Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nägelsbachstr. 49c, 91052, Erlangen, Germany.
BMC Psychiatry. 2018 Sep 24;18(1):308. doi: 10.1186/s12888-018-1886-5.
The ability to perform activities of daily living (ADLs) is a central marker in the diagnosis and progression of the dementia syndrome. ADLs can be identified as basic ADLs (BADLs), which are fairly easy to perform, or instrumental ADLs (IADLs), which involve more complex activities. Presently, the only performance-based assessment of IADL capabilities in persons with cognitive impairment is the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM). The aim of the present study was to revalidate the ETAM in persons with mild cognitive impairment (MCI) or mild dementia and to analyze its application to persons with moderate dementia.
We used baseline data from a cluster randomized controlled trial involving a sample of 443 users of 34 day-care centers in Germany. We analyzed groups of persons with MCI, mild dementia, and moderate dementia, categorized on the basis of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). An item analysis was performed, and new discriminant validities were calculated. We computed a confirmatory factor analysis (CFA) to examine the postulated theoretical model of the ETAM with all six items loading on a single IADL factor. This was the first time that the ETAM's sensitivity to change was analyzed after a time period of 6 months.
The overall sample scored on average 17.3 points (SD = 7.2) on the ETAM (range: 0-30 points). Persons with MCI scored on average 23.2 points, persons with mild dementia scored 18.4 points, and persons with moderate dementia scored 12.9 points, p < .001 (ANOVA). The item analysis yielded good difficulty indices and discrimination powers. The CFA indicated a good fit between the model and the observed data. After 6 months, both the ETAM score at baseline and the change in MMSE score (t0-t1) were significant predictors of the ETAM score at t1.
The ETAM is a valid and reliable instrument for assessing IADL capabilities in persons with MCI or mild dementia. It is sensitive to changes in cognitive abilities. The test parameters confirm its application to persons with moderate dementia.
Identifier: ISRCTN16412551 (Registration date: 30 July 2014, registered retrospectively).
日常生活活动（ADLs）的能力是痴呆综合征诊断和进展的一个核心标志物。ADLs 可分为基本日常生活活动（BADLs），这些活动相当容易完成，或工具性日常生活活动（IADLs），这些活动涉及更复杂的活动。目前，对认知障碍者的 IADL 能力进行的唯一基于表现的评估是在轻度痴呆或轻度认知障碍患者中的埃尔朗根日常生活活动测试（ETAM）。本研究的目的是重新验证轻度认知障碍（MCI）或轻度痴呆患者中的 ETAM，并分析其在中度痴呆患者中的应用。
我们使用了一项涉及德国 34 个日间护理中心的 443 名使用者的聚类随机对照试验的基线数据。我们分析了 MCI、轻度痴呆和中度痴呆患者组，根据简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）进行分类。进行了项目分析，并计算了新的判别效度。我们进行了验证性因子分析（CFA），以检验 ETAM 的假设理论模型，其中所有六项条目都加载在单个 IADL 因子上。这是第一次在 6 个月的时间间隔后分析 ETAM 的敏感性变化。
总体样本在 ETAM 上的平均得分为 17.3 分（标准差=7.2）（范围：0-30 分）。MCI 患者的平均得分为 23.2 分，轻度痴呆患者的得分为 18.4 分，中度痴呆患者的得分为 12.9 分，p<.001（方差分析）。项目分析产生了良好的难度指数和区分能力。CFA 表明模型与观察数据之间具有良好的拟合度。6 个月后，ETAM 的基线得分和 MMSE 得分的变化（t0-t1）均是 t1 时 ETAM 得分的显著预测因子。
ETAM 是一种评估 MCI 或轻度痴呆患者 IADL 能力的有效且可靠的工具。它对认知能力的变化敏感。测试参数证实了它在中度痴呆患者中的应用。
标识符：ISRCTN81115251（注册日期：2014 年 7 月 30 日，回顾性注册）。
