简版CSI-D与MMSE在我国中老年人痴呆筛查中的应用效果比较研究

Comparison of the Brief CSI-D and MMSE Scales in Screening for Dementia in Middle-aged and Elderly Chinese People

背景随着人口老龄化形势日益严峻,痴呆患者数量也在不断增加,由于痴呆对患者健康和生活质量的影响较大,其早期预防和识别显得尤为重要。目的比较简版社区痴呆筛查量表(CSI-D)和简易精神状况检查量表(MMSE)在中老年人痴呆筛查中的应用效果,并对两种量表测量结果的一致性进行分析。方法于2021年11月,采用2018年中国健康与养老全国追踪调查(CHARLS)数据,选取简版CSI-D、MMSE条目评估结果及其他关键变量(性别、年龄、居住地、受教育程度和婚姻状态)值完整的中老年人2668例作为研究对象。分别采用简版CSI-D和MMSE对其进行痴呆筛查,采用Pearson相关分析中老年人简版CSI-D得分与其MMSE得分的相关性,计算简版CSI-D和MMSE在全体及不同特征中老年人中的筛查结果一致率,并使用Kappa检验分析两种量表测量结果的一致性。结果2668例中老年人简版CSI-D平均得分为(5.84±2.26)分,MMSE平均得分为(24.93±3.24)分。Pearson相关分析结果显示,中老年人简版CSI-D得分与其MMSE得分呈线性正相关(r=0.394,P<0.001)。在简版CSI-D和MMSE下,中老年人痴呆筛查阳性率分别为27.36%(730/2668)和22.11%(590/2668),两者比较,差异有统计学意义(χ^(2)=40.167,P<0.001)。两种量表在全体中老年人中的筛查结果一致率为20.22%(222/1098),在不同特征中老年人中的筛查结果一致率为12.50%~30.43%。Kappa检验结果显示:两种量表评估结果间一致性Kappa值为0.121(P<0.001),一致性强度为微弱。结论对于基层居民,通过简版CSI-D和MMSE得出的痴呆筛查结果有一定差异且一致性强度较弱,应用时要根据实际情况具体分析。今后,也需结合痴呆诊断的“金标准”,对两种量表的筛查准确性进行深入的比较与探讨。

Background The number of dementia patients is increasing along with the aging of the population.Dementia greatly impairs health and quality of life of patients,so early prevention and identification are particularly important.Objective To compare the results of the brief Community Screening Interview for Dementia(CSI-D)and the Mini-Mental State Examination(MMSE)in dementia screening,and to assess the examination consistency of the two scales.Methods In November 2021,we collected data of a sample of 2668 middle-aged and elderly people with complete data(including assessment results of CSI-D and MMSE,sex,age,place of residence,education level and marital status)of the CHARLS 2018.The brief CSI-D and MMSE were used to screen the risk of dementia.Pearson correlation analysis was used to analyze the correlation of the scores of the brief CSI-D with those of MMSE.The consistencies of the two scales in the screening of dementia in all cases and subgroups divided by personal characteristics were calculated,the overall consistency was assessed using Kappa statistic.Results The average CSI-D score and average MMSE score for all participants were(5.84±2.26)and(24.93±3.24),respectively.Pearson correlation analysis showed that the brief CSI-D score was positively correlated with the MMSE score(r=0.394,P<0.001).The overall prevalence of dementia was 27.36%(730/2668)screened by the brief CSI-D,and was 22.11%(590/2668)by the MMSE,showing statistically significant difference(χ^(2)=40.167,P<0.001).The consistency of the two scales in screening dementia in all cases was 20.22%,and ranged from 12.50%to 30.43%in screening dementia in subgroups divided by personal characteristics.Kappa statistic showed that the kappa value between the two scales was 0.121(P<0.001),suggesting a weak level of consistency.Conclusion In general,there are differences and weak consistency in the screening results of dementia between CSI-D and MMSE in general household population.Therefore,the use of the scales should be analyzed according to the actual situation.The in-depth comparison and discussion on the screening accuracy of the two scales could be further performed in combination with the gold standard for diagnosing dementia.