Cost-benefit and discriminant validity of a stepwise dementia case-finding approach in an Asian older adult community  

作　　者：Ting Pang Binte Xia Xuhao Zhao Yaping Zhang Cheuk Ni Kan Saima Hilal Christopher Chen Narayanaswamy Venketasubramanian Tien Yin Wong Ching-YuCheng Changzheng Yuan Xin Xu 

机构地区：[1]School of Public Health,the 2nd Affiliated Hospital of School of Medicine,Zhejiang University,Hangzhou,Zhejiang,China [2]Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province,Hangzhou,Zhejiang,China [3]Memory,Ageing and Cognition Centre,Department of Pharmacology,Yong Loo Lin School of Medicine,National University of Singapore,Singapore [4]Raffles Neuroscience Centre,Raffles Hospital,Singapore [5]Singapore Eye Research Institute,Singapore National Eye Centre,Singapore [6]Tsinghua Medicine,Tsinghua University,Beijing,China [7]School of Clinical Medicine,Beijing Tsinghua Changgang Hospital,Beijing,China

出　　处：《General Psychiatry》2023年第5期393-401,共9页综合精神医学（英文）

基　　金：funded by National Natural Science Foundation of China(72274170);Interdisciplinary Research Project of the Zhejiang University(519600*17222022201);National Medical Research Council(R-184-006-184-511);Dean’s Fund Research of the Zhejiang University(188021-171257702/004/010).

摘　　要：Background Case-finding is a recommended approach for dementia early detection in the community.Aims To investigate the discriminant validity and cost-effectiveness of a stepwise dementia case-finding approach in a Singaporean older adult community.Methods The two-phase study was conducted in the community from 2009 to 2015 in Singapore.A total of 3780 participants(age≥60 years)completed phase I(a brief cognitive screening);918 completed phase II and were included in the final analysis.In phase I,all participants were administered the Abbreviated Mental Test(AMT)and the Progressive Forgetfulness Question(PFQ).Those who screened positive on either test were invited to phase II,whereby the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)and a formal neuropsychological battery were administered,followed by the research diagnosis of no cognitive impairment,cognitive impairment no dementia(CIND)-Mild(≤2 impaired cognitive domains),CIND-Moderate(>2 impaired domains)or dementia.Receiver operating characteristic curve analyses were conducted for the different cognitive instruments.All discriminant indices were calculated,including sensitivity,specificity,positive and negative predictive values(NPV)and accuracy.Cost-effectiveness analysis was conducted by estimating the amount of screening time needed and the number of older adults requiring re-evaluation in two case-finding scenarios,ie,with or without preselection by the PFQ.Results The stepwise case-finding approach(preselection by the PFQ,then MMSE or MoCA or AMT)showed an excellent NPV(>99%)and accuracy(>86%)for excluding dementia-free cases.Without preselection by the PFQ,screening time for the three cognitive tools were 317.5,317.5 and 254 hours,with 159,302 and 175 screen-positive older adults involved in further evaluation.By adopting the stepwise case-finding approach,total screening time were 156.5,156.5 and 126.2 hours,which decreased by 50.7%,50.7% and 50.3% as compared with those without preselection.Furthermore,after preselection,

关 键 词：IMPAIRED finding STEPWISE 

分 类 号：R749[医药卫生—神经病学与精神病学]