Breitbart W, Rosenfeld B, Roth A, Smith M J, Cohen K, Passik S
Department of Psychiatry, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Pain Symptom Manage. 1997 Mar;13(3):128-37. doi: 10.1016/s0885-3924(96)00316-8.
We conducted two studies with medically hospitalized cancer and acquired immunodeficiency syndrome (AIDS) patients to assess the reliability and validity of a new measure of delirium severity, the Memorial Delirium Assessment Scale (MDAS). The first study used multiple raters who jointly administered the MDAS to 33 patients, 17 of whom met DSM III-R/DSM IV criteria for delirium, 8 met diagnostic criteria for another cognitive impairment disorder (for example, dementia), and 8 had non-cognitive psychiatric disorders (for example, adjustment disorder). Results indicate high levels of inter-rater reliability for the MDAS (0.92) and the individual MDAS items (ranging from 0.64 to 0.99), as well as high levels of internal consistency (coefficient alpha = 0.91). Mean MDAS ratings differed significantly between delirious patients and the comparison sample of patients with other cognitive impairment disorders or no cognitive impairment (P < 0.0002). The second study compared MDAS ratings of 51 medically hospitalized delirious patients with cancer and AIDS made by one clinician to ratings on several other measures of delirium (Delirium Rating Scale, clinician's ratings of delirium severely) and cognitive functioning (Mini-Mental State Examination) made by a second clinician. Results demonstrated a high correlation between MDAS scores and ratings on the Delirium Rating Scale (r = 0.88, p < 0.0001), the Mini-Mental State Examination (r = -0.91, P < 0.0001), and clinician's global ratings of delirium severity (r = 0.89, P < 0.0001). Thus, our findings indicate that the MDAS is a brief, reliable tool for assessing delirium severity among medically ill populations that can be reliably scored by multiple raters. The MDAS is highly correlated with existing measures of delirium and cognitive impairment, yet offers several advantages over these instruments for repeated assessments which are often necessary in clinical research.
我们对医学住院的癌症患者和获得性免疫缺陷综合征（艾滋病）患者进行了两项研究，以评估一种新的谵妄严重程度测量工具——纪念谵妄评估量表（MDAS）的可靠性和有效性。第一项研究中，多名评估者共同对33名患者使用MDAS进行评估，其中17名符合《精神疾病诊断与统计手册》第三版修订本/第四版（DSM III-R/DSM IV）的谵妄标准，8名符合另一种认知障碍疾病（如痴呆）的诊断标准，8名患有非认知性精神障碍（如适应障碍）。结果表明，MDAS的评估者间信度较高（0.92），MDAS各单项的信度也较高（范围为0.64至0.99），内部一致性水平也较高（α系数 = 0.91）。谵妄患者与其他认知障碍疾病患者或无认知障碍的对照样本之间的MDAS平均评分存在显著差异（P < 0.0002）。第二项研究比较了一名临床医生对51名医学住院的癌症和艾滋病谵妄患者的MDAS评分，以及另一名临床医生对谵妄的其他几种测量方法（谵妄评定量表、临床医生对谵妄严重程度的评定）和认知功能（简易精神状态检查表）的评分。结果显示，MDAS评分与谵妄评定量表评分（r = 0.88，p < 0.0001）、简易精神状态检查表评分（r = -0.91，P < 0.0001）以及临床医生对谵妄严重程度的整体评定（r = 0.89，P < 0.0001）之间高度相关。因此，我们的研究结果表明，MDAS是一种简短、可靠的工具，可用于评估内科疾病患者群体中的谵妄严重程度，多名评估者均可对其进行可靠评分。MDAS与现有的谵妄和认知障碍测量方法高度相关，但在临床研究中经常需要进行重复评估方面，它比这些工具具有几个优势。
