Pfoh Elizabeth R, Chan Kitty S, Dinglas Victor D, Girard Timothy D, Jackson James C, Morris Peter E, Hough Catherine L, Mendez-Tellez Pedro A, Ely E Wesley, Huang Minxuan, Needham Dale M, Hopkins Ramona O
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Outcomes after Critical Illness and Surgery Group, Johns Hopkins University, 1830 E Monument Street, Baltimore, MD, 21205, USA.
Crit Care. 2015 May 5;19(1):220. doi: 10.1186/s13054-015-0934-5.
The Mini-Mental State Examination (MMSE) is a common cognitive screening test, but its utility in identifying impairments in survivors of acute respiratory failure is unclear. The purpose of this study was to evaluate MMSE performance versus a concurrently administered detailed neuropsychological test battery in survivors of acute respiratory failure.
This cross-sectional analysis used data from the ARDSNet Long Term Outcomes Study (ALTOS) and Awakening and Breathing Controlled Trial (ABC). Participants were 242 survivors of acute respiratory failure. The MMSE and detailed neuropsychological tests were administered at 6 and 12 months post-hospital discharge for the ALTOS study, and at hospital discharge, 3 and 12 months for the ABC study. Overall cognitive impairment identified by the MMSE (score <24) was compared to impairments identified by the neuropsychological tests. We also matched orientation, registration, attention, memory and language domains on the MMSE to the corresponding neuropsychological test. Pairwise correlations, sensitivity, specificity, positive and negative predictive values, and agreement were assessed.
Agreement between MMSE and neuropsychological tests for overall cognitive impairment was fair (42 to 80%). Specificity was excellent (≥93%), but sensitivity was poor (19 to 37%). Correlations between MMSE domains and corresponding neuropsychological tests were weak to moderate (6 months: r = 0.11 to 0.28; 12 months: r = 0.09 to 0.34). The highest correlation between the MMSE and neuropsychological domains was for attention at 6 months (r = 0.28) and language at 12 months (r = 0.34).
In acute respiratory failure survivors, the MMSE has poor sensitivity in detecting cognitive impairment compared with concurrently administered detailed neuropsychological tests. MMSE results in this population should be interpreted with caution.
简易精神状态检查表（MMSE）是一种常见的认知筛查测试，但它在识别急性呼吸衰竭幸存者的认知障碍方面的效用尚不清楚。本研究的目的是评估急性呼吸衰竭幸存者中MMSE的表现与同时进行的详细神经心理测试组的表现。
这项横断面分析使用了急性呼吸窘迫综合征网络长期结局研究（ALTOS）和觉醒与呼吸控制试验（ABC）的数据。参与者为242名急性呼吸衰竭幸存者。在ALTOS研究中，MMSE和详细神经心理测试在出院后6个月和12个月进行，而在ABC研究中，分别在出院时、3个月和12个月进行。将MMSE识别出的总体认知障碍（得分<24）与神经心理测试识别出的障碍进行比较。我们还将MMSE上的定向、登记、注意力、记忆和语言领域与相应的神经心理测试进行匹配。评估了成对相关性、敏感性、特异性、阳性和阴性预测值以及一致性。
MMSE与神经心理测试在总体认知障碍方面的一致性一般（42%至80%）。特异性极佳（≥93%），但敏感性较差（19%至37%）。MMSE各领域与相应神经心理测试之间的相关性较弱至中等（6个月：r = 0.11至0.28；12个月：r = 0.09至0.34）。MMSE与神经心理领域之间的最高相关性在6个月时为注意力（r = 0.28），在12个月时为语言（r = 0.34）。
在急性呼吸衰竭幸存者中，与同时进行的详细神经心理测试相比，MMSE在检测认知障碍方面敏感性较差。对该人群的MMSE结果应谨慎解读。
