Royall Donald R, Matsuoka Teruyuki, Palmer Raymond F, Kato Yuka, Taniguchi Shogo, Ogawa Mayu, Fujimoto Hiroshi, Okamura Aiko, Shibata Keisuke, Nakamura Kaeko, Nakaaki Shutaro, Koumi Hiroyuki, Mimura Masaru, Fukui Kenji, Narumoto Jin
Department of Psychiatry, University of Texas Health Science Center at San Antonio.
Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine.
Neuropsychology. 2015 Sep;29(5):683-92. doi: 10.1037/neu0000153. Epub 2015 Feb 9.
"δ", a latent variable constructed from batteries that contain both cognitive and functional status measures, can accurately diagnose dementia relative to expert clinicians. The minimal assessment needed is unknown.
We validated 2 δ homologs in a convenience sample of elderly Japanese persons with normal cognition (NC), mild cognitive impairment (MCI), and dementia (n = 176). The latent δ homolog "d" (for dementia) was constructed from Instrumental Activities of Daily Living (IADL) and Japanese translations of the Executive Clock-Drawing Task (CLOX), Frontal Assessment Battery (FAB), and Executive Interview (EXIT25). The latent delta homolog "d3" was constructed from a restricted set of d's factor loadings.
d and d3 were highly intercorrelated (r = .97) and strongly related to both IADL and dementia severity, as rated blindly by the Clinical Dementia Rating Scale (CDR). d was more strongly related to IADL and CDR than any of its indicators. In multivariate regression, d explained more variance in CDR scores than all of its indicators combined. d's areas under the receiver operating characteristic curve (AUC) were 0.95 for the discrimination between Alzheimer's disease (AD) vs. NC, 0.84 for AD vs. MCI and 0.81 for NC vs. MCI. d3's AUC's were statistically indiscriminable. These AUC's are higher than any of d's indicators, as reported recently by Matsuoka et al. (2014), as well as the Mini-Mental State Examination (MMSE), which had been made available by Matsuoka et al. to the CDR raters.
Latent variables can improve upon a battery's diagnostic performance and offer the potential for accurate dementia case-finding after a minimal bedside assessment.
“δ”是一个由包含认知和功能状态测量的成套测试构建的潜在变量，相对于专家临床医生，它能够准确诊断痴呆症。所需的最小评估量尚不清楚。
我们在一个便利样本中验证了2个δ同系物，该样本包括认知正常（NC）、轻度认知障碍（MCI）和痴呆症的日本老年人（n = 176）。潜在的δ同系物“d”（用于痴呆症）由日常生活活动能力（IADL）以及执行时钟绘画任务（CLOX）、额叶评估量表（FAB）和执行访谈（EXIT25）的日语翻译构建而成。潜在的δ同系物“d3”由d的一组受限因子载荷构建而成。
d和d3高度相关（r = 0.97），并且与IADL和痴呆症严重程度密切相关，临床痴呆评定量表（CDR）的盲评结果显示了这一点。d与IADL和CDR的相关性比其任何指标都更强。在多变量回归中，d对CDR分数的解释方差比其所有指标的总和还要多。d在接受者操作特征曲线（AUC）下的面积，在区分阿尔茨海默病（AD）与NC时为0.95，AD与MCI时为0.84，NC与MCI时为0.81。d3的AUC在统计学上无显著差异。这些AUC高于d的任何指标，如松冈等人（2014年）最近报道的，以及松冈等人提供给CDR评分者的简易精神状态检查表（MMSE）。
潜在变量可以提高成套测试诊断性能，并在最小化床边评估后提供准确发现痴呆症病例的潜力。
