自助式认知评估测验对老年轻度认知功能障碍诊断效能的初步研究

A preliminary study on diagnostic performance of self-help cognitive assessment test for mild cognitive impairment in the elderly

  • 摘要:
    背景 中国老龄化问题严峻,轻度认知功能障碍(mild cognitive impairment,MCI)患者向痴呆转化风险高,现有的MCI筛查方法成本高、依赖专业人员,难以满足大规模筛查需求。目的 分析自助式认知评估测验(self-help cognitive assessment test,SCAT)对老年MCI的筛查效能,为其应用于大规模早期筛查提供工具支持。方法 纳入2024年3 — 10月北京市某三甲医院及社区年龄60 ~ 80岁的认知正常和MCI老年人,由神经科医师依据临床标准确诊,评估SCAT、蒙特利尔认知评估量表北京版(the Montreal Cognitive Assessment Beijing version,MoCA-BJ),应用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析SCAT的诊断效能,并与MoCA-BJ进行相关性比较。结果 本研究共纳入205例认知功能正常和65例MCI老年人,与MCI组相比,认知正常组高学历比例高,初中学历者比例低(χ2 =29.224,P<0.001),其他一般资料均没有显著性差异(P>0.05)。MCI组SCAT总分低于认知正常组(37.89±7.81 vs 50.01±10.00,P<0.001,Cohen's d =1.27),差异具有统计学意义。SCAT区分认知功能正常和MCI老人的最佳截断值为43分,此时ROC曲线下面积为0.833(95% CI:0.776 ~ 0.891),其诊断MCI的灵敏度0.780,特异度0.757。SCAT总分与MoCA-BJ(r=0.482,P<0.001)呈中等相关。结论 SCAT筛查老年MCI具有较好的诊断效能,且支持自助操作、能在移动端应用,更加便捷实用。

     

    Abstract:
    Background The aging population in China faces a critical challenge due to the high risk of progression from mild cognitive impairment (MCI) to dementia. Existing MCI screening methods are limited by high costs or reliance on specialized professionals, hindering large-scale implementation. Objective To investigate the diagnostic efficacy of the self-help cognitive assessment test (SCAT) for MCI screening in older adults and provide a practical tool for early identification in large-scale settings. Methods The study recruited cognitively normal and MCI elderly individuals aged 60-80 years from a tertiary hospital and communities in Beijing from March to October in 2024. All participants were clinically diagnosed by neurologists using standardized criteria. SCAT, the Montreal Cognitive Assessment Beijing version (MoCA-BJ) were administered. Receiver operating characteristic (ROC) curve analysis was performed to evaluate SCAT's diagnostic performance (sensitivity, specificity). Correlations between SCAT and MoCA-BJ were assessed. Results A total of 205 cognitively normal elderly individuals and 65 elderly individuals with MCI were included in this study. Compared with the MCI group, the cognitively normal group had a higher proportion of individuals with high - level education and a lower proportion of those with junior high school education (χ² = 29.224, P<0.001). There were no significant differences in other general data between the two groups (P>0.05).The SCAT total score in the MCI group was (37.89±7.81), which was significantly lower than that in the cognitively normal group (50.01±10.00) (P<0.001, Cohen's d =1.269). The optimal cutoff score of SCAT for screening MCI from the elderly individuals with normal cognitive function was 43 points. At this cutoff, the area under the ROC curve (AUC) was 0.833 (95% CI: 0.776 - 0.891), with a sensitivity of 0.780 and specificity of 0.757 for diagnosing MCI. SCAT total scores showed moderate correlations with MoCA-BJ (r =0.482, P<0.001). Conclusion SCAT demonstrates acceptable diagnostic efficacy in MCI screening for MCI among older adults, with additional advantages of self-administration and mobile application convenience, making it suitable for large-scale screening initiatives.

     

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