老年快速認知篩查量表應用于輕度認知功能障礙篩查的分界值研究

吳越,程灶火,季慶,包炤華,范潔,湯莉

·論著·

老年快速認知篩查量表應用于輕度認知功能障礙篩查的分界值研究

吳越,程灶火,季慶,包炤華,范潔,湯莉

目的探討老年快速認知篩查量表(quick cognitive screening scale for elderly,QCSS-E)在社區(qū)老年人群中篩查輕度認知功能障礙(mild cognitive impairment,MCI)的分界值。方法采用QCSS-E對社區(qū)223名60歲及以上的老年人進行MCI篩查,同時采用金標準進行臨床診斷,根據(jù)ROC曲線評估QCST-E篩查MCI的整體性能及理想劃界分。結果223名老人中,確診為正常老人(NC)160名、MCI 42例、輕度癡呆21例,分別占71.75%、18.83%和9.42%；3組QCSS-E得分分別為(77.84±4.69)分、(70.31±3.94)分、(62.14±4.68)分,差異具有統(tǒng)計學意義(P<0.01)。當受試者文化程度分別為小學、初中及以上時,QCST-E篩查MCI/NC、輕度癡呆/MCI的最佳臨界分為72、67分和73、68分,以該臨界分采用QCSS-E篩查MCI/NC及輕度癡呆/MCI的靈敏度、特異度分別為88.1%、90%和90.48%、90.48%,篩查結果和臨床診斷一致性檢驗Kappa值分別為0.680、0.791。結論QCSS-E根據(jù)不同文化程度的分界值對老年人進行MCI篩查具有良好的靈敏度和特異度,其結果和臨床診斷一致性較高,適宜基層醫(yī)療單位在社區(qū)老年人中推廣應用。

輕度認知功能障礙； 快速認知篩查量表； 篩查； 分界值

Abstract：Objective：To investigate the cut off value of the quick cognitive screening scale for elderly (QCSS-E) in screening of elderly with mild cognitive impairment (MCI) in community.Method：223 people at the age of 60 years or older from living in community were assessed using QCSS-E,and clinical diagnosed according to the gold standard.Based on ROC analysis,we explored QCSS-E′s optimal cut off value for detecting MCI and mild dementia.Results：Among the 223 elderly,there were 160 with normal cognitive,42 cases of MCI and 21 cases of mild dementia，and the three groups showed significant difference on QCSS-E[(77.84±4.69),(70.31±3.94),(62.14±4.68),respectively,P<0.01].The cut off value was 72 points in judging MCI and NC,67 points in judging mild dementia and MCI in subjects with primary school education,and 73 points,68 points in subjects with junior high school and above culture.Based on the above cut off value,the sensitivity and specificity that screening MCI/NC and mild dementia/MCI was 88.1%,90% and 90.48%,90.48% respectively.The consistency between clinical diagnose results and screening results by QCSS-E was good.Conclusion：QCSS-E has good consistency with clinical diagnosis,and it is suitable for the grass-roots medical personnel to screen the cognitive impairment patient in the elder.

Keywords： mild cognitive impairment; quick cognitive screening scale; screening; cut off value

我國社區(qū)老年人群數(shù)量龐大,老年癡呆的患病率也逐年提升,在老年人群中及時篩出輕度認知功能障礙(MCI)病例并進行干預是降低癡呆患病率及延緩癡呆進展的有效手段。目前,可用于預警MCI的評估技術如：神經(jīng)電生理檢查、神經(jīng)影像學檢查、腦脊液生化指標等,大都操作復雜,不易在老年人群為主體的社區(qū)中推行。因此,神經(jīng)心理測驗仍是不可或缺、及早發(fā)現(xiàn)認知功能異常的有效方法。前期我們編制了老年人快速認知篩查量表(QCSS-E)用于早期認知功能障礙的篩查,取得了較好的效果[1]。結合我國老人半數(shù)以上為低教育程度的現(xiàn)狀,本研究將QCSS-E評分和臨床診斷結果進行比較,確定不同文化程度老年人QCSS-E的理想劃界分值,為進一步在基層推廣提供參考依據(jù)。

1 對象和方法

1.1 對象

采用方便抽樣方法,選取無錫市榮巷、揚名街道60歲及以上常住老年人為研究對象,入組標準：①年齡≥60歲,小學及以上文化；……