Iatraki Eliza, Simos Panagiotis G, Bertsias Antonios, Duijker George, Zaganas Ioannis, Tziraki Chariklia, Vgontzas Alexandros N, Lionis Christos
a Clinic of Social and Family Medicine, Faculty of Medicine , University of Crete , Heraklion , Greece.
b Department of Psychiatry, Faculty of Medicine , University of Crete , Heraklion , Greece.
Eur J Gen Pract. 2017 Dec;23(1):171-178. doi: 10.1080/13814788.2017.1324845.
Under conditions of high demand for primary care services in a setting of low financial resources, there is need for brief, easily administered cognitive screening tools for use in the primary care setting, especially in rural areas. However, interpretation of these cognitive tests' results requires knowledge on their susceptibility to cultural, educational and demographic patient characteristics.
To assess the clinical validity of the 'Test Your Memory' (TYM) and 'General Practitioner assessment of Cognition' (GPCog) which was specifically designed for primary care practice, in a rural primary care setting in Greece, utilizing the 'Mini Mental State Examination' (MMSE) as a reference standard.
The MMSE, TYM, and GPCog were administered to a random sample of 319 community dwelling Greek adults aged 60 to 89 years in 11 rural Primary Healthcare Centres of the Prefecture of Heraklion on the island of Crete, Greece. Analyses examined (a) The association of each instrument with demographic factors and MMSE and (b) optimal cut-off scores, sensitivity and specificity against MMSE-based cognitive impairment risk using ROC analyses with the MMSE 23/24 point cut-off as a reference standard.
We found a sensitivity of 80% and a specificity of 77% for TYM (35/36 or 38/39 cut-off, depending on education). Corresponding values were 89% and 61% for GPCog (7/8 cut-off), respectively.
The TYM and GPCog instruments appear to be suitable for routine use in the primary care setting as tools for cognitive impairment risk detection in elderly rural populations.
在财政资源匮乏且对初级保健服务需求较高的情况下，需要有简短、易于实施的认知筛查工具用于初级保健环境，尤其是在农村地区。然而，解读这些认知测试的结果需要了解其对患者文化、教育和人口统计学特征的敏感性。
在希腊农村初级保健环境中，以“简易精神状态检查表”（MMSE）作为参考标准，评估专门为初级保健实践设计的“测试你的记忆力”（TYM）和“全科医生认知评估”（GPCog）的临床有效性。
在希腊克里特岛伊拉克利翁州的11个农村初级保健中心，对319名年龄在60至89岁的希腊社区成年居民随机样本进行MMSE、TYM和GPCog测试。分析考察了（a）每种工具与人口统计学因素和MMSE的关联，以及（b）使用ROC分析得出的针对基于MMSE的认知障碍风险的最佳临界分数、敏感性和特异性，以MMSE 23/24分的临界值作为参考标准。
我们发现TYM（根据教育程度，临界值为35/36或38/39）的敏感性为80%，特异性为77%。GPCog（临界值为7/8）的相应值分别为89%和61%。
TYM和GPCog工具似乎适合在初级保健环境中常规使用，作为检测农村老年人群认知障碍风险的工具。
