Evaluation of cognitive impairment in older adults - Combining brief informant and performance measures
Evaluation of cognitive impairment in older adults - Combining brief informant and performance measures
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DOI：
10.1001/archneur.64.5.718
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发表时间：
2007-05-01
影响因子：
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通讯作者：
Morris, John C.
中科院分区：
文献类型：
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作者：
Galvin, James E.;Roe, Catherine M.;Morris, John C.
目的：将 AD8（简短的知情者访谈）与绩效测量相结合，开发一种简短的筛查工具，以改善一般实践中认知障碍和痴呆的检测。设计：AD8 向知情者进行。临床医生对患者进行独立评估，并使用临床痴呆评定量表和 30 分钟的神经心理学电池。使用逻辑回归来确定简短测试的最佳组合，以将患者正确分类为无痴呆、不确定痴呆或痴呆。受试者工作特征曲线下面积 (AUC) 评估了组合测试的辨别能力。 患者/环境：患者 (n=255) 连续转诊至痴呆症诊所。患者的平均 +/- SD 年龄为 73.3 +/- 11.3 岁，受教育年限为 13.7 +/- 3.0（平均 +/- SD）。样本中 56% 是女性； 77% 的患者是白人。 结果：结合 AD8 访谈（比值比，1.91；95% 置信区间，1.6-2.3）和建立阿尔茨海默病 10 项单词列表回忆数据库联盟（比值比，1.43；95% 置信区间，1.2-1.7）的模型预测痴呆症，分类正确率为 91.5%（AUC = 0.968；95% 置信区间，0.93-0.99）。 AD8 上 2 或更大的截止值以及单词列表回忆中记住的少于 5 个项目是敏感的 (94%) 和特定的 (82%)。对于不符合痴呆标准的认知障碍，结合 AD8（比值比，2.31；95% 置信区间，1.3-4.0）和单词列表回忆（比值比，1.42；95% 置信区间，1.1-1.8）最具预测性（AUC = 0.91；95% 置信区间，0.8-1.0）。使用与痴呆症相同的截止值可实现敏感性 (85%) 和特异性 (84%) 的最佳组合。结论：将 AD8 访谈与单词列表回忆相结合可提高检测痴呆症存在的能力。 AD8 可以对线人进行测试，与单词列表回忆结合使用，是一种强大而简单的检测认知障碍的方法。
Objective: To combine the AD8, a brief informant interview, with performance measures to develop a brief screening tool to improve detection of cognitive impairment and dementia in general practice.Design: The AD8 was administered to informants. Clinicians conducted independent patient evaluations and administered the Clinical Dementia Rating Scale and a 30-minute neuropsychological battery. Logistic regression was used to determine the best combination of brief tests to correctly classify patients as having no dementia, uncertain dementia, or dementia. The area under the receiver operator characteristic curve (AUC) evaluated the discriminative ability of the combined tests.Patients/Setting: Patients (n=255) were consecutive referrals to a dementia clinic. Patients had a mean +/- SD age of 73.3 +/- 11.3 years, with 13.7 +/- 3.0 (mean +/- SD) years of education. The sample was 56% women; 77% of patients were white.Results: A model combining the AD8 interview (odds ratio, 1.91; 95% confidence interval, 1.6-2.3) and the Consortium to Establish a Registry for Alzheimer Disease 10-item Word List Recall (odds ratio, 1.43; 95% confidence interval, 1.2-1.7) predicted dementia with 91.5% correct classification (AUC = 0.968; 95% confidence interval, 0.93-0.99). A cutoff of 2 or greater on the AD8 and less than 5 items remembered on the Word List Recall was sensitive (94%) and specific (82%). For cognitive impairments not meeting dementia criteria, combining AD8 (odds ratio, 2.31; 95% confidence interval, 1.3-4.0) and Word List Recall (odds ratio, 1.42; 95% confidence interval, 1.1-1.8) was most predictive (AUC = 0.91; 95% confidence interval, 0.8-1.0). Using the same cutoffs as those used for dementia gave the best combination of sensitivity (85%) and specificity (84%).Conclusion: Combining the AD8 interview with the Word List Recall improves the ability to detect the presence of dementia. The AD8 can be administered to an informant and, when combined with Word List Recall, is a powerful yet brief method of detecting cognitive impairment.