The Comparison between Min-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) in Evaluating Patients with Alzheimer's Disease

　　目的：透過探討阿茲海默型失智症(dementia of the Alzheimer type)患者申請健保給付藥物治療之規定，比較「簡短式智能評估(MMSE)」與「臨床失智評估(CDR)」在篩選失智症與申請藥物治療之結果。方法：50位阿茲海默型失智症患者，與32位60歲以上志願者，接受神經心理檢查評定CDR，並接受MMSE。結果：採用MMSE與本研究增加神經心理檢查結果輔助認知功能項目評分之CDR，篩選失智症之結果相當一致(kappa0.87)；採用MMSE與CDR申請藥物之結果亦頗為接近(kappa 0.76)。結論：未考量教育程度之影響，採MMSE≦26分篩選失智症，將提高錯誤篩選率。另一方面，CDR較能對患者整體失智嚴重度作正確評估，且檢付CDR能使較多真正需要藥物治療之患者通過申請。因此，建議採用神經心理檢查評定輔助之CDR，作為申請失智藥物審核標準，非但較能保障患者權益，同時可達善用醫療資源之功效。
　　Objectives: The purpose of this study was to compare the results of Mini Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) in patients with dementia of the Alzheimer's type (DAT) and to explore the feasibility of the clinical criteria adopted by the National Health Insurance (NHI) for acetylcholinesterase inhibitors (AChEI). Methods: Fifty patients with DAT and 32 healthy controls matched for age and education were included in the study. All subjects underwent both MMSE and neuropsychological assessment-assisted CDR evaluations. The NHI of Taiwan approves patients of DAT with either MMSE=10~26 or CDR=1~2 of AChEI. Results: There was a good agreement between MMSE and the neuropsychological assessment-assisted CDR (Kappa 0.87) in assessment of the severity of dementia. The ratios of dementia patients who met the NHI criteria for AChEI treatment were rather close (Kappa 0.76). Conclusion: The cut-off point of MMSE score (≦ 26) in the NHI criteria for mild dementia was associated with a significant false positive rate if education level was not considered. CDR provided a more accurate assessment of severity of dementia than MMSE. Thus, use of the CDR criteria will facilitate ap-proval of the use AChEI in more patients who are in need of treatment with this medication. These findings suggest the need adoption of the neuropsychological assessment-assisted CDR as the NHI standard.