从病历分析评估临床痴呆评定量表与参考方法的可靠性比较。

Reliability of the assessment of the clinical dementia rating scale from the analysis of medical records in comparison with the reference method.

机构信息

Clinical and Research Memory Center of Lyon, Lyon Institute For Aging, Charpennes Hospital, Hospices Civils de Lyon, Lyon, France.

Clinical and Research Memory Center, Hôpital des Charpennes, 27 rue Gabriel Péri, Villeurbanne, 69100, France.

出版信息

Alzheimers Res Ther. 2024 Sep 5;16(1):198. doi: 10.1186/s13195-024-01567-9.

DOI:10.1186/s13195-024-01567-9

PMID:39238042

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11376013/

Abstract

BACKGROUND

The Clinical Dementia Rating (CDR) scale allows to detect the presence of dementia and to assess its severity, however its evaluation requires a significant time (45 min). We evaluated the agreement between two methods of collection of the CDR: face-to-face interview or based on the information available in the patient's medical record.

METHODS

The CLIMER study was conducted among patients attending a memory center. The CDR scale was evaluated during face-to-face interviews between neuropsychologists and patients and their caregivers and based on blind analysis of the information of the patients' medical record by neuropsychologists. The agreement of the CDR sum of boxes (CDR-SB), the 5-point scale CDR and the different domains of the CDR evaluated between the different methods was measured using intraclass correlation (ICC) coefficient, Bland and Altman method, and linearly weighted Kappa.

RESULTS

The study included 139 patients (means ± SD age 80.1 ± 6, 58.3% women, 71.9% with dementia). The ICC for the CDR-SB score assessed by face-to-face and with all the information available in the patient's medical record was 0.95 (95% CI: 0.93-0.97). The mean difference between the CDR-SB score assessed by face-to-face and with the medical record was 0.098 ± 1.036, and 92.4% of the patients lay within the 95% limits of agreement. The ICC for the 5-point scale CDR assessed by face-to-face and with the patient's medical record was 0.92 (95% CI: 0.88-0.95) when all the available information of the patient's medical record was used. The linear weighted Kappa coefficients was 0.79 (95% CI: 0.68-0.91) for the 5-point scale CDR comparison between the two evaluation methods. The analysis by domain of the CDR showed ICC ranging from 0.65 to 0.91 depending of the domains and the methods of evaluation.

CONCLUSION

This study showed an excellent level of agreement of the evaluation of the CDR- SB and the 5-point scale CDR when using all the information of the patient's medical record compared to the face-to-face interview.

TRIAL REGISTRATION

https//clinicaltrials.gov/ct2/show/NCT04763941 Registration Date 02/17/2021.

摘要

背景

临床痴呆评定量表（CDR）可用于检测痴呆的存在并评估其严重程度，但评估需要大量时间（45 分钟）。我们评估了两种 CDR 采集方法的一致性：面对面访谈或基于患者病历中的信息。

方法

CLIMER 研究在记忆中心就诊的患者中进行。CDR 量表由神经心理学家与患者及其护理人员进行面对面访谈评估，并由神经心理学家对患者病历信息进行盲法分析。通过组内相关系数（ICC）、Bland-Altman 法和线性加权 Kappa 评估不同方法之间的 CDR 总和（CDR-SB）、5 分制 CDR 和 CDR 不同领域的一致性。

结果

该研究纳入了 139 名患者（平均年龄 80.1±6 岁，58.3%为女性，71.9%患有痴呆）。面对面评估和使用患者病历中所有信息评估的 CDR-SB 评分的 ICC 为 0.95（95%CI：0.93-0.97）。面对面评估和使用病历评估的 CDR-SB 评分之间的平均差异为 0.098±1.036，92.4%的患者在 95%一致性界限内。当使用患者病历中的所有可用信息时，面对面评估和使用患者病历评估的 5 分制 CDR 的 ICC 为 0.92（95%CI：0.88-0.95）。两种评估方法的 5 分制 CDR 比较的线性加权 Kappa 系数为 0.79（95%CI：0.68-0.91）。根据评估方法和领域的不同，CDR 各领域的分析显示 ICC 范围为 0.65 至 0.91。