College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
The Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
J Med Internet Res. 2023 Jan 30;25:e40858. doi: 10.2196/40858.
Early detection of mild cognitive impairment (MCI) symptoms is an important step to its diagnosis and intervention. We developed a new screening test called "Efficient Online MCI Screening System" (EOmciSS) for use in community-dwelling older adults. It is a self-paced cognitive test to be completed within 10 minutes on tablets or smartphones in homes or care centers for older adults.
This study aims to test the validity of EOmciSS for identifying community-dwelling older adults with MCI risks.
Participants (N=827) completed EOmciSS and other screening tests for MCI. The psychometric properties tested were "subscale item difficulty," "discriminative index," "internal consistency," and "construct validity." We also tested between-group discrimination using the cross-validation method in an MCI group and a normal cognitive function (NCF) group.
A total of 3 accuracy factors and 1 reaction time factor explained the structure of the 20 item factors. The difficulty level of accuracy factors (ie, "trail making," "clock drawing," "cube copying," "delayed recall") was 0.63-0.99, whereas that of the reaction time factor was 0.77-0.95. The discriminative index of the medium-to-high-difficulty item factors was 0.39-0.97. The internal consistency (Cronbach α) ranged from .41 (for few item factors) to .96. The training data set contained 9 item factors (CC-Acc1, P<.001; CD-Acc1, P=.07; CD-Acc2, P=.06; CD-Acc3, P<.001; TM-Acc4, P=.07; DR-Acc1, P=.03; RS, P=.06; DR-RT1, P=.02; and DR-RT2, P=.05) that were significant predictors for an MCI classification versus NCF classification. Depressive symptoms were identified as significant factors (P<.001) influencing the performance of participants, and were an integral part of our test system. Age (P=.15), number of years of education (P=.18), and proficiency in using an electronic device (P=.39) did not significantly influence the scores nor classification of participants. Application of the MCI/NCF cutoff score (7.90 out of 9.67) to the validation data set yielded an area under the curve of 0.912 (P<.001; 95% CI 0.868-0.955). The sensitivity was 84.9%, specificity was 85.1%, and the Youden index was 0.70.
EOmciSS was valid and reliable for identifying older adults with significant risks of MCI. Our results indicate that EOmciSS has higher sensitivity and specificity than those of the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment and the Computerized Cognitive Screen. The user interface, online operation, and self-paced format allowed the test system to be operated by older adults or their caregivers in different settings (eg, home or care centers for older adults). Depressive symptoms should be an integral part in future MCI screening systems because they influence the test performance and, hence, MCI risk.
Chinese Clinical Trial Registry ChiCTR2000039411; http://www.chictr.org.cn/showprojen.aspx?proj=62903.
早期发现轻度认知障碍（MCI）症状是诊断和干预的重要步骤。我们开发了一种名为“高效在线 MCI 筛查系统”（EOmciSS）的新筛查测试，用于社区居住的老年人。它是一种自我计时认知测试，可以在平板电脑或智能手机上在 10 分钟内完成，适用于老年人居住的家庭或护理中心。
本研究旨在测试 EOmciSS 用于识别有 MCI 风险的社区居住老年人的有效性。
参与者（N=827）完成了 EOmciSS 和其他 MCI 筛查测试。测试的心理测量特性包括“子量表项目难度”、“判别指数”、“内部一致性”和“构念效度”。我们还使用交叉验证方法在 MCI 组和正常认知功能（NCF）组之间进行了组间判别。
总共 3 个准确率因素和 1 个反应时间因素解释了 20 个项目因素的结构。准确率因素（即“连线测试”、“时钟绘图”、“立方体复制”、“延迟回忆”）的难度水平为 0.63-0.99，而反应时间因素的难度水平为 0.77-0.95。中高难度项目因素的判别指数为 0.39-0.97。内部一致性（Cronbach α）范围从 0.41（对于少数项目因素）到 0.96。训练数据集包含 9 个项目因素（CC-Acc1，P<.001；CD-Acc1，P=.07；CD-Acc2，P=.06；CD-Acc3，P<.001；TM-Acc4，P=.07；DR-Acc1，P=.03；RS，P=.06；DR-RT1，P=.02；和 DR-RT2，P=.05），这些因素是 MCI 分类与 NCF 分类的显著预测因子。抑郁症状被确定为影响参与者表现的显著因素（P<.001），是我们测试系统的一个组成部分。年龄（P=.15）、受教育年限（P=.18）和使用电子设备的熟练程度（P=.39）对参与者的分数和分类没有显著影响。将 MCI/NCF 截止分数（9.67 分中的 7.90 分）应用于验证数据集，得出曲线下面积为 0.912（P<.001；95%置信区间 0.868-0.955）。灵敏度为 84.9%，特异性为 85.1%，约登指数为 0.70。
EOmciSS 可有效可靠地识别有显著 MCI 风险的老年人。我们的结果表明，EOmciSS 的灵敏度和特异性均高于计算机辅助神经心理筛查轻度认知障碍和计算机认知筛查。用户界面、在线操作和自我计时格式允许测试系统在不同环境（例如老年人居住的家庭或护理中心）中由老年人或其照顾者操作。抑郁症状应该是未来 MCI 筛查系统的一个组成部分，因为它们会影响测试表现，从而影响 MCI 风险。
