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VALIDACIJA KRATKEGA PREIZKUSA SPOZNAVNIH SPOSOBNOSTI
Avtor: Martin Rakuša
Mentor: prof. dr. David B. Vodušek
Somentor: asist. mag. Aleš Kogoj
IZHODIŠCE: S staranjem populacije se pogosteje pojavlja demenca. Kot orodje za podkrepitev suma na demenco so razvili mnoge psihološke teste. Eden najbolj uporabljanih je Mini - Mental State Exam (MMSE), ki je pri nas prirejen kot Kratek preizkus spoznavnih sposobnosti (KPSS). NAMEN: Z nalogo smo želeli validirati rezultate KPSS za slovensko populacijo in tako omogociti uporabo KPSS v vsakdanji klinicni praksi. HIPOTEZA: Predvidevamo, da je rezultat KPSS pri slovenskih bolnikih z demenco primerljiv z rezultatom drugih narodov, pri katerih so opravili podobne raziskave z MMSE. METODE: Bolnike smo izbrali na podlagi klinicne ocene specialista psihiatra. Testirali smo jih s priredbo KPSS iz leta 2000, za katere imamo normativne vrednosti. Celotno populacijo (CP) smo razdelili v tri skupine glede na klinicno oceno psihiatra: zacetni, srednji in pozni stadij demence. Za vsako skupino smo izracunali mediano, kumulacijski faktor in odstotek kumulacijskega faktorja. Upoštevajoc rezultate dobljene pri standardizaciji KPSS in naše rezultate, smo izracunali senzibilnost (SE), specificnost (SP), pozitivno napovedno vrednost (PNV) in negativno napovedno vrednost (NNV) za KPSS pri naslednjih razmejitvenih vrednostih: 27/26, 26/25, 25/24 in 24/23 tockah. Pri izbrani skupini starostnikov, starejših od vkljucno 74 let (IP), smo ponovno dolocili posamezne skupine ter izracunali SE, SP, PNV in NNV pri istih mejnih vrednostih kot pri celotnem vzorcu. Za primerjavo SE, SP, PNV in NNV med CP in IP pri posameznih vrednostih KPSS smo uporabili Fisherjev eksaktni test. REZULTATI: Razpon rezultatov celotnega vzorca 69 bolnikov, starih od 45 do 91 let, je bil od 5 do 30 tock. Mediane vrednosti pri CP in IP so bile enake; pri zdravih prostovoljcih 27, v skupini z zacetnim stadijem demence 23, v skupini s srednjim stadijem demence 16 in v skupini s poznim stadijem demence 10. Pri CP sta SE in NNV z dvigovanjem meje narašcali (od 0,60 in 0,93 pri 24/23 tock do 0,93 in 0,98 pri 27/26 tock), SP in PNV pa padali (od 0,93 in 0,58 pri 24/23 tock do 0,64 in 0,30 pri 27/26 tock). Podobne rezultate smo dobili za IP; od SE 0,55, SP 0,82, PNV 0,61 ter NNV 0,78 pri 24/23 tock do SE 0,90, SP 0,62, PNV 0,55 in NNV 0,92 pri 27/26 tock. Statisticno pomembne razlike (p < 0,05) med CP in IP smo dobili za SP pri vrednostih 26/25 in 24/23 tock ter za PNV pri 27/26, 26/25 tock in NNV pri 26/25, 25/24 in 24/23 tock. ZAKLJUCKI: Glede na rezultate naše raziskave je KPSS primeren za klinicno uporabo v slovenskem prostoru. Uporabljamo ga lahko kot pripomocek za podkrepitev suma na demenco. Menimo, da KPSS pri razmejitveni vrednosti 27/26 tock, kot jo predlagata avtorja MMSE, bolj ustreza raziskovalnemu delu. Za klinicno delo lahko test uporabimo za podkrepitev suma pri visoko izobraženih preiskovancih. Za splošno populacijo predlagamo razmejitveno vrednost 26/25 tock, doseženih pri KPSS, pri kateri sta SE 0,83 in SP 0,74, kar predstavlja primerno razmerje med SE in SP za klinicno uporabo. Pri interpretaciji rezultata KPSS za opredelitev stopnje demence predlagamo naslednje intervale: 30 do 26 tock - normalne kognitivne sposobnosti, 25 do 20 tock - blag upad kognitivnih sposobnosti, 19 do 13 tock - zmeren upad kognitivnih sposobnosti in 12 do 0 tock - hud upad kognitivnih sposobnosti. Intervali se nekoliko razlikujejo od intervalov, ki jih predlagajo avtorji testa za ameriško populacijo. Naše hipoteze nismo v celoti potrdili. Pri standardni razmejitveni vrednosti rezultata KPSS (24/23 tock), ki jo uporabljajo po svetu, smo dobili statisticno nižjo SE ob sicer statisticno enaki SP. Razmejitveni vrednosti in intervali so za CP in IP starejših od vkljucno 74 let enaki.
