可以偵測早期阿茲海默氏症的新檢測


  June 15, 2009 — 研究者發展一種新的認知檢測方法,可以迅速使用於檢測10種技能,報告指出可以偵測93%的阿茲海默氏症案例。線上發表於6月10日的BMJ,研究者認為這個新的自助檢測是個有力且有效的篩檢工具。
  
  主要研究者、英國劍橋Addenbrooke醫院的Jeremy Brown醫師解釋,如果病患於等候區在接待人員的監督下完成這項檢測,醫師可以在2分鐘內進行評分與分析。如果諮詢時觀察病患的填答,也有助於診斷。
  
  Brown醫師是一名神經科專家,但是他的團隊發現,藉由10分鐘的訓練以及一張評分表,記憶門診的無經驗護士也可以進行評估,準確度和專家一樣。
  
  同樣任職於Addenbrooke醫院的Claire Nicholl醫師在編輯評論中指出,該研究顯示,新的檢測方式比這類病患使用的迷你心智狀態檢查更有敏感性(93% vs 52%)。
  
  【比迷你心智狀態檢查更有敏感性】
  Nicholl醫師指出,專家使用的量表比較長,這個新方法並非為了取代它們。
  
  在這個橫斷面研究中,評估的研究對象來自三家醫院、含一個記憶門診。總共有540名控制組參與者以及139名失智或健忘型輕微認知缺損患者。
  
  診斷為早期阿茲海默氏症的臨界點是小於等於42/50,該檢測有不錯的敏感度(93%)與專一度(86%),和「評分者間信度」。
  
  此項檢測需參與者在一張雙面卡片上填寫10個問題的答案,要求對各種領域的事務進行評估,包括病患的語意知識、計算與說出物體名稱的能力、回憶能力。
  
  Nicholl醫師寫道,如果這個記憶測驗要更廣為採用,必須在不同族群進行確效檢驗。屆時,最重要的訊息是,醫師可以使用一套適合其診療對象的檢測,用它來篩檢或適當發現案例,發展使用經驗可以改善早期失智病患的辨識。
  
  【必須確效】
  Nicholl醫師指出,作者並未指出研究對象的種族,但是當地人口主要是白人,檢測問題上的一些項目可能有文化偏差。
  
  阿茲海默氏症協會照護品質計畫主任Elizabeth Gould對Medscape Neurology提出類似的回應;她在最近的訪問中表示,她強調將文化差異儘可能納入考量的重要性,她也強調早期偵測的重要性。
  
  醫師可在www.tymtest.com這個網站上下載這個新的檢測方式、評分表與進一步的介紹。
  
  研究者與編輯都宣告沒有相關財務關係。
  

New Test May Detect Early Alzheimer's Disease

By Allison Gandey
Medscape Medical News

June 15, 2009 — Researchers have developed a new cognitive test that is quick to use, examines 10 skills, and reportedly detects 93% of cases of Alzheimer's disease. Published online June 10 in BMJ, investigators suggest the new self-administered test is a powerful and valid screening tool.

"If a patient completes the test while in the waiting area supervised by the receptionist, it can be scored and analyzed by the doctor in 2 minutes," explain the researchers, led by Jeremy Brown, MD, from Addenbrooke's Hospital, in Cambridge, the United Kingdom. "If there is time during the consultation to observe the patients filling in the test, this can also be a useful aid to diagnosis."

Dr. Brown is a neurologist, but his team found that with 10 minutes' training and a scoring sheet, a nurse without experience working in memory clinics was able to evaluate the test as accurately as a specialist.

In an accompanying editorial, Claire Nicholl, MD, also at Addenbrooke’s Hospital, pointed out that the study showed that the new test was more sensitive than the Mini-Mental State Examination in this patient population (93% vs 52%).

More Sensitive Than Mini-Mental State Examination

"Longer scales are used in specialist settings," Dr. Nicholl notes, "but the test is not designed to replace these."

In this cross-sectional study, investigators evaluated subjects from 3 hospitals including a memory clinic. They looked at 540 control participants and 139 patients with dementia or amnesic mild cognitive impairment.

In the diagnosis of early Alzheimer's disease with a cut-off point of <42/50, the test had good sensitivity (93%), specificity (86%), and interrater reliability.

The test requires participants to write 10 answers on a double-sided card. The requested tasks evaluate a range of areas, including the patient's semantic knowledge, ability to calculate and name objects, and recall.

"If the memory test is to be adopted more widely, it must be validated in a range of settings and different populations," Dr. Nicholl writes. "Until then, the most important message is that clinicians should identify a test that suits their clinical setting, use it to screen or case find as appropriate, and develop experience in its use to improve the identification of patients with early dementia."

Must Be Validated

Dr. Nicholl points out that the authors do not comment on the ethnicity of the study participants, but the local population is mainly white and some of the items on the test likely show some cultural bias.

Elizabeth Gould, director of quality care programs at the Alzheimer's Association, echoed similar concerns to Medscape Neurology. Speaking during a recent interview, she emphasized the importance of taking cultural differences into account as much as possible. She also stressed the importance of early detection.

A Web site is being developed for clinicians to download the new test, scoring sheets, and further instructions. It will be available at www.tymtest.com.

The researchers and editorialist have disclosed no relevant financial relationships.

BMJ. 2009;338:b2030, b1176.

    
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