Mueller Jonathan, Cammermeyer Grethe
Department of Psychiatry, Saint Francis Memorial Hospital, San Francisco, California, USA.
WhidbeyHealth Medical Center, Coupeville, Washington, USA.
Alzheimers Dement. 2023 Oct;19(10):4743-4752. doi: 10.1002/alz.13049. Epub 2023 Apr 10.
Many physicians rely on sum score cognitive screening tests to evaluate patients for cognitive decline. Because the vast majority of cognitively impaired patients never receive more extensive testing, the results of these screening tests impact patients and their family members profoundly. No previous study has examined whether the metrics used by the popular Mini-Mental State Examination, Montreal Cognitive Assessment, and Saint Louis University Mental Status tests reliably identify single-domain deficits or allow clinicians to adequately track disease progression. We compare side by side the metrics used by these three tests to highlight the differences in the ways they measure domain impairments. We then contrast the sum score approach to cognitive screening with brief domain-specific tests that use extended metrics in each domain examined. Last, we suggest that moderate-to-severe domain-specific deficits on these tests should lead physicians to anticipate specific functional problems and alert family members.
许多医生依靠综合评分认知筛查测试来评估患者的认知衰退情况。由于绝大多数认知受损患者从未接受过更全面的测试，这些筛查测试的结果对患者及其家属有着深远影响。此前尚无研究探讨常用的简易精神状态检查表、蒙特利尔认知评估量表和圣路易斯大学精神状态测试所使用的指标能否可靠地识别单领域缺陷，或能否让临床医生充分追踪疾病进展。我们将这三项测试所使用的指标进行并列比较，以突出它们在测量领域损伤方式上的差异。然后，我们将认知筛查的综合评分方法与在每个检查领域使用扩展指标的简短特定领域测试进行对比。最后，我们建议这些测试中出现的中度至重度特定领域缺陷应促使医生预见到特定的功能问题，并提醒家属。
