KISEP Original Articles 41 3 2002 J Korean Neuropsychiatr Assoc Vol 41, No 3 치매선별을위한한국어판하세가와치매척도의신뢰도와타당도 * 김기웅 1) 이동영 1) 안소연 1) 주진형 2) 길영남 1) Reliability and Validity of the Korean Version of Hasegawa Dementia Scale(HDS-K) as a Dementia Screening Instrument * 국문초록 Ki Woong Kim, M.D., Ph.D, 1) Dong Young Lee, 1) Soh Yeon Ahn, 1) Jin Hyeong Jhoo, M.D., 2) Young Nam Kil, R.N. 1) 연구목적 방법 결과 - Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin Department of Neuropsychiatry, Anyang Metro Hospital, Anyang Corresponding author 526
결론 중심단어 서론 - - 1. HDS-R 번안 방법 527
Sensitivity 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 HDS-K MMSE-KC SBT-K 0.0 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 1-specificity Fig. 1. Receiver operator characteristicroc curves of HDS-K, MMSE-KC and SBT-KN=334. - 2. 연구대상 1) 환자군 - - - - - 2) 대조군 3. 신뢰도검증 528
Table 1. Demographic characteristics of the normal elderly individuals and dementia patients Ageyears 4. 타당도검증 NormalN=160 DementiaN=174 64 3320.6% 16 9.2% 6569 5534.4% 16 9.2% 7074 5031.3% 3319.0% 7579 1811.3% 4827.6% 80 4 2.5% 6135.1% MeanSD 68.786.23 75.918.30* Range 4687 4797 Sex Male 5232.5% 6637.9% Female 10867.5% 10862.1% Educationyears 0 3421.2% 8046.0% 16 6540.6% 4827.6% 79 1811.3% 10 5.7% 1012 2415.0% 2212.6% 13 1911.9% 14 8.0% MeanSD 6.645.12 4.635.31* Range 018 018 Significantly differently from control subjects by student t-test, two tailedp0.01 - Table 2. Item-total correlation in HDS-K HDS-K Item Correlation with total HDS-K score 1.583 2.875 3.658 4.454 5.697 6.574 7.792 8.815 9.742 Note. All the correlations are significant at the p0.001 level 결 1. 인구학적변인 - 2. 신뢰도 3. 타당도 과 529
Table 3. Scores of Korean version of Hasegawa Dementia ScaleHDS-K, Korean version of Mini Mental Status ExaminationMMSE-KC and Korean version of Short Blessed TestSBT-K in the normal elderly individuals and dementia patients NormalN=160 DementiaN=174 HDS-K MMSE SBT HDS-K MMSE SBT MeanSD 22.283.82 24.073.44 4.415.42 8.785.10* 11.745.76* 22.746.52* Range 1230 1230 021 026 028 028 Significantly different from normal elderly individuals by ANCOVA considering age and education as covariates p0.01 Table 4. Correlations of HDS-K, MMSE-KC and SBT-K in the normal elderly individuals and dementia patients together and in the dementia patients only HDS-K MMSE-KC SBT-K HDS-K.903.801.876.717 MMSE-KC.908.805 SBT-K Note. The correlation coefficients in the dementia patients are presented in the parentheses. All the correlations are significant by Pearson correlation analysisp0.01. The numbers of the subjects were 334 for the correlations of HDS-K with MMSE-KC, and 331 for the correlations of HDS-K with SBT-K Table 5. The values of accuracy indicies according to various cut-off scores of HDS-K, MMSE-KC and SBT-KN=334 Test Cut-off SE SP PPV NPV AUC HDS-K 0.972 13/14 0.969 0.833 0.967 0.842 14/15 0.956 0.874 0.956 0.874 15/16* 0.950 0.902 0.952 0.899 16/17 0.931 0.914 0.935 0.909 17/18 0.881 0.948 0.896 0.928 MMSE-KC 0.951 18/19 0.925 0.885 0.928 0.881 19/20 0.906 0.908 0.913 0.901 20/21* 0.894 0.925 0.904 0.917 21/22 0.806 0.931 0.839 0.915 22/23 0.731 0.943 0.792 0.921 SBT-K 0.963 8/9 0.940 0.842 0.868 0.931 9/10 0.922 0.848 0.870 0.913 10/11* 0.916 0.892 0.904 0.911 11/12 0.904 0.892 0.903 0.899 12/13 0.898 0.905 0.913 0.895 Note. Optimal cut-off score indicated by ROC curve analysis. Cut-off, SE, SP, PPV, NPV and AUC denote cutoff score, sensitivity, specificity, positive predictive value, negative predictive value and area under the curve, respectively 고 찰 530
