CAJ | 학술논문

目的：：分析影响简易精神状态量表( Mini-Mental State Examination, MMSE)筛查效度的因素,为建立MMSE得分的常规模型、修正并完善现行MMSE筛查标准提供依据。方法：从中国老年健康影响因素跟踪调查( Chinese Longitudinal Healthy Longevity Survey,CLHLS)队列中得到符合纳入标准的19117名正常老年人和137名痴呆患者的MMSE测试结果；用工作特征曲线下面积( area under the curve, AUC)及效度指标对比MMSE各类临界值的筛查效度；用多元线性回归比较正常和痴呆人群的MMSE得分的影响因素的差异；描述正常与痴呆老年人MMSE得分随年龄、性别的变化趋势及差别。结果：MMSE量表的AUC值≥0.75(P<0.05)；正常人群MMSE得分随年龄增长呈非线性下降(男：R2=0.924, P<0.05；女：R2=0.951, P<0.05)；随受教育程度增加呈非线性上升(男：R2=0.948, P<0.05；女：R2=0.859, P<0.05)；女性MMSE平均得分低于同龄男性,且下降速度更快(女性偏回归系数的95%置信区间与男性偏回归系数的95%置信区间不重叠)。不论男女,痴呆老年人的MMSE得分均低于正常老年人(男：Z分数差值：-1.573, P<0.05；女：Z分数差值：-1.222, P<0.05)；MMSE得分随年龄增加下降速度似乎比正常老年人更快(痴呆人群偏回归系数的95%置信区间包含正常人群偏回归系数的95%置信区间)。结论：CLHLS中的MMSE量表筛查效度不受文化程度影响,本研究针对影响MMSE筛查效度的可能因素及其影响程度的探讨得出,性别、年龄、视力和居住地是具有鉴别效度的因素,可作为MMSE量表的辅助工具筛查痴呆人群。
목적：：분석영향간역정신상태량표( Mini-Mental State Examination, MMSE)사사효도적인소,위건립MMSE득분적상규모형、수정병완선현행MMSE사사표준제공의거。방법：종중국노년건강영향인소근종조사( Chinese Longitudinal Healthy Longevity Survey,CLHLS)대렬중득도부합납입표준적19117명정상노년인화137명치태환자적MMSE측시결과；용공작특정곡선하면적( area under the curve, AUC)급효도지표대비MMSE각류림계치적사사효도；용다원선성회귀비교정상화치태인군적MMSE득분적영향인소적차이；묘술정상여치태노년인MMSE득분수년령、성별적변화추세급차별。결과：MMSE량표적AUC치≥0.75(P<0.05)；정상인군MMSE득분수년령증장정비선성하강(남：R2=0.924, P<0.05；녀：R2=0.951, P<0.05)；수수교육정도증가정비선성상승(남：R2=0.948, P<0.05；녀：R2=0.859, P<0.05)；녀성MMSE평균득분저우동령남성,차하강속도경쾌(녀성편회귀계수적95%치신구간여남성편회귀계수적95%치신구간불중첩)。불론남녀,치태노년인적MMSE득분균저우정상노년인(남：Z분수차치：-1.573, P<0.05；녀：Z분수차치：-1.222, P<0.05)；MMSE득분수년령증가하강속도사호비정상노년인경쾌(치태인군편회귀계수적95%치신구간포함정상인군편회귀계수적95%치신구간)。결론：CLHLS중적MMSE량표사사효도불수문화정도영향,본연구침대영향MMSE사사효도적가능인소급기영향정도적탐토득출,성별、년령、시력화거주지시구유감별효도적인소,가작위MMSE량표적보조공구사사치태인군。
Objective:To examine factors that may have impact on the Mini-Mental State Examination ( MMSE) screening validity, which could lead to further establishing the general model of the MMSE score in Chinese health elderly and to improve the screening accuracy of the existing MMSE reference. Methods:Based on the data of the Chinese Longitudinal Healthy Longevity Survey ( CLHLS ) , the MMSE scores of 19 117 normal elderly and 137 dementia patients who met the inclusion criteria were used for the analysis. The area under the curve ( AUC) and validity indexes were used to compare the screening accuracy of various criteria. Multiple linear regression was used to identify factors that had impact on the MMSE score for both the normal and dementia elderly. Descriptive analysis was performed for differences in the MMSE scores by age trends and gender between the normal and dementia elderly. Results:The AUC of MMSE was≥0 . 75 ( P<0 . 05 ) . The MMSE score of the normal elderly declined nonlinearly as the age grew older(male:R2 =0. 924, P<0. 05; female: R2 =0. 951, P<0. 05), and increased nonlinearly as the education level rose(male: R2 =0. 948, P <0. 05; female: R2 =0. 859, P<0. 05). The females had significantly lower MMSE scores than the males, with a faster decline trend with age than the males (95%CI of female partial regression coefficient was not overlapped with 95%CI of male partial regression coefficient) . The dementia elderly showed a much lower MMSE score ( male:difference of Z score:-1 . 573 , P<0 . 05;female:difference of Z score:-1 . 222 , P<0 . 05 ) and ten-ded to with a faster decline speed than that of the normal elderly (95%CI of dementia partial regression coefficient included 95%CI of normal partial regression coefficient) . Conclusion:The screening validity of MMSE in CLHLS is not affected by educational level. The analysis of factors that may impact on the MMSE screening validity are gender, age, vision and residence which with validity identification. These four fac-tors can be used as assist tool of MMSE in the screening of dementia to improve the screening accuracy.