결과 : 결론 : 중심단어 서론 1366

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KISEP Original Articles 38 6 1999 J Korean Neuropsychiatr Assoc Vol 38, No 6 치매선별을위한한국어판간이 Blessed 검사의신뢰도및타당도 * 이동영 1) 윤종철 1) 이강욱 2) 주진형 1) 김기웅 3) 이정희 4) 우종인 1) Reliability and Validity of the Korean Version of Short Blessed TestSBT-K as a Dementia Screening Instrument* 국문초록 연구목적 : Dong Young Lee, M.D., 1) Jong Choul Yoon, M.D., 1) Kang Uk Lee, M.D., 2) Jin Hyeong Jhoo, M.D., 1) Ki Woong Kim, M.D., Ph.D., 3) Jung Hie Lee, M.D., Ph.D., 4) Jong Inn Woo, M.D., Ph.D. 1) 방법 : Department of Neuropsychiatry, Seoul National University Hospital Neuroscience research institute, Seoul National University, College of Medicine, Seoul Department of General Psychiatry, Seoul National Mental Hospital, Seoul Department of Neuropsychiatry, Yongin Mental Hospital, Yongin, Kyonggi Province Research Institute of Aging Physical Culture, Medical Research Center, Seoul National University, Seoul Corresponding author 1365

결과 : 결론 : 중심단어 서론 1366

1. SBT 번안 방법 2. SBT-K의신뢰도및타당도검증 1) 대상군의설정 1367

2) 신뢰도검증 3. 타당도검증 1368

4) 통계분석프로그램 Table 1. Demographic characteristics of dementia patients and control subjects Controln191 Dementian224 Ageyears 5064 4322.5 5424.1 6569 7137.2 2718.5 7074 4423.0 5022.3 7579 2814.7 4319.2 80 5 2.6 4017.9 MeanSD 68.55.8 71.18.1* Range 5385 5288 Sex Male 6534.2 7834.8 Female 12665.8 14665.2 Education 0 2312.1 6027.1 16 9248.3 7735.3 79 2513.2 19 8.6 1012 2513.3 3423.4 13 2513.1 3013.6 MeanSD 7.34.7 6.55.5* Range 020 020 Numberpercent of subject unless otherwise indicated *Significantly different from control subjects by student t-test, two tailedp0.01 결 1. 인구학적변인 과 Table 2. SBT-K scores in the control and dementia groups Test Controln191 Dementian224 MeanSD 3.494.50 021 Range 20.678.18* 028 Parentheses indicate the number of subjects *Significantly different from control subjects by ANCOVA considering age and education as covariatesp0.01 Table 3. Correlations of SBT-K, CERAD-MMSE-K and BDS- ADL-K in the control and dementia groups togetherabove the diagonal and in the dementia group onlybelow the diagonal* SBT-K CERAD-MMSE-K BDS-ADL-K SBT-K.903.766 CERAD-MMSE-K.817.805 BDS-ADL-K.536.649 All correlations are significant at the 0.01 level by Pearson correlation analysis *The numbers of subjects are 415control 191, dementia 224 for the correlation of SBT-K with BDS-ADL-K, and 324 control 167, dementia 157 for the correlations of CE- RAD-MMSE-K with SBT-K, and with BDS-ADL-K 2. 신뢰도 3. 타당도 1369

Table 4. The values of accuracy indices according to various cut-off scores of SBT-Kn415 Cut-off SE SP PPV NPV 5/6.88839.79167.83264.85876 6/7.88839.80208.83966.86034 7/8.87946.84375.86784.85714 8/9.87500.84896.87111.85340 9/10.85268.89583.90521.83902 10/11*.84821.90625.91346.83654 11/12.82143.95833.95833.82143 12/13.79911.96354.96237.80435 *Optimal cut-off score indicated by ROC curve analysis Cut-offcut-off score, SESensitivity, SPSpecificity, PPVPositive predictive value, NPVNegative predictive value Table 5. The values of accuracy indicies according to various cut-off scores of SBT-K and CERAD-MM- SE-Kn324 Test Cut-off SE SP PPV NPV AUC SBT-K.938 6/7.85350.80240.80240.85350 7/8.84076.85030.84076.85030 8/9.83439.85629.84516.84615 9/10*.80892.90419.88811.83425 10/11.80255.91018.89362.83060 11/12.77070.97006.96032.81818 12/13.73885.97605.96667.79902 CERAD-MMSE-K.947 19/20.65605.98802.98095.75342 20/21.70701.96407.94872.77778 21/22.75796.95808.94444.80808 22/23*.82166.95210.94161.85027 23/24.85350.85629.84810.86145 24/25.89172.77246.78652.88356 25/26.91083.67665.72589.88976 *Optimal cut-off score indicated by ROC curve analysis Cut-offcut-off score, SESensitivity, SPSpecificity, PPVPositive predictive value, NPVNegative predictive value, AUCArea under the curve Fig. 1. Receiver operator characteristicroc curves of SBT-K and CERAD-MMSE-KN324. 고 찰 1370

