Defining Optimal Cutoff Scores for Cognitive Impairment Using Movement Disorder Society Task Force Criteria for Mild Cognitive Impairment in Parkinson's Disease
Defining Optimal Cutoff Scores for Cognitive Impairment Using Movement Disorder Society Task Force Criteria for Mild Cognitive Impairment in Parkinson's Disease
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DOI：
10.1002/mds.25655
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发表时间：
2013-12-01
影响因子：
8.6
通讯作者：
Stebbins, Glenn T.
中科院分区：
文献类型：
--
作者：
Goldman, Jennifer G.;Holden, Samantha;Stebbins, Glenn T.
最近提出的运动障碍协会（MDS）工作组帕金森病轻度认知障碍（PD-MCI）诊断标准代表了在多个临床和研究环境中统一定义PD-MCI的第一步。然而，关于具体标准的几个问题仍然没有答案，包括定义神经心理学测试障碍的最佳截止分数。76例非痴呆PD患者接受了全面的神经心理学评估，并被分类为PD-MCI或认知正常的PD（PD-NC）。采用一系列标准差（SD）临界评分，将MDS工作组II级标准（综合评估）诊断PD-MCI的一致性与我们对PD-MCI或PD-NC的共识诊断进行比较。对每个临界值的敏感性、特异性、阳性和阴性预测值进行了检查。评估PD-MCI亚型分类和认知功能损害的分布。PD-MCI诊断的一致性是最大的神经心理学测试使用低于适当的标准的2 SD截止评分定义的损害。与其他临界值相比，该临界值还提供了将PD-MCI与PD-NC分离的最佳区分特性。根据MDS PD-MCI标准，多领域损害比单领域损害更常见，主要表现为执行功能、记忆和视觉空间功能缺陷。MDS工作组PD-MCI II级诊断标准的应用在2 SD临界评分下表现出良好的灵敏度和特异性。PD-MCI中II级标准的多个领域损害的优势表明，不仅测试异常要求的影响，而且PD-MCI中认知缺陷的广泛性。(c)2013年国际帕金森和运动障碍协会
The recently proposed Movement Disorder Society (MDS) Task Force diagnostic criteria for mild cognitive impairment in Parkinson's disease (PD-MCI) represent a first step toward a uniform definition of PD-MCI across multiple clinical and research settings. However, several questions regarding specific criteria remain unanswered, including optimal cutoff scores by which to define impairment on neuropsychological tests. Seventy-six non-demented PD patients underwent comprehensive neuropsychological assessment and were classified as PD-MCI or PD with normal cognition (PD-NC). The concordance of PD-MCI diagnosis by MDS Task Force Level II criteria (comprehensive assessment), using a range of standard deviation (SD) cutoff scores, was compared with our consensus diagnosis of PD-MCI or PD-NC. Sensitivity, specificity, and positive and negative predictive values were examined for each cutoff score. PD-MCI subtype classification and distribution of cognitive domains impaired were evaluated. Concordance for PD-MCI diagnosis was greatest for defining impairment on neuropsychological tests using a 2 SD cutoff score below appropriate norms. This cutoff also provided the best discriminatory properties for separating PD-MCI from PD-NC compared with other cutoff scores. With the MDS PD-MCI criteria, multiple domain impairment was more frequent than single domain impairment, with predominant executive function, memory, and visuospatial function deficits. Application of the MDS Task Force PD-MCI Level II diagnostic criteria demonstrates good sensitivity and specificity at a 2 SD cutoff score. The predominance of multiple domain impairment in PD-MCI with the Level II criteria suggests not only influences of testing abnormality requirements, but also the widespread nature of cognitive deficits within PD-MCI. (c) 2013 International Parkinson and Movement Disorder Society