Margolis Seth A, Papandonatos George D, Tremont Geoffrey, Ott Brian R
Department of Psychiatry and Human Behavior,Warren Alpert Medical School of Brown University,Providence,RI,USA.
Department of Biostatistics,Brown University,Providence,RI,USA.
Int Psychogeriatr. 2018 Mar;30(3):365-373. doi: 10.1017/S1041610217001739. Epub 2017 Sep 25.
ABSTRACTBackground:We assessed the ability of a telephone-administered cognitive screening test - Minnesota Cognitive Acuity Screen (MCAS) - to predict time to assisted living/nursing home placement (i.e. institutionalization) and homecare/institutionalization in healthy controls (HC), mild cognitive impairment (MCI), and Alzheimer's disease (AD).
Participants (N = 146; HC = 37; MCI = 70; AD = 39) had baseline MCAS testing and were re-contacted over eight years for dates of starting homecare, institutionalization, and death. Occasionally, outcomes were obtained via medical records. Accounting for informative censoring due to death within a competing risks framework, Cox regression examined the associations of baseline MCAS performance with the start of (a) institutionalization and (b) homecare/institutionalization.
Hazard ratios (HR) captured the effect of a ten-point difference in baseline MCAS scores, corresponding to a change from the MCI/HC to AD/MCI boundaries. In unadjusted models, increased baseline cognitive impairment was associated with nearly two-fold increases in the hazard of institutionalization (HR = 1.81, 95% CI = 1.32, 2.48) and homecare/institutionalization (HR = 1.87, 95% CI = 1.44, 2.42). However, hazards were not proportional over time in models adjusting for sex. This was resolved when regressions were run for men and women separately. Both sexes showed significant increases in the hazard of institutionalization (Females: HR = 2.39, 95% CI = 1.53-3.74; Males: HR = 1.68, 95% CI = 1.02-2.76) and homecare/institutionalization (Females: HR = 2.31, 95% CI = 1.66, 3.21; Males: HR = 1.98, 95% CI = 1.32, 2.96) with increased impairment, although hazards were lower for males.
Telephone-administered MCAS provides useful information about the risk of needing homecare assistance or institutionalization. It may be particularly useful when office/home visits are prohibitive but cognitive monitoring is indicated.
摘要背景：我们评估了一种通过电话进行的认知筛查测试——明尼苏达认知敏锐度筛查（MCAS）——预测健康对照者（HC）、轻度认知障碍（MCI）和阿尔茨海默病（AD）患者入住辅助生活设施/养老院（即机构化）以及接受家庭护理/机构化的时间的能力。
参与者（N = 146；HC = 37；MCI = 70；AD = 39）接受了基线MCAS测试，并在八年时间里被再次联系，以获取开始接受家庭护理、机构化和死亡的日期。偶尔，通过医疗记录获取结果。在竞争风险框架内考虑因死亡导致的信息删失，Cox回归分析了基线MCAS表现与（a）机构化开始和（b）家庭护理/机构化开始之间的关联。
风险比（HR）反映了基线MCAS分数相差10分的影响，这对应于从MCI/HC边界到AD/MCI边界的变化。在未调整的模型中，基线认知障碍增加与机构化风险（HR = 1.81，95%置信区间 = 1.32，2.48）和家庭护理/机构化风险（HR = 1.87，95%置信区间 = 1.44，2.42）几乎增加两倍相关。然而，在调整性别的模型中，风险随时间不成比例。当分别对男性和女性进行回归分析时，这个问题得到了解决。两性在机构化风险（女性：HR = 2.39，95%置信区间 = 1.53 - 3.74；男性：HR = 1.68，95%置信区间 = 1.02 - 2.76）和家庭护理/机构化风险（女性：HR = 2.31，95%置信区间 = 1.66，3.2l；男性：HR = 1.98，%置信区间 = 1.32，2.96）方面都随着障碍增加而显著增加，尽管男性的风险较低。
通过电话进行的MCAS提供了关于需要家庭护理援助或机构化风险的有用信息。当禁止进行办公室/家访但需要进行认知监测时，它可能特别有用。
