A preliminary study of the Six-Item Screener in detecting cognitive impairment

Abstract

Objective

The present retrospective study was to explore the clinical value of Six-Item Screener (SIS), which is constituted by 6 items from mini-mental status examination (MMSE), to identify cognitive impairment.

Methods

A total number of 1976 patients aged over 50 years, from the Memory Clinic of Huashan Hospital were employed in a battery of neuropsychological tests including MMSE. Subjects with severe conditions, unable to cooperate, or having been previously enrolled, were excluded from this study. The employed subjects were divided into 3 groups: subjective memory complaints (SMCs) (475 cases), patients with mild cognitive impairment (MCI) (440 cases), and patients with Alzheimer’s disease (AD) (1061 cases, including 555 mild, 339 moderate, and 167 severe). A total score of MMSE and a score of SIS composed of date, month, year, three-word delayed recall from MMSE were calculated. Data were analyzed based on educational background.

Results

The cut-off of SIS score was ⩽ 2 for illiterate, ⩽ 3 for elementary, and ⩽ 4 for junior high school or above. The sensitivity and specificity of SIS for detecting mild AD were 88.5% and 78.3%, respectively, with an overall accuracy of 83.8%, while for detecting MCI, the sensitivity and specificity were 34.3% and 90.1%, respectively, with an overall accuracy of 63.2%.

Conclusion

SIS is an effective and reliable instrument for dementia detection in outpatient department. However, it has limited value for MCI identification.

摘要

目的

评价简易精神状态检查表(mini-mental status examination, MMSE)中时间定向与词语延迟回忆得分组成的六分法(Six-Item Screener, SIS)在识别认知损害中的价值。

方法

在华山医院神经内科记忆障碍门诊部的1976例就诊者中, 根据轻度认知损害(mild cognitive impairment, MCI)和痴呆的诊断标准分为认知功能正常的主观抱怨者(475 例)、 MCI 患者(440 例)和阿尔茨海默病(Alzheimer’s disease, AD)患者(共1061 例, 其中轻度AD 555 例、 中度AD 339 例、 重度AD 167 例)。 所有就诊者完成包括MMSE 在内的全套神经心理测验。 分析MMSE 中年份、 月份、 日期以及三个词语延迟回忆(简称三词)的总得分(共6分)在区分不同程度的认知障碍中的作用。

结果

SIS总分以文 盲组⩽ 2 分、 小学组⩽ 3 分、 初中及以上组⩽ 4 分作为划界分, 其识别轻度AD的敏感性为88.5%、 特异性为78.3%、 准确性为83.8%, 识别MCI 的敏感性为34.3%、 特异性为90.1%、 准确性为63.2%。

结论

六分法对于门急诊快速识别痴呆具有一定的价值, 但不适用于识别MCI。