Magaziner J, Zimmerman S I, German P S, Kuhn K, May C, Hooper F, Cox D, Hebel J R, Kittner S, Burton L, Fishman P, Kaup B, Rosario J, Cody M
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.
Ann Epidemiol. 1996 Sep;6(5):431-7. doi: 10.1016/s1047-2797(96)00065-8.
A new method for ascertaining dementia in epidemiologic research and the results of a study to evaluate it are described. The method relies on an expert panel of clinicians reviewing clinically relevant information collected by lay evaluators to arrive at a diagnosis based on DSM-III-R criteria. The approach was developed to study dementia in a statewide sample of over 2400 new admissions to 59 nursing homes in Maryland. Expert panel ascertainment of dementia was compared to that obtained by direct clinical evaluation for 100 nursing home residents. Agreement between the panel and direct assessment was 76% (kappa = 0.59) using a three-category classification of dementia, no dementia, and indeterminate. This ascertainment strategy provides an alternative to methods currently in use and is particularly well-suited for populations with a high prevalence, in those dispersed over large geographic areas, and when timely, cost-effective evaluations are required.
本文描述了一种在流行病学研究中确定痴呆症的新方法以及一项评估该方法的研究结果。该方法依靠临床医生专家小组审查由非专业评估人员收集的临床相关信息，以根据《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）标准做出诊断。该方法是为在马里兰州59家疗养院的2400多名新入院患者的全州样本中研究痴呆症而开发的。将专家小组对痴呆症的确定结果与对100名疗养院居民进行直接临床评估所得结果进行了比较。使用痴呆症、无痴呆症和不确定的三类分类法，专家小组与直接评估之间的一致性为76%（kappa = 0.59）。这种确定策略为目前使用的方法提供了一种替代方案，特别适用于患病率高的人群、分布在广大地理区域的人群以及需要及时、具有成本效益的评估的情况。
