简单、客观的工具可以帮助你更好地检测认知障碍的早期迹象5,6 随着新的治疗方法更早地集中在疾病的连续性中，尽早评估认知障碍比以往任何时候都更加重要.3为了对阿尔茨海默病(AD)进行早期干预，应在症状出现时立即确定认知障碍的原因。1，2
你知道吗?
Medicare年度健康访问需要患者评估以评估认知障碍，AAN指南建议使用简短、经过验证的认知评估工具，并从患者和信息者那里获取认知历史，以确定任何担忧.4
了解有关认知评估服务的医疗保险覆盖范围的详细信息
简单的客观工具，如Mini-Cog©，已被证明对轻度认知障碍的敏感性是9倍，对轻度AD痴呆的敏感性是2倍.5,6
AAN=美国神经病学学会；MCI=轻度认知障碍；MI=记忆障碍筛查。
*与主观医生评估相比；在一项评估迷你Cog©与仅评估医生评估的研究中。其他只需10分钟或更少时间即可执行的客观评估工具的例子包括管理信息系统和GPCOG。
即使在转诊到专家之前，非专家也可以借助Mini-Cog、GPCOG、MoCA或SLUMS等认知评估来启动认知损害或痴呆症的评估.5
以下测试仅具有代表性；有替代工具可用，可由临床医生自行决定是否使用。
Mini-Cog©5,7,8
摘要
综合3个单词的回忆和绘制时钟；在初级保健环境中以多种语言验证；已发现在检测轻度认知障碍方面比MMSE更敏感
持续时间
2-4 min*
GPCOG5,7
摘要
患者部分评估定向、意识和记忆方面的情况。信息科比较病人目前和以前的功能
持续时长
2 to 5 mins (patient);
1 to 3 mins (informant)*
MoCA2,9
摘要
1页30分测试；通过13个任务评估8个认知域；可使用30种语言；已被发现在评估记忆、视觉空间、执行能力、语言功能以及对时间和地点的定向方面比MMSE更敏感
持续时长
10 min
SLUMS10
摘要
30分，11项量表，包括各种认知评估；任务评估注意力、数字计算、立即和延迟回忆、动物命名、数字广度、钟表绘制、图形识别/大小区分以及立即回忆段落中的事实
持续时间
7 min
如果检测到认知障碍，重要的是通过全面的诊断检查来评估原因，或者将患者转介给专科医生2
在初级保健提供者转诊至痴呆症专家后，患者可能会接受生物标记物测试以及进一步的认知、功能和行为测试，以确认诊断为AD.2
MMSE=Mini-Mental State Examination; MoCA=Montreal Cognitive Assessment; SLUMS=Saint Louis University Mental Status.
*Different times reported. Times may vary.5,8,11
†Sensitivity: ability of the test to correctly identify those patients with disease.
‡Specificity: ability of the test to correctly identify those patients without disease.
§A cutoff point of <3 on the Mini-Cog© has been validated for classifying subjects as “probably impaired,” but many individuals with clinically meaningful cognitive impairment will score higher. When greater sensitivity is desired, a cutoff point of ≤3 is recommended, as it may indicate a need for further evaluation of cognitive status.
References:
- Balasa M, Gelpi E, Antonell A, et al. Clinical features and APOE genotype of pathologically proven early-onset Alzheimer disease. Neurology. 2011;76(20):1720-1725.
- Porsteinsson AP, Isaacson RS, Knox S, et al. Diagnosis of early Alzheimer’s disease: clinical practice in 2021. J Prev Alzheimers Dis. 2021;8:371-386.
- Aisen PS, Cummings J, Jack CR Jr, et al. On the path to 2025: understanding the Alzheimer's disease continuum. Alzheimers Res Ther. 2017;9(1):60.
- Petersen RC, Lopez O, Armstrong MJ, et al. Practice guideline update summary: mild cognitive impairment: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90(3):126-135.
- Cordell CB, Borson S, Boustani M, et al. Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimers Dement. 2013;9(2):141-150.
- Borson S, Scanlan JM, Watanabe J, et al. Improving identification of cognitive impairment in primary care. Int J Geriatr Psychiatry. 2006;21(4):349-355.
- Kansagara D, Freeman M. A systematic evidence review of the signs and symptoms of dementia and brief cognitive tests available in VA. Evidence-Based Synthesis Program. 2010. VA-ESP Project #05-225.
- Li X, Dai J, Zhao S, et al. Comparison of the value of Mini-Cog and MMSE screening in the rapid identification of Chinese outpatients with mild cognitive impairment. Medicine (Baltimore). 2018;97(22):e10966.
- Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699.
- Tariq SH, Tumosa N, Chibnall JT, Perry MH, Morley JE. Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder—a pilot study. Am J Geriatr Psychiatry. 2006;14(11):900-910.
- Hort J, O'Brien JT, Gainotti G, et al. EFNS guidelines for the diagnosis and management of Alzheimer’s disease. Eur J Neurol. 2010;1 7(10):1236-1248.
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