AD8联合简易智能状态检查量表用于军队健康体检人群认知功能障碍筛查的初步研究

目的探讨AD8和简易智能状态检查量表(mini-mental state examination,MMSE)联合使用在军队健康体检人群中筛查认知功能障碍的特异性和敏感性。方法选择2013年1月1日~12月31日在解放军总医院接受常规健康体检的军队人群1723例,进行AD8和MMSE测评。结果 1723例接受AD8测评中,AD8≥2分326例(18.9%)。161例主诉认知功能减退者同时接受MMSE测评,AD8≥2分84例(52.2%),MMSE异常78例(48.4%)。临床诊断痴呆66例(41.0%),其中AD8筛查阳性46例(69.7%),MMSE异常55例(83.3%)。ROC曲线分析显示,AD8+MMSE联合筛查痴呆的特异性从AD8单项测试的60.0%提高到91.6%。协方差分析显示,在调整年龄的影响因素后,AD8+MMSE双异常者连线A评分较认知正常者明显升高,MMSE、延迟回忆、执行功能、工作记忆、词语流畅性评分较认知正常者明显降低,差异有统计学意义(P0.01)。结论健康体检时AD8+MMSE联合应用可以提高检出痴呆患者的特异性和可靠性,便于在基层医疗卫生机构推广使用。     

简易认知量表和8条目痴呆筛查问卷在高龄老年人群早期认知功能下降筛查中的应用

目的探讨简易认知量表（Mini-Cog）和8条目痴呆筛查问卷（8-item ascertain dementia, AD8）对80岁以上老年人群早期轻度认知功能障碍（mild cognitive impairment, MCI）的筛查价值。 方法选取杭州市某福利中心的2014年10月前已入住的908名高龄老年人进行Mini-Cog和AD8筛查,随访5年后对仍然健在且能配合完成检查者进行二次认知功能评估。计算Mini-Cog和AD8初筛的敏感度和特异度,并分析随访5年后AD8的ROC曲线结果以及两种量表的一致性检验结果。 结果908例高龄老年人中523例确诊为痴呆（不计入后续筛查及随访调查）,余385例筛查结果显示：Mini-Cog、AD8诊断MCI的敏感度分别为54.88%、57.32%,特异度分别为85.52%、86.43%。随访5年后仍健在且接受二次评估的老年人共167名,其中认知功能正常106例（54例出现认知功能下降）,MCI 61例（36例出现认知功能进一步下降）。对于随访5年的认知功能正常者及MCI者,AD8诊断的AUC分别为0.572（95%CI=0.486-0.658）、0.723（95%CI=0.611-0.835）,Mini-Cog和AD8（以得分>3为分界线）诊断的一致性Kappa值分别为0.105、0.018和0.225、0.524。 结论AD8和Mini-Cog均具有一定的MCI评估效能,尤其适用于养老机构及社区高龄老年群体的认知功能筛查。     

阿尔茨海默病各种临床记忆检测方法的评价

目的评价各种临床记忆检测方法对阿尔茨海默病(Alzheimer’s disease,AD)诊断的临床效度,从而组合出最适宜AD患者的一套记忆力检测量表。方法以北京市十五攻关项目中研究的患者为背景,对正常老年人1 584例(常模组),AD患者351例(AD组),应用各种记忆力检测量表进行临床分析。结果各种记忆力检测量表对AD的记忆力检测均有较好的临床效度。结合记忆力检测量表的敏感性、特异性、临床可行性及不同的记忆模式,以常模组记忆总得分的第5百分位为分界值,联合各量表的记忆检测,轻度AD患者敏感性为82.57%,特异性为93.29%;检测中度AD患者的敏感性为85.46%,特异性为91.63%。结论联合各量表的记忆检查对AD患者的记忆力检测,敏感性及特异性高,对AD的轻、中度分界有辅助作用。     

