LEMBAR JAWABAN

SKILLAB EVIDENCE BASED MEDICINE (EBM)

1. Nilai Abnormalitas

PARAMETER

RATA-RATA +2 SD

NILAI

SGOT/SGPT
HEMOGLOBIN
TRIGLISERIDS

26.29+2(13.92)=54.13
12.47-2(0.32)=11.83
115.30+2(20.04)=155.3

ABNORMALITAS
54.13+0.05=54.18
11.83-0.05=11.78
115.38+0.05= 155.43

KOLESTEROL TOTAL

8
137.24+2(32.40)=

202.04+0.05=202.09

HDL
LDL

202.04
89.44-2(17.11)= 55.22
74.64+2(13.63)=101.9

55.22-0.05=55.17
101.9+0.05=101.95

2. PICO

2.1

Older patients reporting memory loss and concerned about the onset of

I
C
O

dementia
Mini-Cog screening test
Mini Mental State Examination (MMSE)
Accurate diagnosis of dementia or Alzheimers disease

Clinical Question
In older patients with early signs of cognitive impairment is the Mini-Cog as accurate as
the Mini Mental State Examination in diagnosing dementia or Alzheimers disease

2.2

Search Term/Search/Keyword
Mini-Cog and MMSE
2.3

Lakukan Searching www.tripdatabase.com

2.4 Pastekan Abstract Artikel

Abstract
Background : Dementia is considered widely under-detected in primary care, and general
practitioners (GPs) frequently ask for easy to use tools to assist in its early detection.

Aim : To determine the degree of correlation between the Mini-Cog Assessment (MiniCog) as performed by GPs and the Mini-Mental State Examination : (MMSE). Design
of study This was a prospective study (2005, 2006) comparing two cognitive screening
instruments. Setting : Ten general practices in Austria, with patients with a hitherto
undiagnosed suspicion of dementia seen consecutively. Method : Sensitivity, specificity
and positive and negative predictive values (PPVs and NPVs) of the Mini-Cog
(applying both a colour-coded and the original rating method) were assessed for degree
of correlation with the MMSE. In phase one GPs examined patients suspected of
having dementia using the Mini-Cog; in phase two a neurologist retested them applying
the MMSE, a clock-drawing test (CDT) and a routine clinical examination. A
questionnaire on the practicability of the Mini- Cog was answered by GPs. Results : Of
the 107 patients who participated 86 completed the whole study protocol. The MiniCog, as performed by the ten GPs, displayed a sensitivity of 0.85 (95% CI: 0.71, 0.98),
a specificity of 0.58 (95% CI: 0.46, 0.71), a PPV of 0.47 (95% CI: 0.33, 0.61) and an
NPV of 0.90 (95% CI: 0.80, 0.99) as against the MMSE carried out by neurologists.
The GPs judged the Mini-Cog useful and time saving. Conclusion : The Mini-Cog has a
high sensitivity and acceptable specificity in the general practice setting and has proved
to be a practicable tool for the diagnosis of dementia in primary care.

2.4

Lakukan Critical Appraisal dari Artikel

VALIDITY: In Methods section:

Design: Design of study This was a prospective study (2005, 2006) comparing
two cognitive screening instruments
sample, sample size Ten general practices in Austria, with patients with a hitherto
undiagnosed suspicion of dementia seen consecutively.
eligibility criteria
(inclusion, exclusion) sampling method,
method, measurements, methods

randomization

of analysis Sensitivity, specificity and

positive and negative predictive values (PPVs and NPVs) of the Mini-Cog (applying

both a colour-coded and the original rating method) were assessed for degree of
correlation with the MMSE.
IMPORTANCE:
Results : Of the 107 patients who participated 86 completed the whole study protocol. The
Mini- Cog, as performed by the ten GPs, displayed a sensitivity of 0.85 (95% CI: 0.71,
0.98), a specificity of 0.58 (95% CI: 0.46, 0.71), a PPV of 0.47 (95% CI: 0.33, 0.61)
and an NPV of 0.90 (95% CI: 0.80, 0.99) as against the MMSE carried out by
neurologists.

