Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
PLoS One. 2011;6(11):e27069. doi: 10.1371/journal.pone.0027069. Epub 2011 Nov 2.
Illiteracy, a universal problem, limits the utilization of the most widely used short cognitive tests. Our objective was to assess and compare the effectiveness and cost for cognitive impairment (CI) and dementia (DEM) screening of three short cognitive tests applicable to illiterates.
Phase III diagnostic test evaluation study was performed during one year in four Primary Care centers, prospectively including individuals with suspicion of CI or DEM. All underwent the Eurotest, Memory Alteration Test (M@T), and Phototest, applied in a balanced manner. Clinical, functional, and cognitive studies were independently performed in a blinded fashion in a Cognitive Behavioral Neurology Unit, and the gold standard diagnosis was established by consensus of expert neurologists on the basis of these results. Effectiveness of tests was assessed as the proportion of correct diagnoses (diagnostic accuracy [DA]) and the kappa index of concordance (k) with respect to gold standard diagnoses. Costs were based on public prices at the time and hospital accounts.
The study included 139 individuals: 47 with DEM, 36 with CI, and 56 without CI. No significant differences in effectiveness were found among the tests. For DEM screening: Eurotest (k = 0.71 [0.59-0.83], DA = 0.87 [0.80-0.92]), M@T (k = 0.72 [0.60-0.84], DA = 0.87 [0.80-0.92]), Phototest (k = 0.70 [0.57-0.82], DA = 0.86 [0.79-0.91]). For CI screening: Eurotest (k = 0.67 [0.55-0.79]; DA = 0.83 [0.76-0.89]), M@T (k = 0.52 [0.37-0.67]; DA = 0.80 [0.72-0.86]), Phototest (k = 0.59 [0.46-0.72]; DA = 0.79 [0.71-0.86]). There were no differences in the cost of DEM screening, but the cost of CI screening was significantly higher with M@T (330.7 ± 177.1 €, mean ± sd) than with Eurotest (294.1 ± 195.0 €) or Phototest (296.0 ± 196. 5 €). Application time was shorter with Phototest (2.8 ± 0.8 min) than with Eurotest (7.1 ± 1.8 min) or M@T (6.8 ± 2.2 min).
Eurotest, M@T, and Phototest are equally effective. Eurotest and Phototest are both less expensive options but Phototest is the most efficient, requiring the shortest application time.
文盲是一个普遍存在的问题，这限制了最广泛使用的简短认知测试的利用。我们的目的是评估和比较三种适用于文盲的简短认知测试对认知障碍（CI）和痴呆（DEM）筛查的有效性和成本。
在四个初级保健中心进行了为期一年的 III 期诊断测试评估研究，前瞻性地纳入了疑似 CI 或 DEM 的患者。所有患者均接受了 Eurotest、记忆改变测试（M@T）和 Phototest 的平衡应用。在认知行为神经病学单元中以盲法方式独立进行临床、功能和认知研究，并根据这些结果由专家神经病学家共识建立金标准诊断。测试的有效性评估为正确诊断的比例（诊断准确性[DA]）和与金标准诊断的一致性kappa 指数（k）。成本基于当时的公共价格和医院账目。
研究共纳入 139 名患者：47 名患有 DEM，36 名患有 CI，56 名无 CI。在这些测试之间未发现有效性的显著差异。对于 DEM 筛查：Eurotest（k=0.71[0.59-0.83]，DA=0.87[0.80-0.92]）、M@T（k=0.72[0.60-0.84]，DA=0.87[0.80-0.92]）、Phototest（k=0.70[0.57-0.82]，DA=0.86[0.79-0.91]）。对于 CI 筛查：Eurotest（k=0.67[0.55-0.79]；DA=0.83[0.76-0.89]）、M@T（k=0.52[0.37-0.67]；DA=0.80[0.72-0.86]）、Phototest（k=0.59[0.46-0.72]；DA=0.79[0.71-0.86]）。DEM 筛查的成本没有差异，但 M@T 进行 CI 筛查的成本明显高于 Eurotest（330.7±177.1€，平均值±标准差）和 Phototest（294.1±195.0€）。Phototest（2.8±0.8 分钟）的应用时间短于 Eurotest（7.1±1.8 分钟）或 M@T（6.8±2.2 分钟）。
Eurotest、M@T 和 Phototest 的有效性相当。Eurotest 和 Phototest 都是更经济的选择，但 Phototest 更有效，所需的应用时间最短。
