The Mini-Mental State Examination in general medical practice: Clinical utility and acceptance
The Mini-Mental State Examination in general medical practice: Clinical utility and acceptance
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DOI：
10.4065/71.9.829
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发表时间：
1996-09-01
影响因子：
8.9
通讯作者：
Parisi, JE
中科院分区：
文献类型：
--
作者：
Tangalos, EG;Smith, GE;Parisi, JE
目的：为了研究的心理测量学特性，接受，和筛选疗效的简易精神状态检查（MMSE）在内科practice.Material和方法：MMSE被管理超过4,000次，由27名内科医生对3,513名老年患者（2,299名女性和1,214名男性，60至102岁）进行一般医疗检查。在年龄和性别匹配的痴呆患者（N = 185）和对照受试者（N = 227）的子样本中测量MMSE筛查的有效性。在社区样本中，MMSE评分与年龄和教育程度相关。医生对MMSE的态度进行了评估与12个问题的调查。灵敏度，特异性，和预测values.Results：年龄和教育，但不受性别的影响，在年龄大于59岁的人的MMSE的性能。在1至4年的时间间隔内，MMSE总评分的4分或更多的变化需要表明实质性的认知恶化。参与研究的医生认为MMSE对老年人的常规筛查价值不大，但希望将其用作临床测试。传统的MMSE临界值为23分或更低，敏感性为69%，特异性为99%。使用特定年龄和教育程度的临界值将敏感性提高到82%，而不丧失特异性。结论：认识到年龄和教育程度对MMSE的影响，在痴呆基础率较高的人群中应用MMSE，可以提高MMSE的临床应用价值和医生的接受度。MMSE用于筛查认知障碍人群是无效的;它应该用于有认知障碍风险的人。
Objective: To examine the psychometric properties, acceptance, and screening efficacy of the Mini-Mental State Examination (MMSE) in an internal medicine practice.Material and Methods: The MMSE was administered more than 4,000 times by 27 internists to 3,513 elderly patients (2,299 women and 1,214 men, 60 to 102 years old) who underwent general medical examinations. The efficacy of the MMSE for screening was measured in a subsample of age- and sex-matched patients with dementia (N = 185) and control subjects (N = 227). MMSE scores were correlated with age and education in the community sample. The attitudes of physicians about the MMSE were assessed with a 12-question survey. Sensitivity, specificity, and predictive values were calculated.Results: Performance on the MMSE among persons older than 59 years was influenced by age and education but not by sex. During an interval of 1 to 4 years, a change of 4 or more points in the total MMSE score is needed to indicate substantial cognitive deterioration. Participating physicians considered the MMSE of little value for routine screening in unselected populations but wanted it available for use as a clinical test. The traditional MMSE cutoff score of 23 or less had a sensitivity of 69% and a specificity of 99%. Use of age- and education-specific cutoff scores improved the sensitivity to 82% with no loss of specificity. With use of typical base rates for dementia in a general medical practice, the positive predictive value was less than 35%.Conclusion: The clinical utility of the MMSE and acceptance by physicians may be improved through awareness of the influences of age and education on the MMSE and by its application in settings with a high base rate of dementia. The MMSE is ineffective when used to screen unselected populations; it should be used for persons at risk of cognitive compromise.