Gill T M, Williams C S, Richardson E D, Berkman L F, Tinetti M E
Yale University School of Medicine, Department of Internal Medicine, New Haven, CT 06504, USA.
J Am Geriatr Soc. 1997 Apr;45(4):441-5. doi: 10.1111/j.1532-5415.1997.tb05168.x.
To develop and validate a simple tool, based on a reduced set of Mini-Mental State Examination (MMSE) items, that can be used to predict the onset of ADL dependence, and to compare the predictive accuracy of this new tool with that of the MMSE.
Two prospective, population-based cohort studies, in tandem. The predictive model developed in the initial cohort was subsequently validated in a separate cohort.
General community in New Haven, Connecticut.
For the development cohort, 775 community-living persons, 72 years of age and older, who were independent at baseline in their ADI, function. For the validation cohort, 1038 comparable subjects.
All subjects underwent a baseline interview and cognitive assessment in their homes by a trained research nurse using standard instrument. Self-reported ADLs were ascertained at 1 year and 3 years for the development cohort and at 1 year and 21/2 years for the validation cohort.
ADL dependence developed in 221 (28.5%) subjects in the development cohort. Although the rate of ADL dependence increased within each MMSE domain as the number of incorrect items increased, only orientation and short-term memory remained significantly associated with ADL dependence in multivariable analysis. A predictive model, based on the presence of impairments in these two domains, was developed that stratified subjects into three risk groups. Rates of ADL dependence were 22% (neither domain impaired), 44% (one domain impaired), and 68% (both domains impaired) (P < .001). The corresponding rates in the validation cohort, in which 191 (18.4%) subjects developed ADL dependence, were 15%, 26%, and 45% (P < .001). The area under the ROC curves for the MMSE and the reduced item strategy were nearly identical at 0.63 and 0.62, respectively.
A simple and valid six-item strategy, based on the presence of impairments in orientation and short-term memory, predicts the onset of ADL dependence as effectively as does the 30-item MMSE. This new tool may be useful as part of a more comprehensive assessment when determining an older person's risk for developing ADL dependence.
开发并验证一种基于精简版简易精神状态检查表（MMSE）项目的简单工具，该工具可用于预测日常生活活动（ADL）依赖的发生，并将此新工具的预测准确性与MMSE的预测准确性进行比较。
两项基于人群的前瞻性队列研究，同步进行。在初始队列中开发的预测模型随后在另一个队列中进行验证。
康涅狄格州纽黑文的普通社区。
在开发队列中，有775名72岁及以上的社区居住者，他们在基线时日常生活活动独立性量表（ADI）功能方面独立。在验证队列中，有1038名类似的受试者。
所有受试者均在家中接受经过培训的研究护士使用标准工具进行的基线访谈和认知评估。开发队列在1年和3年时确定自我报告的ADL情况，验证队列在1年和2.5年时确定。
在开发队列中，221名（28.5%）受试者出现了ADL依赖。尽管随着每个MMSE领域中错误项目数量的增加，ADL依赖率也有所上升，但在多变量分析中，只有定向和短期记忆与ADL依赖仍存在显著关联。基于这两个领域存在损伤情况开发了一种预测模型，该模型将受试者分为三个风险组。ADL依赖率分别为22%（两个领域均未受损）、44%（一个领域受损）和68%（两个领域均受损）（P < .001）。在验证队列中，191名（18.4%）受试者出现了ADL依赖，相应的比率分别为15%、26%和45%（P < .001）。MMSE和精简项目策略的ROC曲线下面积分别为0.63和0.62，几乎相同。
一种基于定向和短期记忆存在损伤情况的简单且有效的六项策略，预测ADL依赖发生的效果与30项MMSE一样有效。在确定老年人发生ADL依赖的风险时，这种新工具作为更全面评估的一部分可能会很有用。
