日常生活能力量表辅助诊断痴呆值的界定

Critical score on activities of daily living scale to diagnose dementia

目的:通过调查影响中老年人生活能力的相关因素,探讨日常生活能力量表辅助诊断痴呆界值的范围。方法:在北京市随机抽取城市和农村的年龄>40岁中老年人1746人,包括健康组(简明精神状态检查表得分未受教育的>17分,受教育年限>6年的>24分,且无躯体疾病者)1441人、痴呆组(简明精神状态检查表得分低于上述分值)305例,使用日常生活活动能力量表(共20项,自己可以做为1分;有些困难为2分;需要帮助为3分;根本没法做为4分,得分范围20～80分)进行日常生活能力调查,并按性别、年龄、城市农村等因素分层比较。在健康组样本中选择305人,与痴呆组(n=305)在文化程度和年龄方面进行了匹配,采用ROC统计方法,对日常生活活动能力量表辅助诊断痴呆的敏感性和特异性进行分析。结果:按意向处理分析,纳入1746人全部进入结果分析。①日常生活活动能力量表总分:健康组低于痴呆组(20.6±1.86,31.9±14.01,t=14.07,P<0.001)。②健康组各因素与日常生活活动能力量表得分的关系:男性和女性,城市组和农村组比较无差异(P≥0.001);日常生活活动能力量表总分与文化程度呈显著负相关、与年龄呈显著正相关(r=-0.178,0.163,P<0.001)。③在日常生活活动能力量表总分为23分时,对痴呆区分的敏感度和特异度兼顾最好,从文化程度的两个方面(文盲和大学以上文化程度)、年龄的两个阶段(40～65岁,75岁以上)分别在年龄或文化程度方面进行统计,日常生活活动能力量表总分为23分、21分、21分、25分时,对区分痴呆的敏感度和特异度兼顾最好。结论:①痴呆患者的日常生活能力显著低于正常人;年龄越大、文化程度越低,日常生活能力越差。②日常生活活动能力量表量表辅助诊断痴呆的界值范围为23±2分较适宜。

AIM： To study the range of scores on activities of daily life scale （ADL） for diagnosis of dementia through investigating the influential factors for ADL in the middle age and the elderly. METHODS： Totally 1746 middle-aged and old people over 40 years old were sampled randomly in the rural and urban areas of Beijing, including 1441 health controls （health group, score on mini-mental state examination scale more than 17 in uneducated subjects, more than 24 in subjects with more than 6-year education, and without body diseases）, and 305 dementia patients with scores on mini-mental state examination scale less than 17. ADL scale consisting of 20 items was adopted for the investigation of ability of daily living （score 1： I can do something by oneself, score 2： There are some difficulties, score 3： I need help, score 4： I can not do it at all, scoring from 20-80）. Then the results were compared in terms of age, sex, residing place. Of the 1441 controls, 305 subjects were selected matched to the dementia patients in terms of age and educational level. ROC statistical analysis was carried out to analyze the sensibitity and specificity of ADL scale in assisting diagnosis for dementia. RESULTS： According to the intention-to-treat analysis, all the 1 746 subjects were involved in the result analysis. ①The total score of ADL in the healthy group was lower than that in the dementia group （20.6±1.86, 31.9±14.01 ,t=14.07,P〈0.001）.② In healthy group, the total ADL scores were not different significantly between men and women （t=1.32,P≥0.001）, and between the rural area and urban area （t=1.25,P〉≥0.001）.ADL scores had a positive relationship with age and a negative relationship with educational level in the health controls. At the score of 23, ADL had the best sensitivity and specificity in diagnosis of dementia; At the scores of 23, 21, 21, 25, ADL had the best sensitivity and specificity from two aspects in education （illiterate and above college） and two aspects in age （40-65 years old and over 75 years old）. CONCLUSION： Ability of daily living in dementia patients is significantly lower than the normal; the older the age and the lower the educational level, the poorer the ability of daily living. The better range of using activities of daily living to diagnose dementia is the score of 23±2.