Santana Isabel, Duro Diana, Lemos Raquel, Costa Vanessa, Pereira Miguel, Simões Mário R, Freitas Sandra
Centro de Neurociências e Biologia Celular. Universidade de Coimbra. Coimbra. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Consulta de Demência, Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra.
Faculdade de Medicina. Universidade de Coimbra. Coimbra. Consulta de Demência, Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra.
Acta Med Port. 2016 Apr;29(4):240-8. doi: 10.20344/amp.6889. Epub 2016 Apr 29.
The Mini-Mental State Examination is the most commonly used cognitive screening test. In Portugal, the cut-off scores are defined according to literacy groups, but different proposals have been recommended by more representative studies. We therefore propose to confirm the influence of demographical variables, such as age and education, in the subjectâs performance; evaluating the discriminant ability of the new normative data; and to further examine the diagnostic acuity of the validated cut-off scoring for mild cognitive impairment and for the most prevalent types of dementia.
Our study includes 1 441 educated subjects, divided into seven subgroups: Mild cognitive impairment, Alzheimer's disease, frontotemporal dementia, vascular dementia, dementia with Lewy bodies, community-controls and memory clinic-controls.
Altogether age and education explain 10.4% of the Mini-Mental State Examination results variance, with both variables contributing significantly to the resultsâ prediction. The diagnostic acuity based on the most recent normative data was always higher than the one obtained through the validation cut-off scoring, revealing an overall excellent specificity (superior to 90%) and different sensitivity values: excellent for mild Alzheimer's disease (91%), good for dementia with Lewy Bodies (78%) and low for mild cognitive impairment (65%), frontotemporal dementia and vascular dementia (55%).
The performance on the Mini-Mental State Examination is influenced by age and education, supporting the use of normative data that consider those variables. With this approach, the Mini-Mental State Examination could be a sensitive and specific instrument for the Alzheimer's disease screening among all healthcare levels. Nevertheless, its diagnostic acuity is limited in other conditions frequently seen in memory clinics, such as Mild Cognitive Impairment and other types of dementia.
简易精神状态检查表是最常用的认知筛查测试。在葡萄牙，临界值分数是根据识字群体来定义的，但更具代表性的研究提出了不同的建议。因此，我们建议确认年龄和教育等人口统计学变量对受试者表现的影响；评估新的标准化数据的判别能力；并进一步检查经验证的临界值评分对轻度认知障碍和最常见类型痴呆症的诊断敏锐度。
我们的研究纳入了1441名受过教育的受试者，分为七个亚组：轻度认知障碍、阿尔茨海默病、额颞叶痴呆、血管性痴呆、路易体痴呆、社区对照和记忆门诊对照。
年龄和教育总共解释了简易精神状态检查表结果变异的10.4%，这两个变量对结果预测均有显著贡献。基于最新标准化数据的诊断敏锐度始终高于通过验证临界值评分获得的诊断敏锐度，显示出总体出色的特异性（优于90%）和不同的敏感度值：轻度阿尔茨海默病的敏感度极佳（91%），路易体痴呆的敏感度良好（78%），轻度认知障碍、额颞叶痴呆和血管性痴呆的敏感度较低（65%和55%）。
简易精神状态检查表的表现受年龄和教育的影响，支持使用考虑这些变量的标准化数据。通过这种方法，简易精神状态检查表在所有医疗保健层面都可能是一种用于阿尔茨海默病筛查的敏感且特异的工具。然而，其在记忆门诊常见的其他病症（如轻度认知障碍和其他类型痴呆症）中的诊断敏锐度有限。
