篩檢方法

更新日期:2016/9/8

早期偵測失智症

多數的失智症患者並未被他們的家庭醫師所發現,長期的追蹤研究也發現在一般的健康照護系統缺乏早期診斷失智症的能力,因此有輕度失智症的患者中大於90%會被低估,即時在中度或重度失智症也有70%被低估的機會。然而早期的失智症可藉由藥物達到有效的控制23-25。而家庭成員往往沒有注意到長者有認知能力衰退的情況,再者許多長者單獨居住並與親屬少有接觸,更不容易被發現。此已成為公共衛生上一個重大的議題。

神經心理學在失智症的測量方法
認知測試:簡短智能測試(Mini-Mental Status Examination, MMSE)
簡短智能測試應用在認知受損(cognitive impairment)的篩檢上已行之有年。美國健康照護與研究組織對1994年後的研究進行統合分析的結果支持採用簡短智能測試於篩檢認知受損。26 AHCPR採用分數1.78作為標準以區分失智症的標準,此標準具有84%的敏感度與75%的特異度。MMSE的準確度取決於測試者的年紀與教育水準。

AD8問卷
AD8問卷是由美國聖路易州華盛頓大學所研發之問卷,採用8個問題來篩檢失智症,AD8對於由報告者(informant)陳述病人的認知行為改變的的早期症狀測試相當有效。30, 31 AD8 測試主觀在行為上、方位、判斷與功能等認知能力,其分數由0到8分。如由經訓練過後之報告者(informant)進行評測的話,可以偵測到相當早期的認知功能變化31。AD8評斷失智症病人的切點為分數2分以上,敏感度為68%~95.9%,特異度則由78.1%~90%。31-33

偵測失智症的準確度與可靠度(Accuracy and reliability of early detection instruments in dementia)
臨床工作者通常將篩檢失智症的方法區分為認知測試(cognitive tests)與功能性評估(functional assessment)。多數研究的樣本並不夠大,且接受測試的病人相當歧異,使得對於篩檢效果的整體評估相當困難。最佳的認知功能測試的工具為簡短知能測試(MMSE),其從初級照護中心採用標準的診斷工具(如DSM-IV)當成黃金標準進行比較,依據MMSE的切點不同,MMSE的敏感度約為71%~92%,特異度為56%~96%。28, 34 當族群中失智症的盛行率為10%時,陽性預測值為15%~72%。35 而MMSE的缺點在於其準確性取決於病患的年齡、教育程度、種族等因素。其他的篩檢工具如Short Portable Mental Status Questionnaire, Clock Drawing Test, Modified MMSE, Mini-Cog, Hopkins Verbal Learning Test, and the 7-minute screen 也都可用於失智症的篩檢上,但臨床上缺乏使用這些工作在初級照護中心的資料。
此外有些由報告者(informant)對於病人功能性評估的測試如Functional Activities Questionnaire (FAQ), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), 與the Instrumental Activities of Daily Living (IADL) Questionnaire也有被研究其準確度. 36 FAQ 的敏感度與特異度約在90%左右。
由報告者評估病人的失智行為有許多優點,如可適用於不同特性的病人、操作容易、可長期性的紀錄與評估,也可用在不同種族身上。但主要的限制在於並非所有病人都有照護者(caregivers)來協助評估,並且部分功能(如認知)並沒有被評估。更重要的是,較少研究探討關於這部分應用在初級照護的準確度。
而使用基因突變檢測作為阿茲海默症的篩檢工具也被發現十分有用。然而並沒有大規模族群的研究資料,因此其效益與損害目前並無法確定,此外與倫理相關的問題也是需要被解決的。

 

 

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