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The utility of simple questions to evaluate cognitive impairment (本文)

伊達, 悠岳 慶應義塾大学

2020.09.07

概要

Objectives
As the population of patients with cognitive decline grows, physicians and caregivers need brief screening tools. Comprehensive neurocognitive batteries require special training and time for evaluation. We focused on accessibility and compared the diagnostic power of sev-eral easy questions.

Design
“Attended With” (AW) and “Head-Turning Sign” (HTS) factors and participants’ replies to fol- lowing questions were recorded: “Do you feel that you have more difficulties in your daily life than you used to?”, [no consciousness (C-) or consciousness+ (C+)], “Could you tell me about your daily pleasures or pastimes?” [no pleasure (P-) or pleasure + (P+)], “What are notable current/recent news/topics?” [no news (N-) or news+ (N+)].

Setting
This took place in our Memory Clinic between May 2016 and July 2019.

Participants
We enrolled 162 consecutive cases (44 cognitive normal (CN), 55 amnestic mild cognitive impairment (aMCI), and 48 Alzheimer’s disease (AD)).

Measurements
The sensitivity and specificity of each battery were calculated, and on account of those num- bers, the population attributable risk percent % (PAR%) of (AW and HTS+), (C- and P-), (C- and N-), (P- and N-) as analysis of combination of questions, respectively, were calculated.

Results
AW had high sensitivity, 87.4, 95.8% (CN vs aMCI + AD, CN + aMCI vs AD) but the sensitiv- ity of HTS was only 46.4, 57.7%, and HTS showed high specificity, 100.0, 71.8%. C- had high sensitivity, 80.6, 87.5%, whereas P- and N- had high specificity, both 83.9% in CN vs aMCI + AD, 88.1% and 75.9% in CN + aMCI vs AD, respectively. In combination analysis, the PAR% of (C- and N-) were as high as (AW and HTS+).

Conclusions
The combination of (C- and N-) is as powerful as (AW and HTS+) in screening AD. Our find- ings provide novel insights for screening utility of brief questions “Consciousness of Impairment” and “Recent News.”

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