认知障碍初步评价表信度与效度的初步研究

目的对认知障碍初步评价表(COG-12)在阿尔茨海默病(AD)患者中的信度与效度进行评价。方法选择2013年1¹2月就诊于南京医科大学附属脑科医院老年精神科的AD患者148例为AD组,另选择社区志愿者365例为对照组,2组均接受临床痴呆量表、AD8、简易智能状态检查量表、画钟测验评估和COG-12测评。其中100例AD患者知情者在首次评定1个月内重测COG-12。结果 COG-12的克朗巴赫α系数=0.883,重测信度=0.883(P<0.01)。COG-12各条目评分与总分的相关系数为0.4112月就诊于南京医科大学附属脑科医院老年精神科的AD患者148例为AD组,另选择社区志愿者365例为对照组,2组均接受临床痴呆量表、AD8、简易智能状态检查量表、画钟测验评估和COG-12测评。其中100例AD患者知情者在首次评定1个月内重测COG-12。结果 COG-12的克朗巴赫α系数=0.883,重测信度=0.883(P<0.01)。COG-12各条目评分与总分的相关系数为0.41⁰.79(P<0.05,P<0.01);COG-12总分与简易智能状态检量表、画钟测验呈负相关(r=-0.67,r=-0.27,P<0.01),与临床痴呆量表、AD8总分呈正相关(r=0.80,r=0.81,P<0.01)。COG-12鉴别认知正常与轻度AD患者的ROC曲线下面积=0.902,≥6分为认知损害的界限分值敏感性为90.0%,特异性为82.5%;鉴别轻度与中度AD患者的ROC曲线下面积=0.898,敏感性为90.5%,特异性为76.7%。结论 COG-12具有良好的信度和效度,是快速识别痴呆及评估严重程度敏感而准确的筛查评估工具。     

Mini-Cog认知评价量表在脑卒中患者中的应用研究

目的探讨Mini-Cog认知评价量表在脑卒中患者认知功能障碍(CI)评定中的诊断价值。方法选择2019年10月至2020年5月入住常州市第一人民医院神经外科的脑卒中患者103例,分别进行Mini-Cog及简易精神状态评价量表(MMSE)测评。结果(1)100例患者中Mini-Cog诊断为CI的有22例,MMSE诊断为CI的有23例,两者诊断情况比较,差异无统计学意义(P>0.05)。(2)Mini-Cog平均总分为(3.54±1.46)分,MMSE平均总分为(25.47±4.75)分。Spearman分析结果显示两者具有相关性(r=0.636,P<0.01)。组内相关系数(ICC)为0.857,两者具有一致性(P<0.05)。(3)Mini-Cog平均用时(1.85±0.54)min与MMSE平均用时(9.36±1.80)min相比显著下降,差异具有统计学意义(t=39.930,P<0.01)。(4)Mini-Cog ROC曲线下面积(AUC)为0.959,与MMSE的AUC 0.975进行非劣性分析,差异无统计学意义)(z=1.015,P>0.05)。Mini-Cog诊断CI的敏感度为0.87,特异度0.97,最佳截断点是3。结论Mini-Cog可以作为脑卒中患者CI筛查的工具,具有较高的临床应用价值。     

简易认知量表在门诊快速识别轻度认知障碍患者中的价值

目的比较简易认知(Mini-Cog)量表和简易精神状态检查(MMSE)量表在神经内科门诊筛查轻度认知障碍(MCI)患者中的价值。方法 MCI患者(MCI组)和健康对照组各105例,将MCI组按年龄分为三组,40～60岁为年龄组Ⅰ,61～80岁为年龄组Ⅱ,≥81岁为年龄组Ⅲ。同时将MCI组按受教育年限分为文盲(未受教育)组,小学(受教育年限≤6年)组,中学或以上(受教育年限>6年)组。研究对象均进行Mini-Cog量表、MMSE量表、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、临床痴呆评定(CDR)量表测试。结果 MCI组和健康对照组的Mini-Cog量表评分(t=11. 55,P<0. 05)和MMSE量表评分(t=13. 52,P<0. 05)差异均有统计学意义,但Mini-Cog量表识别MCI的敏感性、特异性(85. 71%、78. 09%)均较MMSE量表(64. 77%、70. 48%)高,其中特异性差异无统计学意义(χ~2=1. 60,P> 0. 05)。不同年龄和不同教育程度MCI患者应用Mini-Cog量表效果优于MMSE量表(P<0. 05)。结论 Mini-Cog量表识别MCI患者比MMSE量表更具有优越性,Mini-Cog量表受年龄及教育程度的影响较MMSE量表小,同时具有耗时短(3～4 min)、易于被受检者接受的优点。     

