比较认知筛查工具的诊断准确性：一种加权比较方法。
Comparing diagnostic accuracy of cognitive screening instruments: a weighted comparison approach.
作者信息
Larner A J
机构信息
Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
出版信息
Dement Geriatr Cogn Dis Extra. 2013 Jan;3(1):60-5. doi: 10.1159/000348623. Epub 2013 Mar 1.
BACKGROUND/AIMS: There are many cognitive screening instruments available to clinicians when assessing patients' cognitive function, but the best way to compare the diagnostic utility of these tests is uncertain. One method is to undertake a weighted comparison which takes into account the difference in sensitivity and specificity of two tests, the relative clinical misclassification costs of true- and false-positive diagnosis, and also disease prevalence.
METHODS
Data were examined from four pragmatic diagnostic accuracy studies from one clinic which compared the Mini-Mental State Examination (MMSE) with the Addenbrooke's Cognitive Examination-Revised (ACE-R), the Montreal Cognitive Assessment (MoCA), the Test Your Memory (TYM) test, and the Mini-Mental Parkinson (MMP), respectively.
RESULTS
Weighted comparison calculations suggested a net benefit for ACE-R, MoCA, and MMP compared to MMSE, but a net loss for TYM test compared to MMSE.
CONCLUSION
Routine incorporation of weighted comparison or other similar net benefit measures into diagnostic accuracy studies merits consideration to better inform clinicians of the relative value of cognitive screening instruments.
背景/目的：临床医生在评估患者认知功能时可使用多种认知筛查工具，但比较这些测试诊断效用的最佳方法尚不确定。一种方法是进行加权比较，该方法考虑了两种测试在敏感性和特异性上的差异、真阳性和假阳性诊断的相对临床错误分类成本以及疾病患病率。
方法
对来自一家诊所的四项实用诊断准确性研究的数据进行了分析，这些研究分别将简易精神状态检查表（MMSE）与修订版的Addenbrooke认知检查表（ACE-R）、蒙特利尔认知评估量表（MoCA）、记忆测试（TYM）以及简易精神状态帕金森量表（MMP）进行了比较。
结果
加权比较计算表明，与MMSE相比，ACE-R、MoCA和MMP有净效益，但与MMSE相比，TYM测试有净损失。
结论
在诊断准确性研究中常规纳入加权比较或其他类似的净效益测量方法值得考虑，以便更好地让临床医生了解认知筛查工具相对价值。
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