Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Alzheimer Dis Assoc Disord. 2012 Jul-Sep;26(3):225-31. doi: 10.1097/WAD.0b013e318231cd30.
We have previously established the reliability and cross-sectional validity of the SIST-M (Structured Interview and Scoring Tool-Massachusetts Alzheimer's Disease Research Center), a shortened version of an instrument shown to predict progression to Alzheimer disease (AD), even among persons with very mild cognitive impairment (vMCI).
To test the predictive validity of the SIST-M.
Participants were 342 community-dwelling, nondemented older adults in a longitudinal study. Baseline Clinical Dementia Rating (CDR) ratings were determined by either (1) clinician interviews or (2) a previously developed computer algorithm based on 60 questions (of a possible 131) extracted from clinician interviews. We developed age+sex+education-adjusted Cox proportional hazards models using CDR-sum-of-boxes (CDR-SB) as the predictor, where CDR-SB was determined by either a clinician interview or an algorithm; models were run for the full sample (n = 342) and among those jointly classified as vMCI using clinician-based and algorithm-based CDR ratings (n = 156). We directly compared predictive accuracy using time-dependent receiver operating characteristic (ROC) curves.
AD hazard ratios (HRs) were similar for clinician-based and algorithm-based CDR-SB: for a 1-point increment in CDR-SB, the respective HRs [95% confidence interval (CI)] were 3.1 (2.5, 3.9) and 2.8 (2.2, 3.5); among those with vMCI, the respective HRs (95% CI) were 2.2 (1.6, 3.2) and 2.1 (1.5, 3.0). Similarly high predictive accuracy was achieved: the concordance probability (weighted average of the area-under-the-ROC curves) over follow-up was 0.78 versus 0.76 using clinician-based versus algorithm-based CDR-SB.
CDR scores based on items from this shortened interview had high predictive ability for AD-comparable to that using a lengthy clinical interview.
我们之前已经证实了 SIST-M（结构化访谈和评分工具-马萨诸塞州阿尔茨海默病研究中心）的可靠性和横断面有效性，这是一种可以预测向阿尔茨海默病（AD）进展的工具的缩短版本，即使在认知障碍非常轻微（vMCI）的人群中也是如此。
测试 SIST-M 的预测有效性。
参与者是一项纵向研究中的 342 名居住在社区、无痴呆的老年人。基线临床痴呆评定（CDR）评分由临床医生访谈或基于从临床医生访谈中提取的 60 个问题（总共 131 个）的先前开发的计算机算法确定。我们使用 CDR-盒子总和（CDR-SB）作为预测因子，建立了年龄+性别+教育调整的 Cox 比例风险模型，其中 CDR-SB 由临床医生访谈或算法确定；模型在全样本（n=342）和同时使用基于临床医生和基于算法的 CDR 评分联合分类为 vMCI 的患者（n=156）中进行了运行。我们使用时间依赖性接收器操作特征（ROC）曲线直接比较预测准确性。
基于临床医生和算法的 CDR-SB 的 AD 危险比（HR）相似：CDR-SB 增加 1 分，相应的 HR [95%置信区间（CI）]分别为 3.1（2.5, 3.9）和 2.8（2.2, 3.5）；在 vMCI 患者中，相应的 HR（95%CI）分别为 2.2（1.6, 3.2）和 2.1（1.5, 3.0）。同样实现了较高的预测准确性：在随访期间，基于该简短访谈的项目的一致性概率（ROC 曲线下面积的加权平均值）为 0.78，而基于临床医生访谈和算法的 CDR-SB 的一致性概率分别为 0.76。
基于此缩短访谈的项目的 CDR 评分对 AD 具有较高的预测能力，与使用冗长的临床访谈相当。