CEA、CYFRA21-1联合检测在非小细胞肺癌诊断中的价值

目的：用绘制 ROC 曲线的方法评价癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)联合检测在非小细胞肺癌诊断的临床价值。方法收集78例确诊为非小细胞肺癌的患者及同期79例肺部良性疾病患者的临床资料,使用 SPSS 18.0软件绘制 ROC 曲线分析 CEA 及 CYFRA21-1联合检测诊断非小细胞肺癌的敏感性、特异性及诊断准确性,评价其在诊断非小细胞肺癌中的临床价值。结果非小细胞肺癌组血清 CEA、CYFRA21-1水平显著高于肺部良性病变组(P <0.01)。CEA 单独检测的敏感性为64.2%,特异性为97.5%,CYFRA21-1单独检测的敏感性为61.7%,特异性为88.6%,两者联合检测的敏感性为71.6%,特异性为83.5%,明显高于单项检测。两者联合检测的曲线下面积为0.802,高于 CEA、CYFRA21-1的 ROC 曲线下面积(0.760、0.792)。吸烟的男性患者中两者联合检测的曲线下面积为0.841,敏感性为69.2%,特异性为100.0%。结论 CEA、CYFRA21-1两者联合检测可提高对非小细胞肺癌诊断的敏感性,且对男性吸烟患者的诊断准确性最高,具有一定的临床价值。     

认知障碍简明评价量表对高龄老年人群轻度认知障碍筛查效力的初步研究

目的观察分析认知障碍简明评价量表(Cog-12)对80岁以上的高龄老年人群轻度认知功能障碍(MCI)的检出能力。方法选择年龄≥80岁高龄老人,按照认知水平分为对照组38例、MCI组31例和阿尔茨海默病(AD)组32例。各组完成Cog-12及蒙特利尔认知量表、简易智能状态检查量表、画钟实验等评定。结果与对照组比较MCI组和AD组Cog-12总分显著升高,差异有统计学意义[(9.9±6.1)分、(24.1±10.2)分vs(3.7±2.4)分,P<0.05)]。Cog-12以6分为界值,对MCI诊断的敏感性为74.2%,特异性为89.5%,ROC曲线下面积为0.866。结论Cog-12是一个方便的认知功能筛查工具,可以有效地发现老年人群中的MCI患者。     

瑞金简易记忆测试量表对阿尔茨海默病患者筛查效用的初步研究

目的:为研发适合中国人群的记忆力筛查量表,采用瑞金简易记忆测试(RISMET)量表对阿尔茨海默病(AD)患者进行检测,评价其效用。方法:分别对57例AD患者和46名正常对照者行RISMET量表和简易智能状态检查(MMSE)量表测评,比较2组得分情况;以内部相关系数(ICC)计算重测信度,Cronbach’sα系数评价内部一致性;以受试者工作特征(ROC)曲线评价RISMET量表对于筛查AD患者的敏感性和特异性。结果:①MMSE、RISMET量表及其分项得分(包括定向力、瞬间记忆、逆行性记忆、相似性、画钟测验、计算力、语言流畅性和回忆8项)均AD组0.7;③Spearman相关分析显示RISMET量表与MMSE量表呈正相关(P=0.726,P=0.000),每一分项与总分的相关性均大于2个分项的相关性,具有统计学差异(P     