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참고문헌 1) Woo JI, Lee JH, Yoo KY, Kim CY, Kim YI, Shin YS (1998):Prevalence estimation of dementia in a rural area of Korea. J Am Geriatr Soc 46(8):983-987 2) Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL(1982):A new clinical scale for the staging of dementia. Br J Psychiatry 140:566-572 3) Ross GW, Abbott RD, Petrovitch H, Masaki KH, Murdaugh C, Trockman C, Curb JD, White IR(1997): Frequency and characteristics of silent dementia among elderly Japanese-American men. JAMA 277:800-805 4) Fretcher RH, Fletcher SW, Wagner EH(1996):Clinical Epidemiology:The essentials. 3rd ed. Baltimore, Williams & Wilkins 5) Reid MC, Lachs MS, Feinstein AR(1995):The use of methodological standards in diagnostic test research. JAMA 274:645-651 6) Folstein MF, Folstein SE, McHugh PR(1975): Minimental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12 (3):189-198 7) Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H(1983):Validation of a short orientationmemory-concentration test of cognitive impairment. Am J Psychiatry 140:734-739 8) Imai Y, Hasegawa K(1994):The Revised Hasegawa s Dementia Scale(HDS-R)-Evaluation of its usefulness as a screening test for dementia. J Hong Kong Coll Psychiatr 4(2):20-24 9) Lee JH, Lee KU, Lee DY, Kim KW, Jhoo JH, Lee KH, Kim SY, Han SH, Woo JI(2002):Development of the Korean version of the Consortium to Establish a Registry for Alzheimers Disease(CERAD) Assessment Packet(CERAD-K):Clinical and Neuropsychological Assessment Batteries. J Gerontol B Psychol Sci Soc Sci 57 (1):P47-P53 10) 이동영, 윤종철, 이강욱, 주진형, 김기웅, 이정희, 우종인 (1999): 치매선별을위한한국어판간이 Blessed 검사의신뢰도및타당도. 신경정신의학 38 (6):1297-1307 11) Hasegawa K, Inoue K, Moria K(1974):Study on the brief Intelligence scale for the demented elderly. Seishinigaku 16:965-969 12) 서상규 (1998): 연세말뭉치 1-9를대상으로한현대한국어의어휘빈도-빈도 7 이상. 연세대학교언어정보개발연구원내부보고서 CLID-WP-98-02- 28, 연세대학교언어정보개발연구원 13) American Psychiatric Association(1994) :Diagnostic and Staistical Manual of Mental Disorders, fourth ed. Washington, DC:American Psychiatric Association, pp133-155 14) McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM(1984):Clinical diagnosis of Alzheimer s disease:report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human services Task Force on Alzheimer s Disease. 532
Neurology 34:939-944 15) Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH(1993):Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43 (2):250-60 16) Metz CE(1978):Basic principles of ROC analysis. Semin Nucl Med 8:283-298 17) Hanley JA, McNeil B(1983):A method of comparing the areas under receiver operating characteristic curves derived from the same case. Radiology 148:839-843 18) Flaherty JA, Gaviria FM, Pathak D, Mitchell T, Wintrob R, Richman JA, Birz S(1988):Developing instruments for cross-cultural psychiatric research. J Nerv Ment Dis 176(5):257-263 19) McDowell I, Newel C(1966):The theoretical and technological foundations of health measurement. In:Measuring health:a guide to rating scales and questionnaires. New York, Oxford University Press, pp10-46 20) Morris JC(1994):Handbook of dementing illness. 1st ed, New York, Marcel Dekker, pp72-77 21) 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 22) Kittner SJ, White LR, Farmer ME, Wolz M, Kaplan E, Moes E, Brody JA, Feinleib M(1986):The problem of education adjustment. J Chron Dis 39:163-170 23) 여형용, 이강욱, 이군희, 주진형, 김기웅, 이정희, 하규섭, 정도언, 김용식, 우종인 (1998): 도시및농촌노인의한국판 MMSE 점수에사회인구학적변인이미치는영향에관한연구. 신경병리학 7: 72-80 24) 우종인, 이정희, 홍진표 (1996) : 농촌지역거주노인의연령, 성별, 교육수준이한국판 MMSE 점수에미치는영향에관한연구. 신경정신의학 35: 122-132 533