1371

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1편 :MMSE-K의개발. 신경정신의학 28:125-135 13) Folstein MF, Folstein SE, McHugh PR(1975): Mini-Mental State :a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189-198 14) Mattis S(1988):Dementia Rating Scale. Odessa, Fla:Psychological Assessment Resources 15) Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H(1983):Validation of a short orientation-memory-concentration test of cognitive impairment. Am J Psychiatry 140:734-739 16) Robertson D, Rockwood K, Stolee P(1982):A short mental-status questionnaire. Can J Aging 1:16-20 17) Fletcher RH, Fletcher SW, Wagner EH, eds(1996): Clinical Epidemiology:the essentials. 3rd ed. Baltimore, Williams & Wilkins 18) Reid MC, Lachs MS, Feinstein AR(1995):The Use of methodological standards in diagnostic test research. JAMA 274:645-651 19) Gilford DR, Cummings JL(1999):Evaluating dementia screening test. Neurology 52:224 20) Blessed G, Tomlinson BE, Roth M(1968):The association between quantitative measures of dementia and senile change in the cerebral gray matter of elderly subjects. Br J Psychiatry 114:797 21) Stuss DT, Meiran N, Guzman DA, Lafleche G, Willmer J(1996):Do long tests yield a more accurate diagnosis of dementia that short tests? A comparison of 5 neuropsychological tests. Arch Neurol 53: 1033-1039 22) Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, Mellits ED, Clark C(1989): The Consortium to establish a Registry for Alzheimer s Disease(CERAD). Part I:Clinical and neuropsychological assessment of Alzheimer s Disease. Neurology 39:1159-65 23) American Psychiatric Association(1994):Diagnostic and Statistical Manual of Mental disorders, 4th edition. Washington DC 24) Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A, et al(1993): Vascular dementia:diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43(2):250-260 25) H Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL(1982):A new clinical scale for the staging of dementia. Br J Psychiatry 140:566 26) JH Lee, KU Lee, DY Lee, KW Kim, JH Jhoo, KH Lee, SY Kim, SH Han, JI Woo:Development of the Korean version of the Consortium to Establish a Registry for Alzheimer s Disease(CERAD) Assessment Packet(CERAD-K):Clinical and Neuropsychological Assessment Batteries. J Am Geriatr Soc, Submitted 27) Metz CE(1978):Basic principles of ROC analysis. Semin Nucl Med 8:283-298 28) Hanley JA, McNeil BJ(1982):The meaning and use of the area under a Receiver Operating Characteristic(ROC) Curve. Radiology 143:29-36 29) Hanley JA, McNeil BJ(1983):A method of comparing the areas under receiver operating characteristic curves derived from the same case. Radiology 148:839-843 30) Flaherty JA, Gaviria FM, Pathak D, Mitchell T, Wintrob R, Richman JA, Birzs(1988):Developing Instruments for Cross-Cultural Psychiatric Research. J Nerv Ment Dis 176(5):257-263 31) Brislin RW(1970):Back-translation for cross-cultural research. J Cross-Cultural Psychol 1:185-216 32) McDowell, Newel C(1996):The theoretical and technological foundations of health measurement. In: Measuring health:a guide to rating scales and questionnaires Ed by McDowell, Newel C, New York, Oxford University Press, pp10-46 33) 한국심리학회 (1998): 심리검사제작및사용지침서. 중앙적성출판사, pp30 34) Davous P, Lamour Y, Debrand E, Rondot P(1987): A Comparative evaluation of the short orientation memory concentration test of cognitive impairment. J Neurol Neurosurg Psychiatry 50:1312-1317 35) Esocbar JI, Burnam A, Karno M, Forsythe A, Landsverk J, Golding M(1986):Use of Mini-Mental state Examination(MMSE) in a community population of mixed ethnicity:cultural and linguistic artifact. J Nerv Ment Dis 174:607-615 36) Fillenbaum GG, Hughes DC, Heyman A, George LK, Blazer DG(1988):Relation of health and demographic characteristics to Mini-mental State Examination score among community residents. Psychol Med 18:719-726 37) O conner DW, Pollitt PA, Treasure FP, Brook CPB, Reiss BB, Roth M(1986):the influence of education, social class and sex on Mini-Mental State scores. 1373

