Marks Timothy S, Giles Gordon M, Al-Heizan Muhammad O, Edwards Dorothy F
Department of Kinesiology-Occupational Therapy, The University of Wisconsin-Madison, Madison, WI, United States.
Department of Occupational Therapy, Samuel Merritt University, Oakland, CA, United States.
Front Aging Neurosci. 2020 Feb 20;12:33. doi: 10.3389/fnagi.2020.00033. eCollection 2020.
The identification of functional performance deficits is critical to the community independence of older adults. We examined whether a combined cognitive and performance-based medication management measure would be able to better classify an individual's functional cognitive status and potential for instrumental activities of daily living (IADL) impairment than either measure alone. Community-dwelling adults age 55 and older ( = 185) were administered the Mini-Cog, the Medication Transfer Screen-Revised (MTS-R), a combination measure the Medi-Cog-Revised (Medi-Cog-R), the Performance Assessment of Self-Care Skills (PASS) Checkbook Balancing and Shopping tasks (PCST), additional cognitive screening measures, and a self-report daily living scale. Receiver operating characteristic (ROC) curve analyses were computed for the Mini-Cog, MTS-R and the Medi-Cog-R using the PCST performance as the criterion measure. The area under the curve (AUC), sensitivity, and specificity were computed for each measure. The Medi-Cog-R most accurately identified individuals as impaired on the PCST. An AUC statistic of 0.82 for the Medi-Cog-R was greater than either the Mini-Cog (0.75) or the MTS-R (0.73). The Medi-Cog-R demonstrated a sensitivity of 0.71 and a specificity of 0.78 in classifying individuals with impaired IADL as measured by the PCST. The Mini-Cog, the MTS-R, and the Medi-Cog-R all show discriminant validity, but the combined measure demonstrates greater sensitivity and specificity than either component measure alone in identifying IADL impairment. The Medi-Cog-R appears to be a useful screening measure for functional cognition and can be used to prompt further assessment and intervention to promote community independence.
识别功能表现缺陷对于老年人的社区独立至关重要。我们研究了一种基于认知与表现的联合用药管理措施，相较于单独使用其中任何一种措施，是否能够更好地对个体的功能性认知状态以及日常生活工具性活动（IADL）受损潜力进行分类。对185名年龄在55岁及以上的社区居住成年人进行了简易认知测试（Mini-Cog）、修订版药物转移筛查（MTS-R）、修订版综合认知测试（Medi-Cog-R）、自我护理技能表现评估（PASS）支票簿平衡和购物任务（PCST）、其他认知筛查措施以及一份自我报告日常生活量表的测试。以PCST表现作为标准测量指标，对Mini-Cog、MTS-R和Medi-Cog-R进行了受试者操作特征（ROC）曲线分析。计算了每种测量方法的曲线下面积（AUC）、敏感性和特异性。Medi-Cog-R最准确地识别出在PCST上受损的个体。Medi-Cog-R的AUC统计值为0.82，高于Mini-Cog（0.75）或MTS-R（0.73）。在将PCST测量的IADL受损个体分类时，Medi-Cog-R的敏感性为0.71，特异性为0.78。Mini-Cog、MTS-R和Medi-Cog-R均显示出判别效度，但在识别IADL受损方面，联合测量方法比单独的任何一个组成测量方法都具有更高的敏感性和特异性。Medi-Cog-R似乎是一种用于功能性认知的有用筛查措施，可用于促使进一步评估和干预，以促进社区独立。