唐山市老年人血压与认知功能状况

目的调查唐山市826例老年人血压水平与认知功能的关系。方法采用一般情况调查表、简易智力状态检查量表(MMSE)以及测量血压等方式对唐山市826例60岁及以上老年人进行认知功能、血压评估并加以分析。结果共调查826例老年人,其中血压水平SBP≥140 mmHg和(或)DBP≥90 mmHg有417例(50.48%);高血压中认知功能障碍检出97例,检出率为23.26%。在高血压状态下,男、女性认知功能障碍检出率在各年龄段间有显著性差异(P<0.01)。在不同血压(收缩压、舒张压)水平下,MMSE评分有显著性差异(P<0.01);认知功能障碍检出率有显著性差异(P<0.05)。结论老年人血压水平与认知功能关系密切,高血压与认知功能障碍一定程度上呈正相关。     

海南版简易智能状态检查量表和蒙特利尔认知评估量表界值划分的初步研究

目的初步探讨中文海南版(琼北闽语版)简易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分在本地人群认知筛查中的可行性及界值的划分。方法选取2019年1~9月海口市养老院和海南省人民医院门诊及住院的本地被试者217例,根据临床诊断分为正常组45例,轻度认知功能障碍(MCI)组54例,轻度痴呆组62例,中度以上痴呆组56例,同时进行MMSE及MoCA评分评估,进行两种量表评分相关性及界值。结果与正常组比较,MCI组、轻度痴呆组和中度以上痴呆组MMSE及MoCA评分明显降低,差异有统计学意义(P<0.05)。正常组、MCI组、轻度痴呆组和中度以上痴呆组MMSE评分明显高于MoCA评分(P<0.01)。Person相关分析显示,MMSE评分与MoCA评分呈正相关(r=0.940,P<0.01)。MCI组、轻度痴呆组和中度以上痴呆组ROC曲线界值为:MCI组MMSE评分低于27分,MoCA评分低于22分;轻度痴呆组MMSE评分低于23分,MoCA评分低于16分;中度以上痴呆组MMSE评分低于15分,MoCA评分低于11分。结论海南版(琼北闽语版)MMSE与MoCA评分有较好的一致性,联合应用对认知障碍及痴呆患者有较好的筛查应用价值。     

Development of a scale to predict decline in patients with mild Alzheimer's disease

OBJECTIVES: To develop a scale that can assist in predicting likelihood of decline from mild dementia over 1 year in patients with Alzheimer's disease (AD). DESIGN: Retrospective cohort study. SETTING: University Memory and Aging Center. PARTICIPANTS: Patients with probable or possible AD and Clinical Dementia Rating (CDR) of 1 at baseline, divided into development and validation cohorts (n = 118 each). MEASUREMENTS: The CDR and neurological and neuropsychological assessments were given at baseline and 1 year later. RESULTS: In the development cohort, high education, low Mini-Mental State Examination score, poor insight, psychotic symptoms, and greater activity of daily living impairment predicted decline in CDR from 1 to 2 or 3. Receiver operating characteristics (ROC) curve analysis identified cutoff scores that maximized sensitivity and specificity for each significant predictor of decline. Based on the cutoff, raw scores were recoded to reflect risk for decline, weighted, and summed to create a final scale score. ROC curve analysis established a cutoff to indicate risk for decline on the final scale score. Sensitivity, specificity, and area under the ROC were 0.76, 0.74, and 0.83 in the development cohort and 0.77, 0.69, and 0.80 in the validation cohort, respectively. Positive and negative predictive values were 0.71 and 0.78 in the development cohort and 0.68 and 0.78 in the validation cohort, respectively. CONCLUSIONS: Decline from mild to moderate or severe impairment represents significant clinical change, with implications for patient and caregiver quality of life and treatment options. The clinical scale developed uses data to enhance prediction about change from mild to moderate or severe stages of AD.     

Which two questions of Mini-Mental State Examination (MMSE) should we start from?

