簡易智能量表(MMSE) 用於早期發現輕度知能障礙(MCI) 的失智 ...

The Mini‐Mental State Examination (MMSE) is the best‐known and the most often used short screening tool for providing an overall measure of ... 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CochraneDatabaseofSystematicReviewsReview-DiagnosticAbstractavailableinEnglishEspañol简体中文BackgroundDementiaisaprogressiveglobalcognitiveimpairmentsyndrome.In2010,morethan35millionpeopleworldwidewereestimatedtobelivingwithdementia.Somepeoplewithmildcognitiveimpairment(MCI)willprogresstodementiabutothersremainstableorrecoverfullfunction.ThereisgreatinterestinfindinggoodpredictorsofdementiainpeoplewithMCI.TheMini‐MentalStateExamination(MMSE)isthebest‐knownandthemostoftenusedshortscreeningtoolforprovidinganoverallmeasureofcognitiveimpairmentinclinical,researchandcommunitysettings.ObjectivesTodeterminetheaccuracyoftheMiniMentalStateExaminationfortheearlydetectionofdementiainpeoplewithmildcognitiveimpairmentSearchmethodsWesearchedALOIS(CochraneDementiaandCognitiveImprovementSpecializedRegisterofdiagnosticandinterventionstudies(inceptiontoMay2014);MEDLINE(OvidSP)(1946toMay2014);EMBASE(OvidSP)(1980toMay2014);BIOSIS(WebofScience)(inceptiontoMay2014);WebofScienceCoreCollection,includingtheConferenceProceedingsCitationIndex(ISIWebofScience)(inceptiontoMay2014);PsycINFO(OvidSP)(inceptiontoMay2014),andLILACS(BIREME)(1982toMay2014).Wealsosearchedspecializedsourcesofdiagnostictestaccuracystudiesandreviews,mostrecentlyinMay2014:MEDION(UniversitiesofMaastrichtandLeuven,www.mediondatabase.nl),DARE(DatabaseofAbstractsofReviewsofEffects,viatheCochraneLibrary),HTADatabase(HealthTechnologyAssessmentDatabase,viatheCochraneLibrary),andARIF(UniversityofBirmingham,UK,www.arif.bham.ac.uk).Nolanguageordaterestrictionswereappliedtotheelectronicsearchesandmethodologicalfilterswerenotusedasamethodtorestrictthesearchoverallsoastomaximizesensitivity.Wealsocheckedreferencelistsofrelevantstudiesandreviews,trackedcitationsinScopusandScienceCitationIndex,usedsearchesofknownrelevantstudiesinPubMedtotrackrelatedarticles,andcontactedresearchgroupsconductingworkonMMSEfordementiadiagnosistotrytolocatepossiblyrelevantbutunpublisheddata.SelectioncriteriaWeconsideredlongitudinalstudiesinwhichresultsoftheMMSEadministeredtoMCIparticipantsatbaselinewereobtainedandthereferencestandardwasobtainedbyfollow‐upovertime.WeincludedparticipantsrecruitedandclinicallyclassifiedasindividualswithMCIunderPetersenandrevisedPetersencriteria,Matthewscriteria,oraClinicalDementiaRating=0.5.Weusedacceptableandcommonlyusedreferencestandardsfordementiaingeneral,Alzheimer’sdementia,Lewybodydementia,vasculardementiaandfrontotemporaldementia.DatacollectionandanalysisWescreenedalltitlesgeneratedbytheelectronicdatabasesearches.Tworeviewauthorsindependentlyassessedtheabstractsofallpotentiallyrelevantstudies.Weassessedtheidentifiedfullpapersforeligibilityandextracteddatatocreatetwobytwotablesfordementiaingeneralandotherdementias.TwoauthorsindependentlyperformedqualityassessmentusingtheQUADAS‐2tool.Duetohighheterogeneityandscarcityofdata,wederivedestimatesofsensitivityatfixedvaluesofspecificityfromthemodelwefittedtoproducethesummaryreceiveroperatingcharacteristiccurve.MainresultsInthisreview,weincluded11heterogeneousstudieswithatotalnumberof1569MCIpatientsfollowedforconversiontodementia.FourstudiesassessedtheroleofbaselinescoresoftheMMSEinconversionfromMCItoall‐causedementiaandeightstudiesassessedthistestinconversionfromMCItoAlzheimer´sdiseasedementia.OnlyonestudyprovidedinformationabouttheMMSEandconversionfromMCItovasculardementia.ForconversionfromMCItodementiaingeneral,theaccuracyofbaselineMMSEscoresrangedfromsensitivitiesof23%to76%andspecificitiesfrom40%to94%.InrelationshiptoconversionfromMCItoAlzheimer’sdiseasedementia,theaccuracyofbaselineMMSEscoresrangedfromsensitivitiesof27%to89%andspecificitiesfrom32%to90%.OnlyonestudyprovidedinformationaboutconversionfromMCItovasculardementia,presentingasensitivityof36%andaspecificityof80%withanincidenceofvasculardementiaof6.2%.Althoughwehadplannedtoexplorepossiblesourcesofheterogeneity,thiswasnotundertakenduetothescarcityofstudiesincludedinouranalysis.Authors'conclusionsOurreviewdidnotfindevidencesupportingasubstantialroleofMMSEasastand‐alonesingle‐administrationtestintheidentificationofMCIpatientswhocoulddevelopdementia.Clinicianscouldprefertorequestadditionalandextensiveteststobesureaboutthemanagementofthesepatients.AnimportantaspecttoassessinfutureupdatesisifconversiontodementiafromMCIstagescouldbepredictedbetterbyMMSEchangesovertimeinsteadofsinglemeasurements.Itisalsoimportanttoassessifasetoftests,ratherthananisolatedone,maybemoresuccessfulinpredictingconversionfromMCItodementia.淺顯易懂的口語結論availableinEnglishEspañol日本語PolskiPortuguês简体中文繁體中文簡易智能量表(MMSE)的基線分數用於早期預測發展為輕度知能障礙(MCI)的失智症患者由於MCI患者發展為失智症的風險增加，因此應對其進行評估和監測。

目前對於記錄失智症發展的最佳方法是什麼，尚無一致意見。

因此為這項任務提出了幾種認知功能測試，而這些測試大多易於管理、完成時間不超過10分鐘、涉及主要執行功能並能產生客觀分數。

我們的文獻回顧評估了與這些簡短測試之一相關的證據，即簡易智能量表(MMSE)，其用於預測認知障礙患者發展為失智症的程度。

在對可用的資訊進行廣泛搜索和分析後，我們沒有發現證據支持MMSE作為獨立單次給藥測試，在識別未來發展為失智症的患者方面發揮實質作用。

AvailableinEspañol日本語PolskiPortuguês简体中文繁體中文翻譯者：謝昀軒（考科藍臺灣研究中心)【本翻譯計畫由臺北醫學大學考科藍臺灣研究中心(CochraneTaiwan)、東亞考科藍聯盟(EACA)統籌執行。

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