Luttenberger Katharina, Reppermund Simone, Schmiedeberg-Sohn Anke, Book Stephanie, Graessel Elmar
Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, Erlangen, 91054, Germany.
Department of Developmental Disability Neuropsychiatry (3DN), School of Psychiatry, University of New South Wales/ UNSW Medicine, 34 Botany Street, UNSW, Sydney, NSW, 2052, Australia.
BMC Geriatr. 2016 May 26;16:111. doi: 10.1186/s12877-016-0271-9.
There are currently no valid, fast, and easy-to-administer performance tests that are designed to assess the capacities to perform activities of daily living in persons with mild dementia and mild cognitive impairment (MCI). However, such measures are urgently needed for determining individual support needs as well as the efficacy of interventions. The aim of the present study was therefore to validate the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia and Mild Cognitive Impairment (ETAM), a performance test that is based on the International Classification of Functioning and Health (ICF), which assesses the relevant domains of living in older adults with MCI and mild dementia who live independently.
The 10 ICF-based items on the research version of the ETAM were tested in a final sample of 81 persons with MCI or mild dementia. The items were selected for the final version in accordance with 6 criteria: 1) all domains must be represented and have equal weight, 2) all items must load on the same factor, 3) item difficulties and item discriminatory powers, 4) convergent validity (Bayer Activities of Daily Living Scale [B-ADL]) and discriminant validity (Mini Mental State Examination [MMSE], Geriatric Depression Scale 15 [GDS-15]), 5) inter-rater reliabilities of the individual items, 6) as little material as possible. Retest reliability was also examined. Cohen's ds were calculated to determine the magnitudes of the differences in ETAM scores between participants diagnosed with different grades of severity of cognitive impairment.
The final version of the ETAM consists of 6 items that cover the five ICF domains communication, mobility, self-care, domestic life (assessed by two 3-point items), and major life areas (specifically, the economic life sub-category) and load on a single factor. The maximum achievable score is 30 points (6 points per domain). The average administration time was 35 min, 19 of which were needed for pure item performance. The internal consistency was α = .71. The three-week test-retest reliability was r = .78, and the inter-rater reliability was r = .97. The ETAM also provided satisfactory discrimination between healthy individuals and persons with MCI or mild dementia as well as between persons with mild and moderate dementia.
The 6-item final version of the ETAM shows satisfactory psychometric characteristics and can be administered quickly. It is therefore suitable for use in both clinical practice and research.
目前尚无有效、快速且易于实施的性能测试来评估轻度痴呆和轻度认知障碍（MCI）患者进行日常生活活动的能力。然而，确定个体支持需求以及干预效果迫切需要此类措施。因此，本研究的目的是验证轻度痴呆和轻度认知障碍患者日常生活活动的埃尔朗根测试（ETAM），这是一项基于国际功能、残疾和健康分类（ICF）的性能测试，用于评估独立生活的MCI和轻度痴呆老年人的相关生活领域。
在81名MCI或轻度痴呆患者的最终样本中测试了ETAM研究版本中基于ICF的10个项目。根据6条标准选择最终版本的项目：1）所有领域都必须有代表且权重相等；2）所有项目必须加载到同一因子上；3）项目难度和项目区分度；4）收敛效度（拜耳日常生活活动量表 [B-ADL]）和区分效度（简易精神状态检查表 [MMSE]、老年抑郁量表15项 [GDS-15]）；5）各个项目的评分者间信度；6）材料尽可能少。还检查了重测信度。计算科恩d值以确定被诊断为不同认知障碍严重程度等级的参与者之间ETAM分数差异的大小。
ETAM的最终版本由6个项目组成，涵盖ICF的五个领域：沟通、活动、自我护理、家庭生活（由两个3分项目评估）和主要生活领域（具体为经济生活子类别），并加载到一个单一因子上。最高可得分为30分（每个领域6分）。平均施测时间为35分钟，其中19分钟用于纯粹的项目执行。内部一致性为α = 0.71。三周重测信度为r = 0.78，评分者间信度为r = 0.97。ETAM在健康个体与MCI或轻度痴呆患者之间以及轻度和中度痴呆患者之间也提供了令人满意的区分。
ETAM的6项最终版本显示出令人满意的心理测量学特征，并且可以快速实施。因此，它适用于临床实践和研究。
