Graham J E, Rockwood K, Beattie B L, McDowell I, Eastwood R, Gauthier S
Department of Epidemiology and Community Medicine, University of Ottawa, Canada.
Neuroepidemiology. 1996;15(5):246-56. doi: 10.1159/000109914.
Standardization of diagnostic procedures for cognitive impairment in large epidemiologic surveys remains difficult. This paper reports results of diagnostic standardization in a subsample of 2,914 elderly (age 65 years+) Canadians from the Canadian Study of Health and Aging (CSHA; n = 10,263). The objectives were to measure the consistency of the CSHA diagnosis as a test of validity; to assess inter-rater reliability, and to assess the impact of neuropsychological data on the diagnosis of dementia. The CSHA clinical assessment included a nurse's examination, Modified Mini-Mental Status (3MS) exam and Cambridge Mental Disorders Examination, neuropsychological tests, medical history and examination, and laboratory investigations. A final diagnosis was reached in a consensus conference which incorporated preliminary diagnoses from both physicians and neuropsychologists. Computer algorithms, which were developed to check consistency between the clinical observations and the final diagnosis, demonstrated 98% concordance with DSM-III-R criteria for dementia and 92% with NINCDS-ADRADA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association) criteria for probable Alzheimer's disease. Inter-rater agreement was high: kappa = 0.81 for dementia/no dementia; kappa = 0.74 for normal/cognitive impairment, not dementia/ dementia. Comparisons of diagnoses between raters by clinical specialty revealed few systematic differences. The impact of neuropsychological input on the physician's diagnosis was most marked in the borderline cases between diagnostic categories.
在大型流行病学调查中，认知障碍诊断程序的标准化仍然困难重重。本文报告了对来自加拿大健康与老龄化研究（CSHA；n = 10,263）的2914名65岁及以上加拿大老年人的子样本进行诊断标准化的结果。目标是衡量CSHA诊断作为有效性检验的一致性；评估评分者间信度，并评估神经心理学数据对痴呆症诊断的影响。CSHA临床评估包括护士检查、改良简易精神状态检查（3MS）、剑桥精神障碍检查、神经心理学测试、病史和检查以及实验室检查。在一个共识会议上达成了最终诊断，该会议纳入了医生和神经心理学家的初步诊断。为检查临床观察结果与最终诊断之间的一致性而开发的计算机算法显示，与痴呆症的DSM-III-R标准一致性为98%，与可能的阿尔茨海默病的NINCDS-ADRADA（美国国立神经疾病和中风研究所以及阿尔茨海默病及相关疾病协会）标准一致性为92%。评分者间一致性较高：痴呆症/非痴呆症的kappa值为0.81；正常/认知障碍（非痴呆症/痴呆症）的kappa值为0.74。按临床专业对评分者之间的诊断进行比较，未发现明显的系统差异。神经心理学输入对医生诊断的影响在诊断类别之间的临界病例中最为明显。
