Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Health Service Bureau, Ministry of Health, Labor and Welfare, Tokyo, Japan.
Geriatr Gerontol Int. 2018 May;18(5):738-744. doi: 10.1111/ggi.13243. Epub 2018 Jan 16.
The aim of the present study was to develop a way of identifying dementia using clinical assessments made by primary care physicians under the existing medical care system in Japan.
A total of 623 people aged ≥65 years underwent standard clinical assessments by primary care physicians under the long-term-care insurance program to determine their grade of activities of daily living related to dementia. To examine the validity of the diagnosis, neuropsychiatrists carried out further diagnosis of dementia for all the participants. We regarded the dementia patients who received care for disability under the long-term care insurance program as having disabling dementia.
Multivariable odds ratio (95% confidence interval) in single-grade increments of the activity was 2.1 (1.7-2.5) for dementia and 2.8 (2.2-3.4) for disabling dementia. The grades ≥I and ≥IIa were near the upper-left corner in the receiver operating characteristic curves. Setting the cut-off point at grades ≥I or ≥IIa yielded a higher integrated discrimination improvement, suggesting a major improvement in reducing misclassification by using these cut-off points. When we used grades ≥I as the cut-off point, the sensitivity (95% confidence limits) was 65% (58-72%) and the specificity was 93% (91-96%) for dementia, and the corresponding values in grades ≥IIa were 54% (47-62%) and 96% (94-97%). The corresponding values for disabling dementia were 83% (76-90%), 92% (90-95%), 73% (65-80%) and 96% (94-97%).
Our findings suggest that selection of grades ≥I or ≥IIa as the cut-off point would reduce instances of misclassification in the identification of dementia and disabling dementia. Geriatr Gerontol Int 2018; 18: 738-744.
本研究旨在开发一种利用日本现有医疗保健系统下初级保健医生进行的临床评估来识别痴呆的方法。
共有 623 名年龄≥65 岁的人接受了初级保健医生根据长期护理保险计划进行的标准临床评估，以确定他们与痴呆相关的日常生活活动的等级。为了检验诊断的有效性，神经精神病学家对所有参与者进行了进一步的痴呆诊断。我们认为在长期护理保险计划下接受残疾护理的痴呆患者患有残疾性痴呆。
活动等级每增加一级的多变量优势比（95%置信区间）为痴呆症 2.1（1.7-2.5）和残疾性痴呆症 2.8（2.2-3.4）。等级≥I 和≥IIa 接近于受试者工作特征曲线的左上角。将截断点设置在等级≥I 或≥IIa 时，综合判别改善程度更高，表明使用这些截断点可显著减少分类错误。当我们将等级≥I 作为截断点时，痴呆的敏感性（95%置信区间）为 65%（58-72%），特异性为 93%（91-96%），等级≥IIa 的相应值分别为 54%（47-62%）和 96%（94-97%）。残疾性痴呆的相应值分别为 83%（76-90%）、92%（90-95%）、73%（65-80%）和 96%（94-97%）。
我们的研究结果表明，选择等级≥I 或≥IIa 作为截断点可以减少识别痴呆和残疾性痴呆时的分类错误。