Psychol Med 19:771-776 38) Fillenbaum GG, Heyman A, Wilkinson WE, Haynes CS(1987):Comparison of two screening tests in Alzheimer s disease:the correlation and reliability of the Mini-Mental State Examination and the modified Blessed Test. Arch Neurol 44:924-927 39) Tierney MC, Szalai JP, Snow WG, Fisher RH, Nores A, Nadon G, Dunn E, St George Hyslop PH (1996):Prediction of probable Alzheimer s disease in memory-impaired patients:a prospective longitudinal study. Neurology 46(3):661-5 40) Linn RT, Wolf PA, Bachman DL, Knoefel JE, Cobb JL, Belanger AJ, kaplan EF, D Agostino RB (1995):The preclinical phase of probable Alzheimer s disease. Arch Neurol 52:485-490 41) Masur DM, Sliwinski M, Lipton RB, Blau AD, Crystal HA(1994):Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons. Neurology 44:1427-1432 42) World Health Organization(1992):Mental and behavioral disorders(f00-f99). In:The international classification of diseases, 10 th rev:icd-10. Geneva ABSTRACT J Korean Neuropsychiatr Assoc Vol 38, No 6, November, 1999 Reliability and Validity of the Korean Version of Short Blessed TestSBT-K as a Dementia Screening Instrument Dong Young Lee, M.D., Jong Choul Yoon, M.D., Kang Uk Lee, M.D., Jin Hyeong Jhoo, M.D., Ki Woong Kim, M.D., Ph.D., Jung Hie Lee, M.D., Ph.D., Jong Inn Woo, M.D., Ph.D. Department of Neuropsychiatry, Seoul National University Hospital Neuroscience research institute, Seoul National University, College of Medicine, Seoul We aimed to develop the Korean version of Short Blessed testsbt-k by analyzing its reliability and validity, showing its usefulness as a dementia screening instrument. The translation, including back translation procedure, was carried out, keeping the basic structure of SBT. SBT-K. The Korean Version of Blessed Dementia Scale-Activity of Daily LivingBDS-ADL- K and Clinical Dementia Rating ScaleCDR were administered to 224 dementia patients and 191 control subjects, and The Korean Version of Consortium to Establish a Registry of Alzheimer s Disease- Mini-Mental State ExaminationCERAD-MMSE-K was to 157 patients and 167 controls. The correlation of SBT-K scores between two raters, correlation between the test and retest after one month, and its internal consistency were analyzed. To verify the concurrent validity of SBT-K, its correlation with each testcerad-mmse-k, BDS-ADL-K, and CDR was analyzed. The sensitivity and specificity for each cut-off point of SBT-K were calculated and the Receiver Operator CharacteristicROC curve analysis was done to get its optimal cut-off point. SBT-K was found to have significantly high internal consistency, inter-rater reliability, and test-retest reliability. The significant correlation of SBT-K with each test described above was also shown. Its optimal cut-off point was estimated as 10/11, and the sensitivity and specificity were 0.85 and 0.90, respectively. The ROC curve analysis indicated that the diagnostic efficiency of SBT-K was comparable with CERAD-MMSE-K. We conclude that SBT-K has not only high reliability and validity, but also usefulness as a screening instrument for dementia. KEY WORDSDementia Screening instrument SBT-K Reliability Validity. 1374

부록 한국어판간이 Blessed 검사 (The Korean version of Short Blessed Test:SBT-K) 1375