ABSTRACT J Korean Neuropsychiatr Assoc Vol 41, No 3, May, 2002 Reliability and Validity of the Korean Version of Hasegawa Dementia Scale(HDS-K) as a Dementia Screening Instrument Ki Woong Kim, M.D., Ph.D, Dong Young Lee, Soh Yeon Ahn, Jin Hyeong Jhoo, M.D., Young Nam Kil, R.N. Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin Objects:We developed the Korean version of Hasegawa Dementia Scale(HDS-K) by translating the revised Hasegawa Dementia Scale(HDS-R) which is known to be a useful brief screening instrument for dementia. Materials and Methods:The translation was carried out keeping the basic structure of Revised Hasegawa Dementia Scale(HDS-R). HDS-K, along with MMSE-KC, SBT-K and CDR, were administered to 174 dementia patients and 160 elderly control subjects. Cronbach alpha coefficient, inter-rator reliability, and test-retest reliability of HDS-K were examined. The correlations of MMSE-KC, SBT-K and CDR with HDS-K were also examined to confirm the validity of HDS-K. Cut-off scores for dementia were estimated by Receiver Operator Characteristic(ROC) curve anslyses. By comparing Area Under Curve(AUC), the diagnostic efficiency of HDS-K was compared with those of MMSE-KC and SBT-K. Results: 1) HDS-K was found to have significantly high internal consistency(cronbach alpha coefficient= 0.948, p<0.01), inter-rater reliability(pearson correlation coefficient=0.999, p<0.01) and test-retest reliability(pearson correlation coefficient=0.848, p<0.01). 2) All the correlations of HDS-K with MMSE-KC, SBT-K and CDR were significant indicating that HDS-K has good concurrent validity. Its optimal cut-off point for dementia was estimated as 15/16, where the sensitivity and specificity were 0.950 and 0.902, respectively. 3) The ROC curve analysis indicated that the diagnostic efficiency of HDS-K(AUC=0.972) was comparable with MMSE-KC(AUC=0.951) and SBT-K(AUC=0.963). Conclusion:We conclude that HDS-K is a reliable, valid, and useful screening instrument for dementia. KEY WORDS:HDS-K Reliability Validity Dementia Screening instrument. 534
부록 1 한국어판하세가와치매척도 (The Korean version of Revised Hasegawa Dementia Scale:HDS-K) 1. 0 1 2. 0 1 0 1 0 1 0 1 3.. 3.,, 0 1 2 4... 기차호랑이사과,. 0 3 1 2 5. 100 7, 6. 0 1 2 5. 7 93 7. 6... 123, 321.. 682, 7. 3529 0 1 2 7.. 기차 ( 단서 : 타고다닐수있는것 ) 0 1 2 호랑이 ( 단서 : 동물또는짐승 ) 0 1 2 사과 ( 단서 : 과일 ) 0 1 2 8.. 0 3 1 4 2 5 시계 열쇠 도장 연필 동전 9... 1. 2. 3. 4. 5. 0 1 2 6. 7. 8. 9. 10. 3 4 5 총점 /30 535
부록 2 한국어판하세가와치매척도시행지침 문제 1. ( 최저 0점, 최고 1점 ) 두살아래부터 두살위까지정답 문제 2. ( 최저 0점, 최고 4점 ) 각항목당 1점 문제 3. ( 최저 0점, 최고 2점 ) 2점 1 점0점 문제 4. ( 최저 0점, 최고 3점 ) 각단어당 1점 문제 5. ( 최저 0점, 최고 2점 ) 0점 1점 1점 0점 문제 6. ( 최저 0점, 최고 2점 ) 0점 1점 1점0점 문제 7. ( 최저 0점, 최고 3점 ) 2점 1점 0점 536
문제 8. ( 최저 0점, 최고 5점 ) 이항목은채점하지않는다. 정확히회상한물건의개수 문제 9. ( 최저 0점, 최고 5점 ) 채소류에속하는정확한단어총수에서 5를뺀값 정확한반응이 5개이하일경우에는 0점10 개이상일경우에는 5점 537