背景與目的：人口老化的社會（≧65歲者佔人口比率14%以上）稱為老年人的社會。失智症是主要影響老年人的認知功能障礙，其特徵是漸進性認知的功能減退，早期診斷是非常重要的。然而，能有效快速診斷失智症是困難的，尤其是在失智症的初期。如何發展網路平台，方便民眾使用電腦、平板或手機，自行在線上進行失智症之評估，並能早期有效篩檢出失智症患者，並進而改善其症狀及增強日常生活能力，不僅能提高病人的生活品質，同時可以減少後續的醫療成本與負擔。本研究旨在發展一套高精準度與效率之多向度電腦化適性測驗，以為臨床之應用。方法：研究對象係以南部某醫學中心臨床神經科醫師所開立之 失智症檢查366人資料， 利用多向度 Rasch 模式的 Conquest 軟體進行試題的參數估計，再進行失智量表8向度(即分量表)的電腦化適性測驗(Multi-dimensional Computerized Adaptive Test)的模擬分析，與全部作答傳統非電腦適性測驗(Non Adaptive Test NAT)的精準度(不相等分數比率小於5%)及效率性(答題數量的節省)，及決定其決斷點。結果：結果顯示，電腦化適性測驗(MCAT)比傳統非電腦適性測驗(NAT) 的題目節省20.19%(=(53-42.3)/53)。顯注表現電腦化適性測驗(MCAT)各構面呈現高度相關。受試成績不同百分比小於5%的 t 檢定顯示能?估計值沒有顯著差?。總體決斷點分數可以設定於-0.7與0.7洛基分數，即33%及67%。結論：發展網路平台，方便民眾使用電腦、平板或手機自行在線上進行快速有效失智症的評估，將有助於篩檢之推廣。 Objectives: Along with the elder population in increase, the diagnosis of dementia with efficiency and accuracy is important in healthcare settings. We aimed to develop a website that can help parents with their own computers, tablets, or smart phones for online screening and prediction of dementia responding Clinical Dementia Rating (CDR) Scale.Methods: The CDR scale was applied to 366 outpatients in a hospital of southern part Taiwan, (1) using multi-dimensional computer adaptive test(MCAT) with parameters for items across six dimensions, (2) simulating responses to compare the efficiency and precision of MCAT and NAT(non-adaptive test). The number of items saved and the cutoff points determined for the tool were determined.Results: MCAT yielded significantly more precise measurements and was significantly more efficient than was NAT: it yielded a 20.19% (=(53-42.3)/53) saving in item length when measurement differences less than 5% were allowed. Person-measure correlation coefficients were highly consistent among the five domains. The cutoff points for the overall measures were -0.7 and 0.7 logits, which was equivalent to 33 and 67 in percentile scores. Significantly fewer items were answered on MCAT than on NAT without compromising MCAT’s precision.Conclusions: Developing a website to help parents with their own computers, tablets, or smart phones for online screening and prediction of dementia in elders is useful and not difficult.