The MMSE is a simple and commonly used instrument to evaluate cognitive impairment. With the aim of enabling the examiner to skip a large portion of the MMSE when screening subjects with lower possibility of cognitive impairment, we examined the internal distribution of the MMSE scores among 792 older adults visiting a teaching hospital, a long-term care hospital, nursing homes, and a geriatric clinic. The correlation coefficients between the summed scores of any two items of MMSE and the total score were compared. A receiver operating characteristic (ROC) curve was drawn to show the sensitivity and the specificity of predicting cognitive impairment, which was defined by the total MMSE score being less than 24. The mean MMSE score was 20.5 +/- 6.9 (+/-S.D.). A good predictor for cognitive impairment was the summed scores of the time orientation and serial sevens with a sensitivity of 98.2% and a specificity of 69.2% if cut-off was set at 7/7+. This finding appears to help streamline the screening process for cognitive impairment in general elderly population.     

蒙特利尔认知评估量表筛查轻度认知功能障碍分界值的研究

目的研究蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)在筛查轻度认知功能障碍(MCI)中的应用价值,初步探讨MoCA筛查MCI的最佳界值。方法分别采用简易智能状态检查量表(MMSE)及MoCA评估入组的男性患者153例,根据诊断标准分为对照组69例、MCI组60例、AD组24例。进行2种量表得分的相关性分析,并且计算MoCA筛查MCI患者的敏感性、特异性、Kappa值、约登指数等,并选取最佳分界值。结果与对照组比较,MCI组和AD组MMSE评分和MoCA评分明显降低(P<0.05)。MMSE评分与MoCA评分呈正相关(r=0.847,P<0.01);以26分为分界值,MoCA诊断MCI的敏感性为98.3%,特异性为85.5%,Kappa值=0.830;绘制ROC曲线得到MoCA筛查MCI的最佳分界值为25分,敏感性为93.3%,特异性为97.1%,Kappa值=0.906。结论本研究人群MMSE评分与MoCA评分有很好的相关性,并且与临床诊断一致性好,推荐25分为该类人群MCI的分界值。     

Predicting cognitive sequelae in survivors of critical illness with cognitive screening tests

Rationale: Survivors of critical illness have a high rate of cognitive impairments that may persist years after hospital discharge. Data are lacking regarding whether cognitive screening tests administered at hospital discharge can be used to predict which critically ill patients are likely to have long-term cognitive sequelae. Objectives: This prospective study assessed whether two cognitive screening tests, the Mini-Mental State Examination (MMSE) and Mini-Cog, administered at hospital discharge, predict cognitive sequelae in survivors of critical illness 6 months after hospital discharge. Methods: Seventy critically ill patients completed the MMSE and Mini-Cog just before hospital discharge. Of these 70 patients, 53 completed a neuropsychological battery 6 months after hospital discharge. Measurements and Main Results: At hospital discharge, 45 patients (64%) had impaired performance on the MMSE (score < 27, mean = 24.4) and 32 (45%) on the Mini-Cog. Twenty-seven patients (39%) were impaired on both the MMSE and Mini-Cog, whereas only 20 patients (28%) had scores in the normal range on both tests. Cognitive sequelae occurred in 57% of survivors (30 of 53) at 6 months, with predominant dysfunction in the memory (38%) and executive (36%) domains. Logistic regression analyses showed that neither the MMSE nor the Mini-Cog predicted cognitive sequelae at 6 months. Conclusions: A large number of critically ill survivors had cognitive impairments, as assessed by the MMSE and Mini-Cog, at hospital discharge. However, the MMSE and Mini-Cog scores did not predict long-term cognitive sequelae at 6-month follow-up and cannot be used as surrogate endpoints for long-term cognitive impairment.     

