Almeida O P
Departamento de Saúde Mental, Santa Casa de São Paulo.
Arq Neuropsiquiatr. 1998 Sep;56(3B):605-12. doi: 10.1590/s0004-282x1998000400014.
The diagnosis of dementia is based on the presence of memory deficits and decline of other cognitive functions. Many scales have been designed to aid the clinician in the assessment of at risk subjects, such as the elderly. The Mini-Mental State Examination (MMSE) is the most widely used of such scales, although its use as an aid to the diagnosis of dementia has not as yet been studied in a Brazilian sample of patients. The current study was designed with 2 main aims: (1) to determine the best cut-off point of the MMSE for the diagnosis of dementia in a sample of elderly subjects assessed in a mental health outpatient unit and; (2) evaluate the impact of age and schooling on MMSE scores. Two hundred and eleven subjects aged 60 or over assessed at the Mental Health Outpatient Unit for the elderly at "Santa Casa de São Paulo" between February 1997 and February 1998 were included in the study. They were assessed with the SRQ-20, MMSE, and a clinical interview for the diagnosis of dementia according to the ICD-10. Seventy patients received the diagnosis of dementia. The MMSE cut-off point of 23/24 (cases/non-cases) was associated with a sensitivity of 84.3% and specificity of 60.3%. MMSE scores were associated with age (r = -0.41, p < 0.001) and schooling (F = 12.69, p < 0.001). Analysis of covariance taking age into account showed that MMSE scores were significantly lower among those with no formal education (F = 10.51, p < 0.001). A cut-off point of 19/20 on the MMSE was associated with sensitivity of 80.0% and specificity of 70.9% for the diagnosis of dementia in this particular group. Subjects with previous school history were better classified to the diagnosis of dementia with the cut-off point of 23/24: sensitivity of 77.8% and specificity of 75.4%. The evaluation of elderly subjects with the MMSE should take education into account, and different cut-off points should be used accordingly as a guideline to the diagnosis of dementia.
痴呆症的诊断基于记忆缺陷和其他认知功能衰退的存在。已经设计了许多量表来帮助临床医生评估高危人群，如老年人。简易精神状态检查表（MMSE）是此类量表中使用最广泛的，尽管其作为痴呆症诊断辅助工具在巴西患者样本中的应用尚未得到研究。本研究旨在实现两个主要目标：（1）确定在心理健康门诊接受评估的老年受试者样本中，用于痴呆症诊断的MMSE最佳截断点；（2）评估年龄和受教育程度对MMSE分数的影响。1997年2月至1998年2月期间，在圣保罗圣卡塔琳娜医院老年心理健康门诊接受评估的211名60岁及以上受试者纳入了本研究。根据ICD - 10，他们接受了SRQ - 20、MMSE评估以及痴呆症诊断的临床访谈。70名患者被诊断为痴呆症。MMSE截断点为23/24（病例/非病例）时，敏感性为84.3%，特异性为60.3%。MMSE分数与年龄（r = - 0.41，p < 0.001）和受教育程度（F = 12.69，p < 0.001）相关。考虑年龄因素的协方差分析表明，未接受正规教育者的MMSE分数显著更低（F = 10.51，p < 0.001）。在这个特定群体中，MMSE截断点为19/20时，痴呆症诊断的敏感性为80.0%，特异性为70.9%。有上学经历的受试者采用23/24的截断点对痴呆症诊断的分类效果更好：敏感性为77.8%，特异性为75.4%。使用MMSE评估老年受试者时应考虑受教育程度，并相应地使用不同的截断点作为痴呆症诊断的指导。
