引用本文:付继平,陈安妮,陈洁芬,李 艳,徐书雯.住院老年患者综合评估认知筛查量表应用的比较[J].中国临床新医学,2019,12(11):1209-1212.
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住院老年患者综合评估认知筛查量表应用的比较
付继平,陈安妮,陈洁芬,李 艳,徐书雯
515041 广东,汕头大学医学院(付继平,陈安妮);510080 广州,广东省人民医院(广东省医学科学院),广东省老年医学研究所老年医学科(付继平,陈安妮,陈洁芬,李 艳,徐书雯)
摘要:
[摘要] 目的 比较简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、简易智力状态评估量表(Mini-cog)及画钟试验(CDT)这四个量表在筛查老年住院患者认知功能受损的评估效能,旨在制定简单、易懂、适合中国住院老年患者的老年综合评估(CGA)量表。方法 采用CGA量表对广东省人民医院老年科病房2017-04~2018-08住院的75岁及以上老年患者进行评估,每例患者认知评估部分均采用MMSE、MoCA、Mini-cog及CDT量表,根据评估结果计算灵敏度、特异度、Kappa系数及约登指数,使用受试者工作特征曲线(ROC)确定曲线下面积(AUC)。结果 接受评估的225例患者中,认知受损107例。MMSE筛查认知受损灵敏度为0.76,特异度为0.93,约登指数为0.69;MoCA筛查认知受损灵敏度为0.97,特异度为0.41,约登指数为0.38;Mini-cog筛查认知受损灵敏度为0.72,特异度为0.79,约登指数为0.51;CDT筛查认知受损灵敏度为0.63,特异度为0.74,约登指数为0.37。与实际认知状态相比,MMSE筛查认知受损的Kappa系数最高(0.695),其次为Mini-cog(0.509),MoCA最低(0.368)。结论 MMSE筛查认知受损的灵敏度、特异度较高,真实性最大,与实际认知状态的一致性最好,其次为Mini-cog。因此对75岁及以上住院老年患者进行CGA时,可以选用MMSE筛查患者是否有认知受损,如若阳性,可对认知方面进一步进行评估。
关键词:  认知受损  综合评估  简易智能精神状态检查量表  蒙特利尔认知评估量表  简易智力状态评估量表  画钟试验  老年人
DOI:10.3969/j.issn.1674-3806.2019.11.16
分类号:R 749
基金项目:
Comparison of the application of cognitive screening scales for comprehensive assessment in elderly inpatients
FU Ji-ping, CHEN An-ni, CHEN Jie-fen, et al.
Medical College of Shantou University, Guangdong 515041, China
Abstract:
[Abstract] Objective To compare mini mental state examination(MMSE), montreal cognitive assessment(MoCA), mini cognitive assessment test(Mini-cog) and clock drawing test(CDT) in the evaluation of cognitive impairment of elderly inpatients, and to make a simple, easily understandable and suitable comprehensive geriatric assessment(CGA) scale for the elderly inpatients in China. Methods CGA scale was used to evaluate the hospitalized patients aged 75 years or more in the Geriatric Department of Guangdong Provincial People′s Hospital from April 2017 to August 2018, and MMSE, MoCA, Mini-cog and CDT were used in each patient′s cognitive assessment. The sensitivity, specificity, Kappa coefficient and Youden index were calculated based on the evaluation results. The area under the curve(AUC) was determined by the receiver operating characteristic curve(ROC). Results Of the 225 patients evaluated, 107 were cognitively impaired. The sensitivity of MMSE in screening cognitive impairment was 0.76; the specificity was 0.93, and the Youden index was 0.69. The sensitivity and specificity of MoCA in screening cognitive impairment were 0.97 and 0.41 respectively, and the Youden index was 0.38. The sensitivity of Mini-cog in screening cognitive impairment was 0.72; the specificity was 0.79, and the Youden index was 0.51. The sensitivity of CDT in screening cognitive impairment was 0.63; the specificity was 0.74 and the Youden index was 0.37. Compared with that of the actual cognitive status, the Kappa coefficient of MMSE in screening cognitive impairment was the highest(0.695), followed by that of Mini-cog(0.509), and the Kappa coefficient of MoCA was the lowest(0.368). Conclusion MMSE has higher sensitivity, specificity, authenticity and better consistency than the other cognition screening scales, followed by Mini-cog. Therefore, MMSE can be used to screen the patients with cognitive impairment when CGA is carried out in the elderly patients aged 75 and over. If it is positive, further assessment can be made on the cognitive aspect.
Key words:  Cognition impairment  Comprehensive assessment  Mini mental state examination(MMSE)  Montreal cognitive assessment(MoCA)  Mini cognitive assessment test(Mini-cog)  Clock drawing test(CDT)  Elderly people