Validation of a telephone cognitive assessment battery
Validation of a telephone cognitive assessment battery
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DOI：
10.1111/j.1532-5415.1997.tb02935.x
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发表时间：
1997-11-01
影响因子：
6.3
通讯作者：
Rowland, DY
中科院分区：
文献类型：
--
作者：
Debanne, SM;Patterson, MB;Rowland, DY
目的：介绍和评价一种工具，电话认知评估成套测验（TCAB），旨在通过电话评估老年人的认知状态。TCAB涉及精神状态，推理和执行能力，初级和次级记忆以及语言。它包括六个神经心理学测试，大约需要15到20分钟才能完成。设计：该仪器是评估与比较横截面设计，与数据收集的前瞻性和回顾性。从最近招募到登记处的40例阿尔茨海默病病例和40例认知完整的登记处对照中选择。控制随机选择，使两组有类似的年龄，性别和education.MEASUREMENTS分布：所有参与者的认知状态进行了评估，利用TCAB和通常的人。登记评估，包括病史数据和认知状态的亲自评估。为了测量重复测试的潜在学习效果，一半的病例和一半的对照组在他们亲自进行登记评估之前通过电话与TCAB进行了招募和评估（评估之间至少有2周的等待期），而另外两半在他们成为登记的一部分之后接受了TCAB。由一名研究者对所有参与者进行TCAB。两名临床评价者对受试者的登记诊断设盲，根据TCAB结果和医学疾病和抑郁症状的简要列表，将受试者独立分类为认知受损、正常或可疑。最终的分类是通过共识，并随后与登记处的诊断相比，在这里采取的是金standard.RESULTS：测试分数的主题TCAB评估之前，接受人的评估进行了比较，与那些接受人的评估第一。无论是病例组还是正常对照组，两组（先TCAB组，后TCAB组）的平均得分之间均无显著差异。TCAB分类的两名初始评价者获得了较高的kappa统计值，证明了良好的评价者间可靠性。关于协调的TCAB分类，TCAB根据认知状态正确分类受试者的能力，同时控制潜在的混杂因素，如年龄和教育水平，通过判别分析技术进行评估。TCAB分类和年龄的知识允许95%的参与者的正确分类，这并没有显着证明其他潜在的决定因素的知识。敏感性和特异性计算下两个方案的分类这些科目中的“可疑"类别。TCAB的阳性和阴性预测值的计算假设在老年人群中认知损害的患病率为10%。高阴性预测值（超过99%）都获得了这两个图式下，而阳性预测值被认为是更依赖于questionables.CONCLUSION研究的认知状态的老年人，特别是那些需要定期随访的研究，如那些专注于健康老龄化，通常遭受缺乏代表性的主题，这往往是由于潜在参与者的流动性问题造成的。同样重要的是，在痴呆症的流行病学研究中，最初招募的正常人作为对照，定期重新评估，这可能会受到同样的障碍的阻碍。只要电话评估有效，通过电话测量认知状态的能力似乎有助于解决这些问题。TCAB似乎以与面对面评估相同的方式区分研究登记处老年参与者中轻度认知障碍和健康正常受试者。因此，当由受过训练的个人管理时，它提供了通过电话评估这些类型的老年受试者的认知状态的有效和可靠的手段。需要进一步开展工作，以证明其适用于其他领域，例如，社区范围内，设置。
OBJECTIVE: To present and evaluate an instrument, the Telephone Cognitive Assessment Battery (TCAB), designed to be administered over the telephone to assess the cognitive status of older individuals. The TCAB addresses mental status, reasoning and executive ability, primary and secondary memory, and language. It consists of six neuropsychological tests and takes approximately 15 to 20 minutes to complete.DESIGN: The instrument is evaluated with a comparative cross-sectional design, with data collected both prospectively and retrospectively.SETTING: The University Hospitals of Cleveland/Case Western Reserve University Alzheimer Center Research Registry.PARTICIPANTS: Forty Alzheimer's Disease cases selected from among those most recently recruited into the Registry and 40 cognitively intact Registry controls. Controls were selected randomly so that the two groups had similar distributions of age, sex, and education.MEASUREMENTS: The cognitive status of all participants was assessed utilizing both the TCAB and the usual in-person. Registry evaluation, which includes medical history data and in-person assessment of cognitive status. In order to measure the potential learning effect of repeated testing, half of the cases and half of the controls were recruited and assessed over the telephone with the TCAB before their in-person Registry evaluation (with a waiting period of at least 2 weeks between evaluations), whereas the other two halves received the TCAB after they had become part of the Registry. The TCAB was administered to all participants by a single investigator. Two clinical evaluators, blinded to the Registry diagnosis of the subjects, independently classified the subjects as cognitively impaired, normal, or questionable on the basis of the results of the TCAB and a brief listing of medical illness and depressive symptoms. A final classification was achieved through consensus and subsequently compared with the Registry diagnosis, taken here to be the gold standard.RESULTS: Test scores of subjects assessed by TCAB before receiving the in-person assessment were compared with those of subjects receiving the in-person assessment first. There were no significant differences between mean scores of the two groups (those with TCAB first and those with TCAB last) for either cases or normal controls. High values of the kappa statistic were obtained for the two initial evaluators of the TCAB classification, demonstrating excellent interrater reliability. Regarding the reconciled TCAB classification, the ability of the TCAB to correctly classify subjects according to cognitive status, while controlling for potential confounders such as age and educational level, was assessed by means of discriminant analysis techniques. Knowledge of the TCAB classification and age allowed the correct classification of 95% of the participants; this was not significantly unproved by knowledge of other potential determinants. Sensitivity and specificity were calculated under two schema for classifying those subjects in the ''questionable'' category. Positive and negative predictive values of the TCAB were computed assuming a prevalence of cognitive impairment of 10% in the older population. High negative predictive values (over 99%) were obtained under both schema, whereas the positive predictive values were seen to be more dependent on the classification of questionables.CONCLUSION Research studies involving ascertainment of cognitive status of older people, particularly those that require periodic follow-up, such as those focusing on healthy aging, commonly suffer from lack of representativeness of subjects, often brought about by problems related to mobility of potential participants. It is also crucial that normal individuals who are recruited initially to serve as controls in epidemiologic studies of dementing illnesses be reevaluated periodically, and this may be hindered by the same obstacles. The ability to measure cognitive status by telephone would seem to aid in the solution to these problems as long as the telephone assessment is valid. The TCAB appears to discriminate between mildly cognitively impaired and healthy normal subjects in a population of older participants of research registries in much the same way as in-person assessment. Thus, when administered by a trained individual, it of offers a valid and reliable means of assessing the cognitive status of these types of older subjects by telephone. Further work is needed to demonstrate its applicability to other, e.g., community-wide, settings.