Nelson A, Fogel B S, Faust D
J Nerv Ment Dis. 1986 Feb;174(2):73-83. doi: 10.1097/00005053-198602000-00002.
Bedside cognitive screening instruments are used increasingly in clinical and research settings to detect cognitive impairment and to quantify its severity. The authors review the five most frequently cited bedside screening tests that use an interview format and require brief administration times: the Mini-Mental State Examination, the Cognitive Capacity Screening Examination, Mattis Dementia Rating Scale, Kahn's Mental Status Questionnaire, and the Short Portable Mental Status Questionnaire. The tests all have adequate inter-rater reliability, and adequate test-retest reliability has been established for three of the tests. All of the tests show close correspondence with clinical diagnoses of delirium and dementia and are useful for the diagnosis and quantification of these syndromes. However, there is currently no evidence that the tests increase the level of diagnostic accuracy achieved through clinical examination alone. All of the tests have substantial false-negative rates, with false-negative errors frequent among patients with focal lesions, particularly of the right hemisphere. False-positive errors may be more common among patients with less education and lower socioeconomic status. The tests reviewed do not detect many types of cognitive deficit that may bear critically on differential diagnosis and case management. Suggestions are given for further research on the current measures and for the development of new screening tests that would meet a broader range of clinical purposes.
床边认知筛查工具在临床和研究环境中越来越多地被用于检测认知障碍并量化其严重程度。作者回顾了五种最常被引用的采用访谈形式且所需施测时间较短的床边筛查测试：简易精神状态检查表、认知能力筛查检查表、马蒂斯痴呆评定量表、卡恩精神状态问卷和简短便携式精神状态问卷。这些测试都具有足够的评分者间信度，并且其中三项测试已建立了足够的重测信度。所有测试都与谵妄和痴呆的临床诊断密切相关，对这些综合征的诊断和量化很有用。然而，目前没有证据表明这些测试能提高仅通过临床检查所达到的诊断准确性水平。所有测试都有相当高的假阴性率，在有局灶性病变的患者中，尤其是右半球病变的患者中，假阴性错误很常见。假阳性错误在受教育程度较低和社会经济地位较低的患者中可能更常见。所回顾的测试未检测出许多可能对鉴别诊断和病例管理至关重要的认知缺陷类型。针对当前测量方法的进一步研究以及开发能满足更广泛临床目的的新筛查测试提出了建议。
