老年人快速认知筛查量表在社区人群应用的效度研究

Validity study of quick cognitive screening scale for elderly in community population

目的验证老年人快速认知筛查量表(quick cognitive screening scale for elderly,QCSS-E)在社区人群中筛查轻度认知障碍(mild cognitive impairment,MCI)和阿尔茨海默型痴呆(dementia with alzheimer's type ,DAT)的校标效度和筛查效能。方法采用分层方便取样法,在无锡地区募集55岁及以上社区老年人,获得1 298名有效样本,分别进行临床访谈、实验室检查及QCSS-E、日常生活能力量表(activity of daily living scale, ADL)、简易精神状况评定量表(mini-mental status examination,MMSE)、阿尔茨海默病评定量表认知分量表(alzheimer's disease assessment scale-cognitive subscale, ADAS-cog)、临床痴呆评定量表(clinical dementia rating scale,CDR)、核心神经心理测验(core neuropsychological test,CNT)等评定,以Peterson MCI标准及DSM-V AD痴呆诊断标准为金标准,区分为健康对照组(HC组)、MCI组及DAT组,验证QCSS-E的校标效度、筛查效能并制定最佳划界分。结果三组被试的年龄、教育年限、婚姻状况、家庭结构、职业以及MMSE分、ADAS-Cog分、CNT分、QCSS-E总分及领域分等组间比较均差异有统计学意义(均P<0.01)。QCSS-E总分及各领域分与MMSE、ADAS-cog和CNT等测验分数的相关均具有统计学意义(P<0.01)。QCSS-E总分鉴别MCI/HC的曲线下面积(AUC)为83.5%,划界分为74.5分时,归类正确率最高(75.0%);QCSS-E总分鉴别DAT/HC的AUC为98.0%,划界分为64.5分时,归类正确率最高(94.2%)。结论QCSS-E筛查MCI及DAT具有较好的校标效度和较高的筛查效能。

Objective To verify the criteria validity and effectiveness of the QCSS-E for screening of mild cognitive impairment (MCI) and early dementia with Alzheimer's type (DAT) among the elderly in community. Methods With stratified convenient sampling, 1 298 elderly aged 55 and over recruited from Wuxi community, who finished the clinical interviews, laboratory examination and psychological tests such as QCSS-E, ADL, MMSE, ADAS-cog, CDR, and Core Neuropsychological Test.Then they were divided into health control group(HC), MCI group and DAT group by the diagnostic criteria of Peterson’s MCI and DSM-5 AD dementia.The criteria validity and screening efficacy of QCSS-E were verified and the optimal cut off value for detecting MCI and DAT were explored. Results There were statistically significant differences in age, education level, marital status, family structure, occupation, and scores of MMSE, ADAS-cog, CNT, and QCSS-E total score and domain scores among three groups (all P<0.01). The total score and every domains score of QCSS-E were significantly correlated with test scores such as MMSE, ADAS-cog and CNT (all P<0.01). Using the total QCSS-E score to discriminate MCI from health control, the area under the curve (AUC) was 83.5%. When the cut off value was 74.5, the accuracy rate of classification was the highest (75.0%). Using the total QCSS-E score to discriminate DAT from health control, the AUC was 83.5%. When the cut off value was 64.5, the accuracy rate of classification was the highest (94.2%). Conclusion The QCSS-E has better criteria validity and higher effectiveness in screening MCI and DAT.