Hartmaier S L, Sloane P D, Guess H A, Koch G G, Mitchell C M, Phillips C D
Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill.
J Gerontol A Biol Sci Med Sci. 1995 Mar;50(2):M128-33. doi: 10.1093/gerona/50a.2.m128.
Almost all nursing homes in the United States are required by the 1987 Omnibus Budget Reconciliation Act to assess each resident's functional, medical, psychosocial, and cognitive status using a standard instrument known as the Minimum Data Set (MDS). We report a validation study to show that the MDS Cognitive Performance Scale (CPS), a cognitive measure generated from 5 MDS items (comatose status, decision making, short-term memory, making self understood, and eating) can be used to detect cognitive impairment as defined by the Mini-Mental State Examination (MMSE).
Two hundred subjects were randomly recruited from 8 nursing home facilities in North Carolina. Two medical students administered the MMSE, while a geriatric research nurse was responsible for collecting MDS cognitive items, which included the 5 items required for generating CPS scores. Cognitive impairment was defined by MMSE scores adjusted for education. Agreement between the CPS and the MMSE in identifying cognitively impaired subjects was then evaluated.
The CPS showed substantial agreement with the MMSE in the identification of cognitive impairment; the sensitivity was .94 (95% confidence interval [CI]: .90, .98), the specificity was .94 (95% CI: .87, .96), and the diagnostic accuracy as measured by the area under the receiver operating characteristics (ROC) curve was .96 (95% CI: .88, 1.0).
The MDS Cognitive Performance Scale, when performed by a trained research nurse using recommended protocols, provides a valid measure of cognitive status in nursing home residents.
根据1987年《综合预算协调法案》，美国几乎所有疗养院都必须使用一种名为最低数据集（MDS）的标准工具来评估每位居民的功能、医疗、心理社会和认知状况。我们报告一项验证研究，以表明MDS认知表现量表（CPS），一种由5个MDS项目（昏迷状态、决策能力、短期记忆、表达自己的意思和进食）生成的认知测量工具，可用于检测由简易精神状态检查表（MMSE）定义的认知障碍。
从北卡罗来纳州的8家疗养院设施中随机招募了200名受试者。两名医学生进行MMSE测试，而一名老年病学研究护士负责收集MDS认知项目，其中包括生成CPS分数所需的5个项目。认知障碍由根据教育程度调整后的MMSE分数定义。然后评估CPS与MMSE在识别认知障碍受试者方面的一致性。
CPS在识别认知障碍方面与MMSE显示出高度一致性；敏感性为0.94（95%置信区间[CI]：0.90，0.98），特异性为0.94（95%CI：0.87，0.96），通过受试者工作特征（ROC）曲线下面积测量的诊断准确性为0.96（95%CI：0.88，1.0）。
当由经过培训的研究护士按照推荐方案进行操作时，MDS认知表现量表可为疗养院居民的认知状况提供有效的测量。
