Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America.
PLoS One. 2020 Oct 15;15(10):e0240422. doi: 10.1371/journal.pone.0240422. eCollection 2020.
Community detection of mild cognitive impairment (MCI) and Alzheimer's disease and related disorders (ADRD) is a challenge. While Gold Standard assessments are commonly used in research centers, these methods are time consuming, require extensive training, and are not practical in most clinical settings or in community-based research projects. Many of these methods require an informant (e.g., spouse, adult child) to provide ratings of the patients' cognitive and functional abilities. A patient-reported outcome that captures the presence of cognitive impairment and corresponds to Gold Standard assessments could improve case ascertainment, clinical care, and recruitment into clinical research. We tested the patient version of the Quick Dementia Rating System (QDRS) as a patient-reported outcome to detect MCI and ADRD.
The patient QDRS was validated in a sample of 261 consecutive patient-caregiver dyads compared with the informant version of the QDRS, the Clinical Dementia Rating (CDR), neuropsychological tests, and Gold Standard measures of function, behavior, and mood. Psychometric properties including item variability, floor and ceiling effects, construct, concurrent, and known-groups validity, and internal consistency were determined.
The patient QDRS strongly correlated with Gold Standard measures of cognition, function, mood, behavior, and global staging methods (p-values < .001) and had strong psychometric properties with excellent data quality and internal consistency (Cronbach alpha = 0.923, 95%CI:0.91-0.94). The patient QDRS had excellent agreement with the informant QDRS, the CDR and its sum of boxes (Intraclass Correlation Coefficients: 9.781-0.876). Receiver operator characteristic curves showed excellent discrimination between normal controls from CDR 0.5 (AUC:0.820;95% CI: 0.74-0.90) and for normal controls from any cognitive impairment (AUC:0.885;95% CI: 0.83-0.94).
The patient QDRS validly and reliably differentiates individuals with and without cognitive impairment and can be completed by patients through all stages of dementia. The patient QDRS is highly correlated with Gold Standard measures of cognitive, function, behavior, and global staging. The patient QDRS provides a rapid method to screen patients for MCI and ADRD in clinical practice, determine study eligibility, improve case ascertainment in community studies.
轻度认知障碍（MCI）和阿尔茨海默病及相关疾病（ADRD）的社区检测是一个挑战。虽然金标准评估通常用于研究中心，但这些方法耗时、需要广泛的培训，并且在大多数临床环境或基于社区的研究项目中不切实际。其中许多方法需要一个知情人（例如配偶、成年子女）来评估患者的认知和功能能力。一种可以捕捉认知障碍并与金标准评估相对应的患者报告结果，可以改善病例确定、临床护理和临床研究招募。我们测试了患者版快速痴呆评定量表（QDRS）作为一种患者报告结果，以检测 MCI 和 ADRD。
在 261 例连续的患者-照护者配对样本中，对患者版 QDRS 进行了验证，与 QDRS 的知情人版本、临床痴呆评定量表（CDR）、神经心理学测试以及功能、行为和情绪的金标准测量方法进行了比较。确定了计量学特性，包括项目变异性、地板和天花板效应、结构、同时和已知群体有效性以及内部一致性。
患者 QDRS 与认知、功能、情绪、行为和总体分期方法的金标准测量方法高度相关（p 值<0.001），并且具有出色的计量学特性，数据质量和内部一致性都很好（Cronbach 阿尔法=0.923，95%CI：0.91-0.94）。患者 QDRS 与知情人 QDRS、CDR 及其盒数总和具有极好的一致性（内类相关系数：9.781-0.876）。受试者工作特征曲线显示出极好的区分 CDR 0.5 的正常对照和任何认知障碍的正常对照的能力（AUC：0.820；95%CI：0.74-0.90）和任何认知障碍的正常对照（AUC：0.885；95%CI：0.83-0.94）。
患者 QDRS 可有效可靠地区分有认知障碍和无认知障碍的个体，并且可以在痴呆的所有阶段由患者完成。患者 QDRS 与认知、功能、行为和总体分期的金标准测量高度相关。患者 QDRS 为临床实践中筛查 MCI 和 ADRD 患者、确定研究资格、提高社区研究中的病例确定提供了一种快速方法。
