Jones B N, Teng E L, Folstein M F, Harrison K S
Johns Hopkins Hospital, Baltimore, Maryland.
Ann Intern Med. 1993 Nov 15;119(10):1001-4. doi: 10.7326/0003-4819-119-10-199311150-00006.
To compare the Mental Alternation Test, a new 60-second bedside test of cognition, with the Mini-Mental State Exam (MMSE) and the Trailmaking Test, parts A and B, in patients with human immunodeficiency virus (HIV) infection.
Cohort study.
Sixty-two inpatients with HIV infection.
The AIDS service of a referral hospital.
Scores on the MMSE; the Trailmaking Test, parts A and B; and the Mental Alternation Test were compared using correlation calculations and analyses of variance. Receiver operating curves were constructed to identify the best cutoff score on the Mental Alternation Test for detecting impaired performance on the MMSE and the Trailmaking Test.
The Mental Alternation Test score correlated significantly with MMSE (r = 0.68, P < 0.01) and Trailmaking Test, part B, scores (r = -0.54, P < 0.01). The receiver operating curves showed that a Mental Alternation Test cutoff score of 15 yielded the best results for the detection of abnormal performance on the MMSE (sensitivity, 95% [95% CI, 90% to 100%]; specificity, 79% [CI, 69% to 89%]) and the Trailmaking Test, part B (sensitivity, 78% [CI, 68% to 88%]; specificity 93% [CI, 90% to 100%]). Patients making fewer than 15 alternations in 30 seconds were significantly more likely to have abnormal MMSE (P < 0.0001) and Trailmaking Test, part B, scores (P < 0.0001). The Mental Alternation Test had good reproducibility; analyses of reliability included test-retest correlation (r = 0.80) and inter-rater reliability (r = 0.85, kappa = 0.84). Time of administration was approximately 60 seconds.
The Mental Alternation Test of cognition has good sensitivity and specificity and is easily administered. It is a valuable test to identify patients who may need further cognitive evaluation.
比较一种新的60秒床边认知测试——心理交替测试，与简易精神状态检查表（MMSE）以及连线测试A和B部分，用于人类免疫缺陷病毒（HIV）感染患者。
队列研究。
62名HIV感染住院患者。
一家转诊医院的艾滋病服务部门。
使用相关性计算和方差分析比较MMSE、连线测试A和B部分以及心理交替测试的得分。构建受试者工作特征曲线，以确定心理交替测试中用于检测MMSE和连线测试表现受损的最佳临界值。
心理交替测试得分与MMSE得分显著相关（r = 0.68，P < 0.01），与连线测试B部分得分也显著相关（r = -0.54，P < 0.01）。受试者工作特征曲线显示，心理交替测试临界值为15时，在检测MMSE异常表现方面效果最佳（敏感性，95% [95%可信区间，90%至100%]；特异性，79% [可信区间，69%至89%]），在检测连线测试B部分异常表现方面效果也最佳（敏感性，78% [可信区间，68%至88%]；特异性93% [可信区间，90%至100%]）。在30秒内交替次数少于15次的患者，MMSE异常（P < 0.0001）和连线测试B部分得分异常（P < 0.0001）的可能性显著更高。心理交替测试具有良好的可重复性；可靠性分析包括重测相关性（r = 0.80）和评分者间信度（r = 0.85，kappa = 0.84）。测试用时约60秒。
认知的心理交替测试具有良好的敏感性和特异性，且易于实施。它是识别可能需要进一步认知评估患者的一项有价值的测试。
