简易认知量表和8条目痴呆筛查问卷在高龄老年人群早期认知功能下降筛查中的应用

doi:10.3877/cma.j.issn.2095-8757.2020.02.005

目的

探讨简易认知量表（Mini-Cog）和8条目痴呆筛查问卷（8-item ascertain dementia, AD8）对80岁以上老年人群早期轻度认知功能障碍（mild cognitive impairment, MCI）的筛查价值。

方法

选取杭州市某福利中心的2014年10月前已入住的908名高龄老年人进行Mini-Cog和AD8筛查，随访5年后对仍然健在且能配合完成检查者进行二次认知功能评估。计算Mini-Cog和AD8初筛的敏感度和特异度，并分析随访5年后AD8的ROC曲线结果以及两种量表的一致性检验结果。

结果

908例高龄老年人中523例确诊为痴呆（不计入后续筛查及随访调查），余385例筛查结果显示：Mini-Cog、AD8诊断MCI的敏感度分别为54.88%、57.32%，特异度分别为85.52%、86.43%。随访5年后仍健在且接受二次评估的老年人共167名，其中认知功能正常106例（54例出现认知功能下降），MCI 61例（36例出现认知功能进一步下降）。对于随访5年的认知功能正常者及MCI者，AD8诊断的AUC分别为0.572（95%CI=0.486-0.658）、0.723（95%CI=0.611-0.835），Mini-Cog和AD8（以得分>3为分界线）诊断的一致性Kappa值分别为0.105、0.018和0.225、0.524。

结论

AD8和Mini-Cog均具有一定的MCI评估效能，尤其适用于养老机构及社区高龄老年群体的认知功能筛查。

关键词: 简易认知功能筛查, 8条目痴呆筛查问卷, 轻度认知功能障碍, 认知功能下降, 养老机构

Objective

To investigate the value of Mini-Cog and 8-item ascertain dementia (AD8) in the diagnosis of mild cognitive impairment (MCI) and predicting cognitive deterioration in the 80 above years old population.

Methods

908 elderly individuals who had been admitted to Hangzhou welfare center before October 2014 were selected for Mini-Cog and AD8 screening. After 5 years of follow-up, the second cognitive function assessment was performed on those who were still alive and able to complete the examination. The sensitivity and specificity of Mini-Cog and AD8 preliminary screening were calculated, the ROC curve results of AD8 and the consistency test results of the two scales after 5 years of follow-up were analyzed.

Results

Among the 908 elderly individuals, 523 were diagnosed as dementia (not included in subsequent screening and follow-up).The remaining 385 individuals showed that the sensitivity of Mini-Cog and AD8 to diagnose MCI was 54.88% and 57.32%, and the specificity was 85.52% and 86.43%. A totally of 167 elderly people who were still alive and accepted the second assessment after five-years follow up, of which 106 cases had normal cognitive function (54 cases had cognitive function decline), and 61 cases of MCI (36 cases had further cognitive decline). For elderly people with normal cognitive function and MCI who were followed up for 5 years, the AUC for AD8 diagnosis was 0.572(95%CI=0.486-0.658), 0.723(95%CI=0.611-0.835), the diagnostic consistency Kappa values of Mini-Cog and AD8 (the cut-off value is over 3) were 0.105, 0.018 and 0.225, 0.524.

Conclusion

Both AD8 and Mini-Cog have a certain MCI evaluation performance, which is especially suitable for the cognitive function screening of elderly care institutions and communities.

Key words: Mini-Cog, 8-item ascertain dementia, Mild cognitive impairment, Cognitive deterioration, Nursing home

表1 Mini-Cog和AD8的筛查结果

量表	MCI老年人（例）		健康老年人（例）		敏感度	特异度	阳性预测值	阴性预测值	约登指数
量表	真阳性	假阴性	真阴性	假阳性	敏感度	特异度	阳性预测值	阴性预测值	约登指数
Mini-Cog	90	74	189	32	54.88%	85.52%	0.7377	0.7186	0.4040
AD8	94	70	191	30	57.32%	86.43%	0.7580	0.7318	0.4375

表1 Mini-Cog和AD8的筛查结果

量表	MCI老年人（例）		健康老年人（例）		敏感度	特异度	阳性预测值	阴性预测值	约登指数
量表	真阳性	假阴性	真阴性	假阳性	敏感度	特异度	阳性预测值	阴性预测值	约登指数
Mini-Cog	90	74	189	32	54.88%	85.52%	0.7377	0.7186	0.4040
AD8	94	70	191	30	57.32%	86.43%	0.7580	0.7318	0.4375

表2 167例随访者首次及二次筛查情况（例）

结果	首次筛查		二次筛查
结果	Mini-Cog	AD8	Mini-Cog	AD8
阳性	47	40	114	98
阴性	120	127	53	69

表2 167例随访者首次及二次筛查情况（例）

结果	首次筛查		二次筛查
结果	Mini-Cog	AD8	Mini-Cog	AD8
阳性	47	40	114	98
阴性	120	127	53	69

图1 8条目痴呆筛查量表对随访5年的认知功能正常者及轻度认知功能障碍者的预测分析

表3 106例认知功能正常者AD8及Mini-Cog筛查的一致性分析（例）

认知功能变化	AD8（得分>3）		Mini-Cog
认知功能变化	-	+	-	+
认知功能稳定	51	0	49	3
认知功能恶化	53	2	45	9

表3 106例认知功能正常者AD8及Mini-Cog筛查的一致性分析（例）

认知功能变化	AD8（得分>3）		Mini-Cog
认知功能变化	-	+	-	+
认知功能稳定	51	0	49	3
认知功能恶化	53	2	45	9

表4 61例MCI者AD8及Mini-Cog筛查的一致性分析（例）

认知功能变化	AD8（得分>1）		Mini-Cog
认知功能变化	-	+	-	+
认知功能稳定	26	7	14	11
认知功能恶化	7	21	12	24

表4 61例MCI者AD8及Mini-Cog筛查的一致性分析（例）

认知功能变化	AD8（得分>1）		Mini-Cog
认知功能变化	-	+	-	+
认知功能稳定	26	7	14	11
认知功能恶化	7	21	12	24

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Application of Mini-Cog and AD8 in early cognitive status evaluation and predicting cognitive deterioration of aged population

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Application of Mini-Cog and AD8 in early cognitive status evaluation and predicting cognitive deterioration of aged population