Ranson Janice M, Kuźma Elżbieta, Hamilton William, Muniz-Terrera Graciela, Langa Kenneth M, Llewellyn David J
University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan.
Neurol Clin Pract. 2019 Apr;9(2):109-117. doi: 10.1212/CPJ.0000000000000566.
Brief cognitive assessments can result in false-positive and false-negative dementia misclassification. We aimed to identify predictors of misclassification by 3 brief cognitive assessments; the Mini-Mental State Examination (MMSE), Memory Impairment Screen (MIS) and animal naming (AN).
Participants were 824 older adults in the population-based US Aging, Demographics and Memory Study with adjudicated dementia diagnosis (DSM-III-R and DSM-IV criteria) as the reference standard. Predictors of false-negative, false-positive and overall misclassification by the MMSE (cut-point <24), MIS (cut-point <5) and AN (cut-point <9) were analysed separately in multivariate bootstrapped fractional polynomial regression models. Twenty-two candidate predictors included sociodemographics, dementia risk factors and potential sources of test bias.
Misclassification by at least one assessment occurred in 301 (35.7%) participants, whereas only 14 (1.7%) were misclassified by all 3 assessments. There were different patterns of predictors for misclassification by each assessment. Years of education predicts higher false-negatives (odds ratio [OR] 1.23, 95% confidence interval [95% CI] 1.07-1.40) and lower false-positives (OR 0.77, 95% CI 0.70-0.83) by the MMSE. Nursing home residency predicts lower false-negatives (OR 0.15, 95% CI 0.03-0.63) and higher false-positives (OR 4.85, 95% CI 1.27-18.45) by AN. Across the assessments, false-negatives were most consistently predicted by absence of informant-rated poor memory. False-positives were most consistently predicted by age, nursing home residency and non-Caucasian ethnicity (all < 0.05 in at least 2 models). The only consistent predictor of overall misclassification across all assessments was absence of informant-rated poor memory.
Dementia is often misclassified when using brief cognitive assessments, largely due to test specific biases.
简短认知评估可能导致痴呆症误诊出现假阳性和假阴性结果。我们旨在通过三种简短认知评估确定误诊的预测因素，即简易精神状态检查表（MMSE）、记忆损害筛查表（MIS）和动物命名测试（AN）。
研究对象为824名美国基于人群的老龄化、人口统计学和记忆研究中的老年人，以经裁定的痴呆症诊断（DSM-III-R和DSM-IV标准）作为参考标准。在多变量自抽样分数多项式回归模型中，分别分析MMSE（临界值<24）、MIS（临界值<5）和AN（临界值<9）出现假阴性、假阳性及总体误诊的预测因素。22个候选预测因素包括社会人口统计学、痴呆症风险因素和测试偏差的潜在来源。
301名（35.7%）参与者至少有一项评估出现误诊，而所有三项评估均误诊的只有14名（1.7%）。每项评估的误诊预测因素模式不同。受教育年限可预测MMSE出现更高的假阴性（比值比[OR]1.23，95%置信区间[95%CI]1.07 - 1.40）和更低的假阳性（OR 0.77，95%CI 0.70 - 0.83）。养老院居住情况可预测AN出现更低的假阴性（OR 0.15，95%CI 0.03 - 0.63）和更高的假阳性（OR 4.85，95%CI 1.27 - 18.45）。在所有评估中，假阴性最一致的预测因素是无 informant 评定的记忆差。假阳性最一致的预测因素是年龄、养老院居住情况和非白种人种族（在至少2个模型中均P<0.05）。所有评估中总体误诊的唯一一致预测因素是无 informant 评定的记忆差。
使用简短认知评估时，痴呆症常被误诊，这主要是由于测试的特定偏差。
