Peavy G M, Salmon D P, Rice V A, Galasko D, Samuel W, Taylor K I, Ernesto C, Butters N, Thal L
San Diego Department of Veterans Affairs Medical Center, California, USA.
Arch Neurol. 1996 Apr;53(4):367-72. doi: 10.1001/archneur.1996.00550040107020.
Although the assessment of cognitive functioning in the late stages of Alzheimer's Disease (AD) is important for identifying abilities that may improve communication and interactions with severely impaired patients in clinical and institutional settings and for assessing the efficacy of pharmacologic agents and behavioral interventions for the treatment of AD, few adequate instruments exist for measuring the cognitive capacities of these severely demented individuals.
To evaluate the reliability and validity of the Severe Cognitive Impairment Profile (SCIP), a measure of neuropsychological functioning in severely demented patients, and compare it with other available instruments.
We administered the Mattis Dementia Rating Scale (DRS), Mini-Mental State Examination (MMSE), SCIP, and Severe Impairment Battery (SIB) to 41 severely demented patients with AD participating in an AD research center. We used (1) Spearman rank correlation coefficients to assess interrater and test-retest reliability and construct validity of the SCIP; (2) one-way analysis of variance with post hoc comparisons to examine performance on the SCIP and the SIB at different levels of dementia severity; and (3) descriptive statistics to establish the sensitivity of the SCIP to cognitive functioning in a subgroup of very severely demented patients.
Interrater and test-retest reliability correlation coefficients were highly significant for total SCIP score (r=0.99 and r=0.96, respectively) as well as for all SCIP subscales. High correlations were also found between SCIP scores and two widely used tests of global cognitive functioning, the DRS (r=0.91) and the MMSE (r=0.84), suggesting good construct validity. The SCIP was able to significantly differentiate between four groups of severely impaired patients divided by level of dementia severity, while the SIB was unable to differentiate between the less severely demented groups. A subgroup of 16 very severely demented patients (DRS score, <50 points) obtained an average of 45% of total possible points on the SCIP, compared with an average of 1% and 21% of total possible points on the MMSE and DRS, respectively. After approximately 1 year of decline, 12 severely demented patients with AD were able to correctly answer an average of more than 58% of the items on the SCIP, compared with only 30% on the DRS and 20% on the MMSE.
The SCIP is a reliable, valid measure of neuropsychological functioning in severely demented patients with AD with the ability to avoid both floor and ceiling effects and to evaluate a wider range of cognitive abilities than other tests used with severely impaired individuals.
尽管评估阿尔茨海默病（AD）晚期的认知功能对于确定在临床和机构环境中可能改善与严重受损患者沟通及互动的能力，以及评估治疗AD的药物和行为干预的疗效很重要，但用于测量这些严重痴呆个体认知能力的合适工具很少。
评估严重认知障碍量表（SCIP）的可靠性和有效性，该量表用于测量严重痴呆患者的神经心理功能，并将其与其他现有工具进行比较。
我们对41名参与AD研究中心的严重痴呆AD患者进行了马蒂斯痴呆评定量表（DRS）、简易精神状态检查表（MMSE）、SCIP和严重损伤成套测验（SIB）的测试。我们使用（1）斯皮尔曼等级相关系数来评估SCIP的评分者间信度、重测信度和结构效度；（2）采用方差分析及事后比较来检验不同痴呆严重程度水平下SCIP和SIB的表现；（3）描述性统计来确定SCIP对极重度痴呆患者亚组认知功能的敏感性。
SCIP总分的评分者间信度和重测信度相关系数非常显著（分别为r = 0.99和r = 0.96），所有SCIP子量表也是如此。SCIP得分与两种广泛使用的整体认知功能测试，即DRS（r = 0.91）和MMSE（r = 0.84）之间也发现了高度相关性，表明具有良好的结构效度。SCIP能够显著区分按痴呆严重程度划分的四组严重受损患者，而SIB无法区分轻度痴呆组。16名极重度痴呆患者亚组（DRS得分<50分）在SCIP上获得的平均分数为总分的45%，而在MMSE和DRS上分别为总分的1%和21%。在大约1年的衰退期后，12名严重痴呆的AD患者在SCIP上能够正确回答平均超过58%的项目，而在DRS上为30%，在MMSE上为20%。
SCIP是一种可靠、有效的测量严重痴呆AD患者神经心理功能的工具，能够避免地板效应和天花板效应，并且比用于严重受损个体的其他测试能评估更广泛的认知能力。