Implementing Routine Cognitive Screening of Older Adults in Primary Care: Process and Impact on Physician Behavior

Background Early detection of cognitive impairment is a goal of high-quality geriatric medical care, but new approaches are needed to reduce rates of missed cases. Objective To evaluate whether adding routine cognitive screening to primary care visits for older adults increases rates of dementia diagnosis, specialist referral, or prescribing of antidementia medications. Setting Four primary care clinics in a university-affiliated primary care network. Design A quality improvement screening project and quasiexperimental comparison of 2 intervention clinics and 2 control clinics. The Mini-Cog was administered by medical assistants to intervention clinic patients aged 65+ years. Rates of dementia diagnoses, referrals, and medication prescribing were tracked over time using computerized administrative data. Results Twenty-six medical assistants successfully screened 70% (n = 524) of all eligible patients who made at least 1 clinic visit during the intervention period; 18% screened positive. There were no complaints about workflow interruption. Relative to baseline rates and control clinics, Mini-Cog screening was associated with increased dementia diagnoses, specialist referrals, and prescribing of cognitive enhancing medications. Patients without previous dementia indicators who had a positive Mini-Cog were more likely than all other patients to receive a new dementia diagnosis, specialty referral, or cognitive enhancing medication. However, relevant physician action occurred in only 17% of screen-positive patients. Responses were most related to the lowest Mini-Cog score level (0/5) and advanced age. Conclusion Mini-Cog screening by office staff is feasible in primary care practice and has measurable effects on physician behavior. However, new physician action relevant to dementia was likely to occur only when impairment was severe, and additional efforts are needed to help primary care physicians follow up appropriately on information suggesting cognitive impairment in older patients. An erratum to this article can be found at     

A quick dementia screening tool for primary care physicians

The accuracy and consuming-time of screening methods are important factors in the early diagnosis of dementia. In this study, we aimed to know whether the eight-item test (including three-item recall, attention and calculation, subtracted from the mini-mental state examination (MMSE), clock drawing test (CDT), and instrumental activities of daily living (IADL) impairment or any combination of the above tests can be used as a quick and effective dementia screening tool. A total of 188 seniors aged over 60 years were enrolled at a geriatric clinic. The result revealed that a cutoff score of 6/7 in an eight-item scale had a sensitivity of 94.9% and a specificity of 59.1% in the detection of dementia. In terms of sensitivity and specificity, the eight-item scale performed better than a score of two in three-item recall (51.3%/87.3%), a score of one in three-item recall (83.3%/53.6%), CDT (39.0%/96.9%), mini-cognitive assessment instrument (Mini-Cog) test (53.7%/95.5%), a score of less than three in attention/calculation test (74.7%/77.3%), impairment of transportation or medication in IADL (67.2%/90.6%), and any impairment in IADL (77.2%/67.9%). In subgroup analysis, a cutoff score of 5/6 were adjusted for the low-education group. We conclude that an eight-item test is a sufficient and simple tool for the screening of early dementia in primary-care clinics focused on older people care.     

氧化应激指标对糖尿病伴阻塞性睡眠呼吸暂停低通气综合征认知功能的诊断效能

目的探讨血清氧化应激指标8-异前列腺素F2α(8-iso-PGF2α)和8-羟基脱氧鸟苷酸(8-OHdG)对2型糖尿病伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者认知功能障碍的诊断效能。方法选取华北理工大学附属医院收治的2型糖尿病患者83例,分为2型糖尿病伴OSAHS组(观察组)43例和糖尿病组40例,另选择同时期健康体检者50例为对照组。比较3组血清8-iso-PGF2α和8-OHdG水平,采用蒙特利尔认知评估量表(MoCA)评分神经功能,采用Pearson相关分析。结果对照组、糖尿病组及观察组血清8-iso-PGF2α和8-OHdG水平呈明显升高趋势,MoCA评分呈明显降低趋势,差异有统计学意义(P<0.05)。Pearson相关分析显示,2型糖尿病合并OSAHS患者血清8-iso-PGF2α、8-OHdG水平与MoCA评分呈负相关(P<0.01)。血清8-iso-PGF2α、8-OHdG水平预测2型糖尿病伴OSAHS患者认知功能障碍的ROC曲线下面积分别为0.787(95%CI:0.708~0.867)、0.798(95%CI:0.720~0.875)。结论血清8-iso-PGF2α和8-OHdG是2型糖尿病伴OSAHS患者认知功能障碍形成的重要影响因素,与患者认知障碍损伤程度呈正相关,可预测认知功能的损伤情况。