[Abstract / English version]
VALIDACIJA KRATKEGA PREIZKUSA SPOZNAVNIH SPOSOBNOSTI
Author: Martin Rakuša
Mentor: prof. dr. David B. Vodušek
Co-mentor: asist. mag. Aleš Kogoj
BACKGROUND: With population ageing dementia is appearing more frequently. To strengthen the suspicion for dementia, many psychological tests were developed. The most used is Mini - Mental State Exam (MMSE), which is adopted for use in Slovenia as "Kratek preizkus spoznavnih sposobnosti" (KPSS). AIM: Our study aimed to validate the results of KPSS for the Slovenian population and to make the use of KPSS possible in clinical practice. HYPOTHESIS: We assumed that the results of KPSS testing in Slovenian demented patients are comparable with results of similar studies made in other nations with MMSE. METHODS: Patients were chosen based on psychiatric clinical evaluation and were tested with the KPSS version of 2000. The whole population (WP) was divided into three groups based on psychiatric clinical evaluation. For each group the median score, cumulative factor and cumulative percent were calculated. Considering the results of standardization of KPSS and our results, sensibility (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were calculated at cut-offs: 27/26, 26/25, 25/24 and 24/23 points. For the selected group of senior citizens 74 or older (IP), we also calculated SE, SP, PPV and NPV at the same cut-offs as for the WP. For comparison of SE, SP, PPV and NPV between WP and IP Fisher's Exact Test were used. RESULTS: Results of KPSS for WP (69 patients, 45-91 years old), range between 5 and 30 points. Median score for WP and IP were equal; healthy volunteers 27, group of mild dementia 23, group of moderate dementia 16 and group of severe dementia 10. The SE and NPV for WP increased with rising cut-off score (from 0.60 and 0.93 at 24/23 points to 0.93 and 0.98 at 27/26 points), SP and PPV decreased (from 0.93 and 0.58 at 24/23 points to 0.64 and 0.30 at 27/26 points). Results for IP were similar; from SE 0.55, SP 0.82, PPV 0.61 and NPV 0.78 at 24/23 points till SE 0.90, SP 0.62, PPV 0.55 and NPV 0.92 at 27/26 points. Statistically significant differences between WP and IP (p < 0.05) were observed for SP at cut-off score 25/26 and 24/23 points, for PPV at 27/26, 26/25 points and NPV at 26/25, 25/24 in 24/23 points. CONCLUSIONS: We confirmed that KPSS is adequate for clinical use in Slovenia. We can use it as a tool to strengthen clinical suspicion for dementia. We suggest that the cut-off score 27/26 points (suggested by authors of MMSE) is more suitable for research work. For clinical work it is adequate for educated patients. For general population a cut-off score 26/25 points was suggested. At this value SE is 0.83 and SP is 0.74 which is a good compromise for clinical work. To staging of dementia, we suggest following intervals: 30 do 26 points normal cognitive function, 25 to 20 points mild cognitive impairment, 19 to 13 points moderate cognitive impairment and 12 do 0 points severe cognitive impairment. There is a small difference between our and American intervals (suggested by MMSE authors). Our hypothesis was not fully confirmed. At the standard cut-off score 24/23 used globally, we got lower SE and statistically equal SP. The suggested cut-off score and intervals are the same for WP and IP.