Creavin Sam, Fish Mark, Gallacher John, Bayer Antony, Ben-Shlomo Yoav
NIHR academic clinical fellow in general practice;
Department of Neurology, Musgrove Park Hospital, Taunton.
Br J Gen Pract. 2015 Aug;65(637):e489-99. doi: 10.3399/bjgp15X686053.
Diagnosis of dementia often requires specialist referral and detailed, time-consuming assessments.
To investigate the utility of simple clinical items that non-specialist clinicians could use, in addition to routine practice, to diagnose all-cause dementia syndrome.
Cross-sectional diagnostic test accuracy study. Participants were identified from the electoral roll and general practice lists in Caerphilly and adjoining villages in South Wales, UK.
Participants (1225 men aged 45-59 years) were screened for cognitive impairment using the Cambridge Cognitive Examination, CAMCOG, at phase 5 of the Caerphilly Prospective Study (CaPS). Index tests were a standardised clinical evaluation, neurological examination, and individual items on the Informant Questionnaire for Cognitive Disorders in the Elderly (IQCODE).
Two-hundred and five men who screened positive (68%) and 45 (4.8%) who screened negative were seen, with 59 diagnosed with dementia. The model comprising problems with personal finance and planning had an area under the curve (AUC) of 0.92 (95% confidence interval [CI] = 0.86 to 0.97), positive likelihood ratio (LR+) of 23.7 (95% CI = 5.88 to 95.6), negative likelihood ratio (LR-) of 0.41 (95% CI = 0.27 to 0.62). The best single item for ruling out was no problems learning to use new gadgets (LR- of 0.22, 95% CI = 0.11 to 0.43).
This study found that three simple questions have high utility for diagnosing dementia in men who are cognitively screened. If confirmed, this could lead to less burdensome assessment where clinical assessment suggests possible dementia.
痴呆症的诊断通常需要专科转诊以及详细且耗时的评估。
探讨非专科临床医生除常规诊疗外可用于诊断全因性痴呆综合征的简单临床项目的效用。
横断面诊断试验准确性研究。研究对象从英国南威尔士卡菲利及周边村庄的选民名册和全科医疗名单中确定。
在卡菲利前瞻性研究（CaPS）的第5阶段，使用剑桥认知检查（CAMCOG）对参与者（1225名年龄在45 - 59岁的男性）进行认知障碍筛查。指标测试包括标准化临床评估、神经系统检查以及老年认知障碍 informant 问卷（IQCODE）上的单项内容。
对205名筛查呈阳性（68%）和45名筛查呈阴性（4.8%）的男性进行了检查，其中59人被诊断为痴呆症。包含个人财务和规划问题的模型曲线下面积（AUC）为0.92（95%置信区间[CI]=0.86至0.97），阳性似然比（LR +）为23.7（95%CI = 5.88至95.6），阴性似然比（LR -）为0.41（95%CI = 0.27至0.62）。排除痴呆症的最佳单项指标是学习使用新小工具无困难（LR -为0.22，95%CI = 0.11至0.43）。
本研究发现，三个简单问题在对认知筛查的男性进行痴呆症诊断方面具有很高的效用。如果得到证实，这可能会在临床评估提示可能患有痴呆症时减轻评估负担。
