| Summary: | 碩士 === 國立成功大學 === 職能治療學系碩博士班 === 97 === Background and purposes:
The multi-cognitive impairment is obvious in the patients with Alzheimer’s disease (AD). In clinical practice, the neuropsychological assessments used to evaluate AD, do not provide further information for the care of the patients. The Large Allen Cognitive Level Test (LACL) based on the cognitive disability model (CDM) is a screening for the cognitive function and the required assistance for the cognitive impaired. However there is little research about the applicability of LACL for the patients with AD. The purpose of this study was to examine the reliability and validity of LACL, including the test-retest reliability, concurrent and convergent validity, as well as the discriminant validity for the individuals with and without AD.
Methods:
Fifty-seven patients with mild to moderate AD diagnosed by NINCDS-ADRDA criteria were recruited as the patient group and 21 community volunteers without cognitive impairments participated as the control group. The cognitive functions were evaluated by LACL, Mini-Mental Status Exam (MMSE), Cognitive Ability Screening Instrument (CASI), Clinical Dementia Rating scale (CDR), Digit Span forward (DS_f), Trail Making Test-A & B (TMT A & B), Barthel Index (BI), and Lawton’s Instrumental Activities of Daily Living (IADL). The interval between the pre- and post-LACL test was two weeks. All participants gave written informed consent prior to their participation.
Results:
The results showed that the test-retest reliability of LACL were excellent in control and AD group (ICC= .951 & .858, ps <.001; SEM%=1.67% & 4.22%; SRD%= 4.63% & 11.71%, respectivelys). There were significant differences in age, education, and GDS among the three groups. After controlling for these variables, the LACL score highly correlated with the CDR (r =- .827, p<.001), MMSE(r=.879, p<.001) and CASI (r = .871, p<.001), and moderately to highly correlated to other cognitive and functional assessments (DS_f, r = .665, p<.001; TMT_B, r = -.540, p<.001; BI, r = .383, p < .01; IADL, r = .805, p < .001). There were significant group differences in LACL by ANCOVA (F = 71.26, p<.001). With discriminant analysis, the percentage of LACL scores correctly classified 89.7% of the subjects into their original groups. Using receiver operating characteristic (ROC) curve analysis, a cut off point at 4.7 provided the optimised sensitivity ( .857) and specificity ( .912) for LACL to differentiate participants with or without AD.
Conclusions:
The findings support that LACL is a reliable and valid instrument, and is useful for the screening of AD. Further application and investigation with LACL and the CDM guidelines are warranted for clinical practice.
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