Isik Ahmet T, Soysal Pinar, Kaya Derya, Usarel Cansu
Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
Department of Geriatric Medicine, Geriatric Center, Kayseri Education and Research Hospital, Kayseri, Turkey.
Psychogeriatrics. 2018 Mar;18(2):98-105. doi: 10.1111/psyg.12289. Epub 2018 Feb 6.
A simple, quick, and efficient screening tool for detecting mild cognitive impairment (MCI) and Alzheimer's disease (AD) is essential, especially in the primary care setting. In this study, we examined the neuropsychological profiles of elderly patients and aimed to assess the diagnostic value of the triple test, comprised of the attended alone sign (AAS), head-turning sign, and applause sign (AS), for detecting MCI and AD.
Comprehensive geriatric assessment was performed in 354 elderly outpatients, and the presence or absence of AS, AAS and HTS was investigated.
Of the 354 patients, 93 patients were considered to be cognitively impaired (MCI: 30; AD: 63); the remaining 261 were cognitively healthy. Relative to those without AS, patients with AS had significantly lower scores on the Mini-Mental State Examination, the clock-drawing test, Instrumental Activities of Daily Living Scale, and Basic Activities of Daily Living Scale (P < 0.001, for each). Similar significant differences were found between patients who were positive and negative for the HTS (P < 0.001) and between those who attended the clinic alone and those who were accompanied (P < 0.001). The sensitivity of the triple test for identifying cognitively impairment (CI), MCI, and AD was 0.61, 0.30, and 0.72, respectively; the specificity was 0.85, 0.68, and 0.83, respectively; and the positive and negative predictive values were 0.69, 0.09, and 0.59, respectively, and 0.79, 0.90, and 0.89, respectively.
The present study suggests that the triple test is a simple, quick, and efficient screening tool for detecting cognitive impairment, and the results may reflect deterioration in patients' activities of daily living. Additionally, it could be advantageous in clinical practice because educational level does not affect the test outcome. Therefore, it may be an appropriate test to screen for cognitive impairment in the elderly, both as a bedside diagnostic test and in daily clinical practice, especially in the primary care setting.
一种简单、快速且有效的用于检测轻度认知障碍（MCI）和阿尔茨海默病（AD）的筛查工具至关重要，尤其是在基层医疗环境中。在本研究中，我们检查了老年患者的神经心理学特征，并旨在评估由单独就诊体征（AAS）、转头体征和鼓掌体征（AS）组成的三联试验对检测MCI和AD的诊断价值。
对354名老年门诊患者进行了全面的老年综合评估，并调查了AS、AAS和HTS的有无情况。
在354名患者中，93名患者被认为存在认知障碍（MCI：30例；AD：63例）；其余261名认知健康。与无AS的患者相比，有AS的患者在简易精神状态检查表、画钟试验、日常生活活动能力量表和日常生活基本活动量表上的得分显著更低（每项P<0.001）。在HTS呈阳性和阴性的患者之间（P<0.001）以及单独就诊和有陪同就诊的患者之间（P<0.001）也发现了类似的显著差异。三联试验用于识别认知障碍（CI）、MCI和AD的敏感性分别为0.61、0.30和0.72；特异性分别为0.85、0.68和0.83；阳性预测值和阴性预测值分别为0.69、0.09和0.59，以及0.79、0.90和0.89。
本研究表明，三联试验是一种用于检测认知障碍的简单、快速且有效的筛查工具，其结果可能反映患者日常生活活动能力的下降。此外，由于教育水平不影响试验结果，因此在临床实践中可能具有优势。因此，它可能是一种适用于筛查老年人认知障碍的试验，既可以作为床边诊断试验，也可用于日常临床实践，尤其是在基层医疗环境中。
