Pang Ting, Zhao Xuhao, He Xindi, Kan Cheuk Ni, Venketasubramanian Narayanaswamy, Cheng Ching-Yu, Yuan Changzheng, Chen Christopher, Xu Xin
School of Public Health & the 2nd Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China.
Memory, Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Front Aging Neurosci. 2022 Aug 8;14:901592. doi: 10.3389/fnagi.2022.901592. eCollection 2022.
To compare the discriminant validity of three different single-question assessments of subjective cognitive complaints (SCC) for dementia in a community-based older adult population in Singapore.
Eligible older adults aged ≥60 were recruited into phase I for identifying those who require further assessment using the Abbreviated Mental Test (AMT) and progressive forgetfulness question (PFQ). Participants who failed either tests entered phase II and were administered various single-question assessments of SCC, such as the 8th question on the patient Ascertain Dementia 8 (AD8-8), informant AD8 (AD8-8), and the 10th item on the Geriatric Depression Scale (GDS-10), followed by the Montreal Cognitive Assessment (MoCA) and a formal neuropsychological battery to identify the participant's cognitive status by a research diagnosis and DSM-IV criteria. Differences in characteristics among diagnostic groups were compared. All discriminatory indices (sensitivity, specificity, positive, and negative predictive values, overall accuracy) for these single-question assessments and their combinations with the MoCA were calculated and reported to confirm their discriminant validity in identifying the existence of subjective complaints and objective impairment.
A total of 3,780 participants were assessed at phase I, of which 957 entered and completed phase II. Of whom, 911 were dementia-free and 46 had dementia. The MoCA (13/14) displayed good sensitivity (95.6%), specificity (81.5%), and overall accuracy (82.1%) for dementia detection. The GDS-10 and AD8-8 showed poor discriminant validity, while the AD8-8 had the highest specificity (83.2%) and the greatest overall accuracy (82.5%) for dementia. Compensatory combination of the AD8-8 with MoCA, the sensitivity and positive predictive values were optimized (100%), while the conjunctive combination of two tools achieved excellent specificity (96.3%) and overall accuracy (94.8%) in discriminating dementia patients.
Combining a reliable single-question SCC assessment with an objective tool can efficiently discriminate dementia patients from healthy older adults in the community.
比较三种不同的主观认知主诉（SCC）单问题评估方法对新加坡社区老年人群痴呆症的判别效度。
年龄≥60岁的符合条件的老年人被纳入第一阶段，以确定那些需要使用简易精神状态检查表（AMT）和进行性遗忘问题（PFQ）进行进一步评估的人。两项测试中任何一项未通过的参与者进入第二阶段，并接受各种SCC单问题评估，如患者痴呆症筛查量表8（AD8-8）的第8个问题、 informant AD8（AD8-8）以及老年抑郁量表（GDS-10）的第10项，随后进行蒙特利尔认知评估（MoCA）和一套正式的神经心理学测试，以根据研究诊断和《精神疾病诊断与统计手册》第四版（DSM-IV）标准确定参与者的认知状态。比较诊断组之间的特征差异。计算并报告这些单问题评估及其与MoCA组合的所有判别指标（敏感性、特异性、阳性和阴性预测值、总体准确性），以确认它们在识别主观主诉和客观损害存在方面的判别效度。
共有3780名参与者在第一阶段接受评估，其中957人进入并完成了第二阶段。其中，911人无痴呆症，46人患有痴呆症。MoCA（13/14）在痴呆症检测方面显示出良好的敏感性（95.6%）、特异性（81.5%）和总体准确性（82.1%）。GDS-1O和AD8-8显示出较差的判别效度，而AD8-8在痴呆症方面具有最高的特异性（83.2%）和最大的总体准确性（82.5%）。AD8-8与MoCA的补偿性组合使敏感性和阳性预测值得到优化（100%），而两种工具的联合组合在区分痴呆症患者方面达到了出色的特异性（96.3%）和总体准确性（94.8%）。
将可靠的单问题SCC评估与客观工具相结合，可以有效地在社区中将痴呆症患者与健康老年人区分开来。