APPLICABILITY: In Discussion section : The Mini-Cog has a high sensitivity and

acceptable specificity in the general practice setting and has proved to be a practicable
tool for the diagnosis of dementia in primary care.

3. Grafik titik potong

Classification: MCI
100
90
80
70
60

Sensitivity (%)
Specificity (%)

50
40
30
20
10
0
40

50
60
70
KretaininKinase

80

3.2 Visually the graph shows the intersection of creatininkinase more than 80 and less than
90.

3.3 Nilai

KretaininKinase
100

Sensitivity: 100.0
Specificity: 92.0
Criterion : >69.1098

Sensitivity

80
60
40
20
0
0

Variable

20

40
60
80
100-Specificity

KretaininKinase
KretaininKinase

Classification variabl

MCI

Sample size

100

Positive group :

MCI = 1

13

Negative group :

MCI = 0

87

Disease prevalence (%)

unknown

Area under the ROC curve (AUC)

100

Area under the ROC curve (AUC)

0.973

Standard Errora

0.0140

95% Confidence intervalb

0.919 to 0.995

z statistic

33.901

Significance level P (Area=0.5)

<0.0001

DeLong et al., 1988

Binomial exact

Youden index

Youden index J

0.9195

Associated criterion

>69.1098

Criterion values and coordinates of the ROC curve [Hide]

Criterion

40.088
6

Sensitivit

95% C

100.00

75.3 100.

Specificit
y
0.00

95% C

+LR

I
0.0 - 4.
2

1.00

-LR

0
>69.109

100.00

75.3 -

91.95

100.

84.1 96.7

12.4

0.00

0
>70.164

92.31

1
>72.903

76.92

69.23

69.23

38.6 -

38.6 -

61.54

31.6 -

94.25

25.1 -

87.1 98.1

96.55

90.3 99.3

97.70

86.1
53.85

85.6 97.4

90.9

8
>76.887

93.10

90.9

7
>76.514

46.2 -

85.6 97.4

95.0

5
>75.240

93.10

99.8

8
>73.249

64.0 -

91.9 99.7

98.85

80.8

93.8 100.

13.3

0.08

11.1

0.25

5
12.0

0.33

5
20.0

0.32

8
26.7

0.39

7
46.8

0.47

0
>77.457

38.46

13.9 -

98.85

68.4

93.8 100.

33.4

0.62

0
>77.995

30.77

9.1 - 6

100.00

1.4

95.8 -

0.69

100.
0

>78.675

0.00

0.0 - 24.7

100.00

95.8-100.0

1.00

4. Randomized clinical trial/ control trial Ace inihibitor ( DATA THERAPHY BAD
OUTCOME)
Tabel : Angka kematian MCI kelompok placebo dan Ace inhibitor
Treatment

Alive

Dead

Total

Randomized

Clinical

44

50

37
81

13
19

50
100

trial/control trial Ace

inhibitor
Placebo
Total

RRR= 0.189 =19%

ARR = 0.14 = 14%
NNT = 7.14
Kesimpulan Ace Inhibitor tidak efektif dalam mencegah kematian MCI hanya 19%

5. (DATA THERAPHY EFFECTIVENESS)

Buatlah kelompok data untuk kelompok pelakuan sebagai :
1 = enalapril+ ASA
2 = Isoborbid + diuretik

Buatlah kelompok data untuk outcome sebagai :

0= sembuh
1=tidak sembuh

Kelompok * Outcome Crosstabulation

Count
Outcome
sembuh
Kelompok

enalapril+ ASA
Isoborbid + diuretik

Total

Total

tidak sembuh

26

24

50

41

50

35

65

100

RRR= 1.889 = 189%

ARR = 0.34 = 34 %
NNT = 2.94
Kesimpulan : penggunaan obat (enalapril+ASA) dan (Isoborbid+diuretik) efektif dalam
menyembuhkan sebanyak 189%