Kayseri Education and Research Hospital,Geriatric Center,Kayseri,Turkey.
Unit for Aging Brain and Dementia,Department of Geriatric Medicine,Dokuz Eylul University,Faculty of Medicine,Izmir,Turkey.
Int Psychogeriatr. 2017 Nov;29(11):1763-1769. doi: 10.1017/S1041610217001181. Epub 2017 Jun 29.
Comprehensive neurocognitive assessment may not be performed in clinical practice, as it takes too much time and requires special training. Development of easily applicable, time-saving, and cost effective screening methods has allowed identifying the individuals that require further evaluation. The aim of present study was to assess the diagnostic value of the Attended With (AW) and Head-Turning Sign (HTS) for screening cognitive impairment (CI).
Comprehensive geriatric assessment was performed in 529 elderly outpatients, and the presence or absence of AW and HTS was investigated in them all.
Of the 529 patients, of whom the mean age was 75.67 ± 8.29 years, 126 patients were considered as CI (102 dementia, 24 mild CI). The patients with positive AW had significantly lower scores on Mini-Mental State Examination, Cognitive State Test, and Montreal Cognitive Assessment, and activities of daily living compared to AW (-) patients (p < 0.001). Similar significant findings were obtained in the patients with positive and negative HTS (p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of AW in detecting CI were 92%, 37%, 31.4%, and 93.7%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of HTS were 80%, 64%, 41.8%, and 91.5%, respectively. The area under the receiver-operating characteristics curve was 0.90 for AW and 0.82 for HTS.
AW and HTS are fast, simple, effective, and sensitive methods for detecting CI. Therefore, they can be used for older adults attending the primary care settings with memory loss. Those with positive AW or HTS can be referred to the relevant centers for detailed cognitive assessment.
全面的神经认知评估在临床实践中可能无法进行，因为它需要太多的时间并且需要特殊的培训。开发易于应用、节省时间和具有成本效益的筛选方法，可以识别需要进一步评估的个体。本研究旨在评估 Attended With (AW) 和 Head-Turning Sign (HTS) 在筛查认知障碍 (CI) 中的诊断价值。
对 529 名老年门诊患者进行全面的老年综合评估，并对所有患者进行 AW 和 HTS 的存在或缺失情况进行调查。
在 529 名患者中，平均年龄为 75.67 ± 8.29 岁，其中 126 名患者被认为患有 CI（102 名痴呆症，24 名轻度 CI）。与 AW（-）患者相比，AW 阳性患者的简易精神状态检查、认知状态测试、蒙特利尔认知评估和日常生活活动评分明显较低（p<0.001）。在 HTS 阳性和阴性患者中也得到了类似的显著发现（p<0.001）。AW 检测 CI 的敏感性、特异性、阳性预测值和阴性预测值分别为 92%、37%、31.4%和 93.7%。HTS 的敏感性、特异性、阳性预测值和阴性预测值分别为 80%、64%、41.8%和 91.5%。AW 和 HTS 的受试者工作特征曲线下面积分别为 0.90 和 0.82。
AW 和 HTS 是检测 CI 的快速、简单、有效和敏感的方法。因此，它们可用于在初级保健环境中出现记忆障碍的老年人。那些 AW 或 HTS 阳性的人可以被转介到相关中心进行详细的认知评估。
