Schmand B, Lindeboom J, Hooijer C, Jonker C
Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands.
J Neurol Neurosurg Psychiatry. 1995 Aug;59(2):170-4. doi: 10.1136/jnnp.59.2.170.
Several authors have suggested that dementia screening tests may be biased against low levels of education, whereas others find that a low level of education is a genuine risk factor for dementia. The present paper attempts to reconcile these conflicting views by examining item bias and test bias indices of the mini mental state examination (MMSE). Psychometric calculations and receiver operating characteristics (ROC) analyses of sensitivity and specificity as performed by earlier studies were replicated and extended from the database of the Amsterdam Study of the Elderly. This is a population survey on cognitive decline and dementia (age range 65-84). Subjects with a low level of education (primary school) were compared with better educated subjects (at least some secondary education). Cases were matched by age and sex. The results indicate that the MMSE is not educationally biased as far as item characteristics, reliability, and construct validity are concerned. Yet its predictive validity as a screening test for dementia is educationally biased. This bias will effectively be eliminated with a two point higher cut off score for the subjects whose education extends beyond primary school. Even after such score correction, a low level of education probably remains a genuine risk factor for dementia.
几位作者认为，痴呆筛查测试可能对低教育水平者存在偏见，而另一些人则发现低教育水平是痴呆的一个真正风险因素。本文试图通过检查简易精神状态检查表（MMSE）的项目偏差和测试偏差指数来调和这些相互矛盾的观点。对早期研究进行的敏感性和特异性的心理测量计算以及受试者工作特征（ROC）分析，从阿姆斯特丹老年人研究数据库中进行了复制和扩展。这是一项关于认知衰退和痴呆的人群调查（年龄范围65 - 84岁）。将低教育水平（小学）的受试者与受教育程度较高的受试者（至少接受过一些中等教育）进行比较。病例按年龄和性别进行匹配。结果表明，就项目特征、可靠性和结构效度而言，MMSE不存在教育偏差。然而，作为痴呆筛查测试，其预测效度存在教育偏差。对于教育程度超过小学的受试者，将临界值提高两分可有效消除这种偏差。即使进行了这样的分数校正，低教育水平可能仍然是痴呆的一个真正风险因素。
