以修訂版長谷川氏失智症量表篩檢譫妄症

The Revised Hasegawa’s Dementia Scale (HDS-R) as a Screening Tool for Delirium

目的：探討修訂版長谷川氏失智症量表 (HDS-R, The Revised Hasegawa’s Dementia Scale) 作為照會精神科醫師於初次會診使用之譫妄篩檢工具之可行性。 方法：以 69 位林口長庚醫 院各科照會精神科之個案為對象。個案首先接受精神科照會住院醫師施測 HDS-R 及簡短 智能測驗 (Mini-Mental State Examination, MMSE)，後由督導照會之精神科專科醫師會談並 依照 DSM-IV 準則診斷。 結果：HDS-R 內部一致性佳 (Cronbach’s coefficient α = 0.894)，且 與 MMSE 相關性高 (r = 0.972, p < 0.001)。譫妄病人之 HDS-R 分數介於 0 到 23 之間，平均 5.8 (S.D.= 6.5)；非譫妄個案則介 4 到 30 之間，平均 22.9 (S.D.=7.5) (unequal variance t test, t = -9.659, d. f. = 45.978, p < 0.001)，接收操作特徵曲線 (receiver-operating characteristic, ROC) 下面 積為 0.946 (95% confident interval 0.875-0.997)。HDS-R 篩檢譫妄最佳切分點為 16/17。 結論：HDS-R 可作為照會精神科醫師於初次會診時使用之譫妄篩檢工具。

Objectives:The objective of this study was to examine the feasibility of the Revised Hasegawa’s Dementia Scale (HDS-R) in screening delirium for consul-tant psychiatrists at their first encounter with the patients in clinical medical/surgi-cal settings. The authors also intended to present the sensitivity, specificity, and the cut-off scores of HDS-R scores in detecting delirium. Methods:We recruited 69 patients who have been referred to psychiatric consultation liaison (C-L) service at a medical center in northern Taiwan. HDS-R and Mini Mental State Examination (MMSE) were applied and the diagnoses were made according to DSM-IV criteria. Results:We found that Cronbach’s coefficient αHDS-R was 0.894, showing sig-nificant correlation with MMSE (r = 0.972, p < 0.001). The HDS-R scores in the delirium group were ranged from 0 to 23, with an average of 5.8 (standard devia-tion = 6.5). The HDS-R scores in the non-delirium group were ranged from 4 to 30, with an average of 22.9 (S. D. = 7.5, unequal variance t test, t = -9.659, degree of freedom = 45.978, p < 0.001). Area under receiver operating characteristic (ROC) curve was 0.946 (95% confident interval 0.875-0.997). The best cut-off point of HDS-R score for screening delirium was 16/17. Conclusion:HDS-R may serve as a screening tool of delirium for consultant psychiatrists who encounter the patients for the first time in the clinical medical/surgical settings.