Luchsinger José A, Teresi Jeanne A, Valdez Lenfis, Rosario Dahiana, de Miguel Maria, Taylor Delphine, Singer Jessica, Chang Nancy, Fuller William S, Boquín Cyrus, Silver Stephanie, Eimicke Joseph P, Kong Jian, Goldberg Terry E, Devanand Davangere P
Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.
Department of Epidemiology, Joseph P. Mailman School of Public Health, CUIMC, New York, NY, USA.
J Alzheimers Dis. 2025 Aug;106(3):964-977. doi: 10.1177/13872877251345083. Epub 2025 May 21.
BackgroundOdor identification deficits predict Alzheimer's disease (AD) in epidemiological studies.ObjectiveTo compare the accuracy of a short odor identification test with a short cognitive screening test for the detection of dementia and cognitive impairment in elderly persons with cognitive concerns.MethodsThis was a cross-sectional study of 600 participants 65 years and older, without known mild cognitive impairment (MCI) or dementia, with cognitive concerns, attending primary care practices in New York City. The odor identification test was the Brief Smell Identification Test (BSIT). The comparator test was the Mini Mental Status Exam II (MMSE). Cognitive diagnoses were made using the National Alzheimer's Coordinating Center Uniform Data set (NACC-UDS) version 3 forms with slight modifications. Test performance was compared using Receiver Operating Characteristic analyses.ResultsThe mean age was 72.65 ± 6.31 years, 73.3% were female, 63.3% were Hispanic, 13.5% non-Hispanic Black, and 20.8% non-Hispanic White; 23.5% were classified as normal cognition, 27.7% as cognitive impairment-not mild cognitive impairment (MCI), 31.2% as amnestic MCI, 5.7% as non-amnestic MCI, and 12% as dementia. The MMSE was superior to the BSIT in detecting dementia and any cognitive impairment. Combining abnormal scores in the BSIT (≤8) to MMSE (≤24) improved the MMSE's specificity and positive predictive value (PPV) in detecting cognitive impairment.ConclusionsThe MMSE was superior to the BSIT in detecting dementia and cognitive impairment in primary care but using both tests improved specificity and PPV for identifying persons with subjective complaints needing further cognitive and biomarker evaluation.
背景
在流行病学研究中，嗅觉识别缺陷可预测阿尔茨海默病（AD）。
目的
比较一项简短嗅觉识别测试与一项简短认知筛查测试在检测有认知问题的老年人痴呆和认知障碍方面的准确性。
方法
这是一项横断面研究，研究对象为600名65岁及以上、无已知轻度认知障碍（MCI）或痴呆、有认知问题且在纽约市初级保健机构就诊的参与者。嗅觉识别测试采用简易嗅觉识别测试（BSIT）。对照测试采用简易精神状态检查表第二版（MMSE）。使用经轻微修改的美国国立阿尔茨海默病协调中心统一数据集（NACC-UDS）第3版表格进行认知诊断。采用受试者操作特征分析比较测试性能。
结果
平均年龄为72.65±6.31岁，73.3%为女性，63.3%为西班牙裔，13.5%为非西班牙裔黑人，20.8%为非西班牙裔白人；23.5%被分类为认知正常，27.7%为认知障碍-非轻度认知障碍（MCI），31.2%为遗忘型MCI，5.7%为非遗忘型MCI，12%为痴呆。在检测痴呆和任何认知障碍方面，MMSE优于BSIT。将BSIT（≤8）和MMSE（≤24）的异常分数相结合，可提高MMSE在检测认知障碍方面的特异性和阳性预测值（PPV）。
结论
在初级保健中，MMSE在检测痴呆和认知障碍方面优于BSIT，但同时使用这两项测试可提高识别有主观症状、需要进一步进行认知和生物标志物评估者的特异性和PPV。
