一改良版的日常生活量表以區分巴金森病患者在認知功能障礙之嚴重程度

A Modified Instrumental Activities of Daily Living Scale to Differentiate Severity of Cognitive Dysfunction in Parkinson’s Disease

背景和目的：本研究的目的是開發一種改良版的日常生活量表（Instrumental Activities of Daily Living scale, IADL），名稱叫做秀傳日常生活量表（Show Chwan Activities of Daily Living scale, SCADL），希望能利用生活功能影響程度來區分巴金森病患者（Parkinson’s disease, PD）在不同程度認知功能障礙。

方法和參與者：本研究在臺灣3 個中心進行，我們針對一系列包括正常認知（normal cognition, NC）、輕度智能障礙（mild cognitive impairment, MCI）與不同階段失智症的巴金森病患者進行了研究。本研究測試了SCADL 的區辨性，並與其他區分老年失智症和正常或輕度智能障礙的簡易篩選量表進行比較。

結果：總共330 例巴金森病患者參與研究，其中正常認知65 例，輕度智能障礙94例，失智症171 例。曲線下面積（area under the curve, AUC）分析顯示， 用於鑒別正常認知和失智、非常輕度失智和輕度失智、輕度失智和中度失智、中度失智和重度失智，SCADL 曲線下的區域為0.94 、0.83 、0.95 和0.91。SCADL 所有曲線下面積均高於其他簡易篩選量表。

結論：SCADL 對鑒別巴金森病患者的不同認知階段是有效的。這種快速篩檢工具可 應用於一般臨床上以及社區調查研究中，以決定是否有必要進行進一步的失智或是智能障礙診斷確認。

 

Background and purposes: The aim of this study was to use a modified Instrumental Activities of Daily Living scale (IADL), namely the Show Chwan Activities of Daily Living (SCADL) scale, for discriminating the severity of cognitive dysfunction in Parkinson’s disease (PD).

Methods and participants: This study was conducted in three centers in Taiwan and consecutive series of participants with normal cognition (NC), mild cognitive impairment (MCI), or different stages of dementia were enrolled. The purpose of the study was to test the performance of SCADL compared with other brief screening instruments for distinguishing dementia from normal or MCI.

Results: A total of 330 individuals with PD were enrolled, including 65 NC, 94 MCI and 171 dementia patients. The receiver operator characteristic (ROC) curves analysis showed the areas under the curve (AUC) of SCADL were 0.94, 0.83, 0.95 and 0.91 for discriminating NC/MCI and dementia, very mild dementia (VMD) and Clinical Dementia Rating Scale (CDR) 1, CDR 1 and CDR 2, and CDR 2 and CDR 3, respectively, and all AUCs were higher than other screening instruments.

Conclusion: Our study showed SCADL was effective and efficient in distinguishing the different cognitive stages of PD. This rapid screening tool can be applied in general practice as well as in a community setting to decide whether further diagnostic confirmation is necessary.