六分法快速识别认知损害的初步研究(英文)

A preliminary study of the Six-Item Screener in detecting cognitive impairment

目的评价简易精神状态检查表(mini-mental status examination,MMSE)中时间定向与词语延迟回忆得分组成的六分法(Six-Item Screener,SIS)在识别认知损害中的价值。方法在华山医院神经内科记忆障碍门诊部的1976例就诊者中,根据轻度认知损害(mild cognitive impairment,MCI)和痴呆的诊断标准分为认知功能正常的主观抱怨者(475例)、MCI患者(440例)和阿尔茨海默病(Alzheimer’s disease,AD)患者(共1061例,其中轻度AD 555例、中度AD339例、重度AD 167例)。所有就诊者完成包括MMSE在内的全套神经心理测验。分析MMSE中年份、月份、日期以及三个词语延迟回忆(简称三词)的总得分(共6分)在区分不同程度的认知障碍中的作用。结果SIS总分以文盲组≤2分、小学组≤3分、初中及以上组≤4分作为划界分,其识别轻度AD的敏感性为88.5%、特异性为78.3%、准确性为83.8%,识别MCI的敏感性为34.3%、特异性为90.1%、准确性为63.2%。结论六分法对于门急诊快速识别痴呆具有一定的价值,但不适用于识别MCI。

Objective The present retrospective study was to explore the clinical value of Six-Item Screener （SIS）, which is constituted by 6 items from mini-mental status examination （MMSE）, to identify cognitive impairment. Methods A total number of 1976 patients aged over 50 years, from the Memory Clinic of Huashan Hospital were employed in a battery of neuropsychological tests including MMSE. Subjects with severe conditions, unable to cooperate, or having been previously enrolled, were excluded from this study. The employed subjects were divided into 3 groups： subjective memory complaints （SMCs） （475 cases）, patients with mild cognitive impairment （MCI） （440 cases）, and patients with Alzheimer＇s disease （AD） （1061 cases, including 555 mild, 339 moderate, and 167 severe）. A total score of MMSE and a score of SIS composed of date, month, year, three-word delayed recall from MMSE were calculated. Data were analyzed based on educational background. Results The cut-off of SIS score was 〈 2 for illiterate, 〈 3 for elementary, and 〈 4 for junior high school or above. The sensitivity and specificity of SIS for detecting mild AD were 88.5% and 78.3%, respectively, with an overall accuracy of 83.8%, while for detecting MCI, the sensitivity and specificity were 34.3% and 90.1%, respectively, with an overall accuracy of 63.2%. Conclusion SIS is an effective and reliable instrument for dementia detection in outpatient department. However, it has limited value for MCI identification.