使用 Rasch 模型测量认知障碍老年人的全球功能。
Measuring global functioning in older adults with cognitive impairments using the Rasch model.
机构信息
Department of Psychological, Health and Territorial Sciences, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy.
Department of Neurology, Boston University, School of Medicine, Boston, MA, USA.
出版信息
BMC Geriatr. 2020 Nov 23;20(1):492. doi: 10.1186/s12877-020-01886-0.
BACKGROUND
Cognitive and functional measures are often measured and interpreted separately during the clinical evaluation of patients with cognitive impairment. This can sometimes lead to a challenging interpretation when measures do not show concordance, especially after a clinical intervention. In this study, the development and evaluation of a new approach, using the Rasch model, that combines cognitive and functional measures in one single and more powerful measure (compared to stand-alone tests) to assess global functioning in older adults with cognitive impairment (including dementia) was presented.
METHODS
Clinical data from 265 older adults' subjects diagnosed with mild cognitive impairment, or dementia, included: The Mini-mental state examination (MMSE), the Esame Neuropsicologico Breve (ENB) - a neuropsychological battery used in Italy-, the Activities of Daily Living (ADL), and the Instrumental Activities of Daily Living (IADL) questionnaires.
RESULTS
Patients with severe cognitive impairment showed lower global functioning score compared to patients with moderate impairment. Receiver Operating Characteristic (ROC) curve analyses were performed to determine sensitivity and specificity of the global functioning score resulting from the combined measure. Results showed that the global functioning score discriminates better between patients with severe and moderate cognitive impairment compared to the ENB, ADL, and IADL when considered separately.
CONCLUSIONS
The Rasch model was able to combine cognitive and functional measures into a single score (global functioning score). All together, these results suggest that the diverse cognitive and functional measures can be considered part of one single dimension (global functioning) and that this dimension can be measured as a single construct and score. This study offers an alternative perspective for future development of instruments that would help clinicians in measuring global functioning in older adults' patients at different stages of cognitive impairments and different baseline level of performance.
背景
在认知障碍患者的临床评估中，通常分别测量和解释认知和功能测量。当这些测量结果不一致时，特别是在临床干预之后，这有时会导致解释变得具有挑战性。在这项研究中，提出了一种新方法的开发和评估，该方法使用 Rasch 模型将认知和功能测量结合在一个单一且更强大的测量中（与独立测试相比），以评估认知障碍（包括痴呆）的老年人的整体功能。
方法
包括轻度认知障碍或痴呆症在内的 265 名老年患者的临床数据包括：简易精神状态检查（MMSE）、意大利使用的神经心理学电池 Esame Neuropsicologico Breve（ENB）、日常生活活动（ADL）和工具性日常生活活动（IADL）问卷。
结果
与中度认知障碍患者相比，严重认知障碍患者的整体功能评分较低。进行了接收器工作特征（ROC）曲线分析，以确定组合测量得出的整体功能评分的敏感性和特异性。结果表明，与分别考虑的 ENB、ADL 和 IADL 相比，整体功能评分更好地区分了严重和中度认知障碍患者。
结论
Rasch 模型能够将认知和功能测量组合成一个单一的分数（整体功能分数）。总的来说，这些结果表明，各种认知和功能测量可以被视为一个单一维度（整体功能）的一部分，并且可以作为单一结构和分数进行测量。这项研究为未来开发有助于临床医生在认知障碍不同阶段和不同基线表现水平的老年患者中测量整体功能的工具提供了另一种视角。
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