介绍最近介绍的阿尔茨海默病的疾病改善治疗方法已经重新振兴了早期痴呆检测的原因。认知“纸与铅笔”测试代表了临床评估的基石,因为它们很便宜,易于执行,并且不需要脑成像或生物测试。认知测试的持续时间差异很大,复杂性,社会语言偏见,探索认知领域,以及它们检测认知障碍(CI)的特异性和敏感性。因此,在生态学上有效的头对头比较对于基于证据的痴呆筛查似乎至关重要.方法我们比较了五个测试:MoCA,ADAS,ACE-III,Eurotest,并对大量老年人样本进行光测(N=456,77.9±8年,71%的女性)。通过将每个测试的结果与其余测试中的大多数结果进行对比,以一种新颖的方式估计了它们的特异性和敏感性(比较特异性和敏感性计算-CSSC)。这消除了对先验金标准的需要,例如痴呆/MCI/对照的临床上明确的样品。我们认为CSSC可以对临床表现进行更生态有效的估计,同时排除由不同的痴呆/MCI诊断标准引起的偏见。以及检测这些条件的熟练程度。结果行为测试特异性和敏感性之间存在明显的权衡。特异性最高的检测灵敏度最低,反之亦然。比较的特殊性和敏感性是,分别:光测(97%,47%),欧洲测试(94%,55%),ADAS(90%,68%),ACE-III(72%,77%),MoCA(55%,95%)。结论假设aCI患病率为10%,最短(〜3分钟)和最简单的仪器-光测,被证明具有最佳的整体性能(准确率92%,PPV66%,净现值94%)。
BACKGROUND: Recent introductions of disease-modifying treatments for Alzheimer\'s disease have re-invigorated the cause of early dementia detection. Cognitive \"paper and pencil\" tests represent the bedrock of clinical assessment, because they are cheap, easy to perform, and do not require brain imaging or biological testing. Cognitive tests vary greatly in duration, complexity, sociolinguistic biases, probed cognitive domains, and their specificity and sensitivity of detecting cognitive impairment (CI). Consequently, an ecologically valid head-to-head comparison seems essential for evidence-based dementia screening.
METHODS: We compared five tests: Montreal cognitive assessment (MoCA), Alzheimer\'s disease assessment scale-cognitive subscale (ADAS), Addenbrooke\'s cognitive examination (ACE-III), euro-coin handling test (Eurotest), and image identification test (Phototest) on a large sample of seniors (N = 456, 77.9 ± 8 years, 71% females). Their specificity and sensitivity were estimated in a novel way by contrasting each test\'s outcome to the majority outcome across the remaining tests (comparative specificity and sensitivity calculation [CSSC]). This obviates the need for an a priori gold standard such as a clinically clear-cut sample of dementia/MCI/controls. We posit that the CSSC results in a more ecologically valid estimation of clinical performance while precluding biases resulting from different dementia/MCI diagnostic criteria and the proficiency in detecting these conditions.
RESULTS: There exists a stark trade-off between behavioral test specificity and sensitivity. The test with the highest specificity had the lowest sensitivity, and vice versa. The comparative specificities and sensitivities were, respectively: Phototest (97%, 47%), Eurotest (94%, 55%), ADAS (90%, 68%), ACE-III (72%, 77%), MoCA (55%, 95%).
CONCLUSIONS: Assuming a CI prevalence of 10%, the shortest (∼3 min) and the simplest instrument, the Phototest, was shown to have the best overall performance (accuracy 92%, PPV 66%, NPV 94%).