and higher than that of the MMSE. Costs were higher with MMSE (275.9 ± 193.3€ [mean ± sd euros]) than with Phototest (208.2 ± 196.8€) or MIS (201.3 ± 193.4€), whose costs did not significantly differ. For CI, the effectiveness did not significantly differ between MIS [k = 0.59 (95%CI, 0.45-0.74), DA = 0.79 (95%CI, 0.64-0.97)] and Phototest [k = 0.58 (95%CI, 0.45-0.74), DA = 0.78 (95%CI, 0.64-0.95)] and was lowest for the MMSE [k = 0.27 (95%CI, 0.09-0.45), DA = 0.69 (95%CI, 0.56-0.84)]. Costs were higher for MMSE (393.4 ± 121.8€) than for Phototest (287.0 ± 197.4€) or MIS (300.1 ± 165.6€), whose costs did not significantly differ.
MMSE is not an effective instrument in our setting. For both DEM and CI, the Phototest and MIS are more effective and less costly, with no difference between them. However, MIS could not be applied to the appreciable percentage of our population who were illiterate.
为了评估和比较 Phototest、简易精神状态检查（MMSE）和记忆障碍筛查（MIS）在筛查痴呆（DEM）和认知障碍（CI）方面的有效性和成本。
一项为期一年的三期研究在四个初级保健（PC）中心对疑似 CI 或 DEM 的连续患者进行。在 PC 中心进行所有筛查测试后，参与者在认知行为神经病学单元（CBNU）由研究人员进行广泛评估，这些研究人员对筛查测试结果一无所知。金标准诊断由专家神经病学家的共识确定。有效性通过正确诊断的比例（诊断准确性 [DA]）和测试结果与金标准诊断的一致性kappa 指数来评估。成本基于公共价格和医院账户。
该研究共纳入 140 名受试者（48 名患有 DEM，37 名患有非 DEM 的 CI，55 名无 CI）。由于 23 名受试者不识字，无法进行 MIS 测试（16.4%）。对于 DEM，MMSE 的最大有效性可以通过不同的截止点获得，这取决于教育水平[K = 0.31（95%置信区间[95%CI]，0.19-0.43），DA = 0.60（95%CI，0.52-0.68）]，而 MIS 的最大有效性可以通过 3/4 的截止点获得[k = 0.63（95%CI，0.48-0.78），DA = 0.83（95%CI，0.80-0.92）]。Phototest 的有效性[k = 0.71（95%CI，0.59-0.83），DA = 0.87（95%CI，0.80-0.92）]与 MIS 相似，高于 MMSE。MMSE 的成本（275.9 ± 193.3 欧元[均值 ± 标准差欧元]）高于 Phototest（208.2 ± 196.8 欧元）和 MIS（201.3 ± 193.4 欧元），但后两者的成本无显著差异。对于 CI，MIS 的有效性[k = 0.59（95%CI，0.45-0.74），DA = 0.79（95%CI，0.64-0.97）]和 Phototest 之间[K = 0.58（95%CI，0.45-0.74），DA = 0.78（95%CI，0.64-0.95）]差异不显著，而 MMSE 的有效性最低[k = 0.27（95%CI，0.09-0.45），DA = 0.69（95%CI，0.56-0.84）]。MMSE 的成本（393.4 ± 121.8 欧元）高于 Phototest（287.0 ± 197.4 欧元）和 MIS（300.1 ± 165.6 欧元），但后两者的成本无显著差异。
在我们的环境中，MMSE 不是一种有效的工具。对于 DEM 和 CI，Phototest 和 MIS 更有效且成本更低，它们之间没有差异。然而，MIS 无法应用于我们相当一部分不识字的人群。
