Nomor 1

Descriptive Statistics
N Minimum Maximum Mean Std. Deviation
SGOT/SGPT 200 1.0 49.0 26.290 13.9232
Hemoglobin 200 12.0 13.0 12.472 .3238
Trigliserid 200 81.0 148.0 115.305 20.0475
TotalKolestrol 200 80.0 199.0 137.235 32.4054
HDL 200 61.0 119.0 89.440 17.1193
LDL 200 50.0 98.0 74.640 13.6341
Valid N (listwise) 200

1.1 Harga rerata = Mean

1.2 Standar Deviasi = Std. Deviation
1.3 buat tabel seperti skillab
Rerat
Parameter SD Rerata 2  SD Nilai Abnormalitas
a
54,13 + 0,05 = 54,18
SGOT/SGP 13,92
26,29 26,29 + 2(13,923) = 54,13  54,18 data dikatakan
T 3
abnormal

11,83 - 0,05 = 11,78

Hemoglobin 12,47 0,324 12,47 - 2(0,324) =11,83  11,78 data dikatakan
abnormal

155,394 + 0,05 = 155,44

20,04
Triglyceride 115,30 115,30 + 2(20,047) = 155,394  155,44 data dikatakan
7
abnormal

202,05 + 0,05 = 202,1

Total 32,40
137,24 137,24 + 2(32,405) = 202,05  202,1 data dikatakan
Kolestrol 5
abnormal

55,22 - 0,05 = 55,17

HDL 89,44 17,119 89,44-2(17,11) = 55,22  55,17 data dikatakan
abnormal

101,908 + 0,05 = 101,958

13,63
LDL 74,64 74,64 + 2(13,634) = 101,908  101,958 data
4
dikatakan abnormal

Note: (+- itu batas atas dan batas bawah dicari kalau bawah – kalau atas +)
 -  sesuai dengan konteksnya contoh Hb semakin menurun semakin abnormal jadi
dipakai minus
 +  sesuai dengan konteksnya SGOT/SGPT semakin naik semakin abnormal jadi
dipakai plus
 Begitu juga dengan >= semakin besar dari angkat tsb maka semakin abnormal
 <= semakin kecil angkanya dari hasil nilai abnormalitas maka semakin abnormal
 Sesuai kurva normalnya
Soal nomor 2.
2.1. Tabel PICO
Unsur PICO Analisis
P (Patient) Older patients
I (Intervention) Mini-Cog
C (Comparison) MMSE
O (Outcome) Detecting Alzheimer’s Disease or dementia

2.2. Clinical Question

In Older Patients, is Mini-Cog test as accurate as the MMSE in detecting Alzheimer’s Disease
or Dementia?

2.3. Keyword
MMSE AND Mini-Cog AND Alzheimer’s OR Dementia
MMSE AND Mini-Cog AND Alzheimer’s Disease

2.4. Search
https://www.ncbi.nlm.nih.gov

https://www.tripdatabase.com/search?criteria=MMSE+AND+Mini-
Cog+AND+Alzheimer’s+OR+Dementia
2.5. Abstract
Cognitive tests for dementia: MMSE, Mini-Cog and ACE-R

The way we diagnose and detect dementia, therefore, is by systematically assessing the
function of various brain regions by using cognitive tests.‘Cognitive’ here means the
‘higher brain functions’ I alluded to earlier; things like memory, numeracy, visual
perception, personality change and planning, to name a few.
The commonest cognitive test used is called the Mini-Mental State Examination
(MMSE). In this test you can score up to 30 points by answering a range of questions
that test your orientation to time and place, your memory, attention and so on. The test
itself takes about 10 minutes to complete. As the authors of this paper state, the
performance of the MMSE in detecting dementia as compared to other tests has not
been systematically assessed and so, that is what they set out to do. One of the reasons
to assess the relative merits of the MMSE is that it is a proprietary instrument, owned
by ‘Psychological Assessment Resources’ meaning that it is not actually free for
organisations to use.
Methods
The reviewers included studies that:
 Looked for patients with either Alzheimer’s, vascular dementia or Parkinson’s disease
in any clinical setting
 Assessed patients or carers face-to-face
 Used a standardised diagnostic criteria to diagnose dementia
 Published the outcome measures they were interested in.
Results
The initial search yielded 26,380 papers! After applying the inclusion/exclusion criteria
they were left with 149 studies, which covered 11 different diagnostic tests and over
40,000 people from around the world.
MMSE
 The vast majority of the studies looked at MMSE (108 of 149)
 Sample size was 36,080 of whom 10,263 had dementia
 From these studies the:
o Mean sensitivity was 81% (CI was 78% to 84%)
o Mean specificity was 89% (CI was 87% to 91%)
o All other markers also showed good diagnostic accuracy (LR+ = 7.45, LR- =
0.21, diagnostic OR was 35.4 and AUC was 92%)
Mini-Cog and ACE-R (the best of the rest)
 Of the 11 remaining tests, two stood out as being ‘better’ than the MMSE
o Mini-Cog (brief test <5 min): sensitivity of 91% and specificity of 86%
o ACE-R (20 min test): sensitivity of 92% and specificity of 89%
 However where the MMSE data was drawn from hundreds of studies:
o Mini-Cog data was drawn from just 9 studies
o ACE-R was drawn from just 13 studies
For all three of the above tests, there was found to be a high degree of heterogeneity.
In essence this is a statistical test telling us that between studies included in the
analyses, the results were quite different from one study to another. Heterogeneity is not
a good thing in systematic reviews.

Further analyses
The reviewers showed that the accuracy of the MMSE was not affected by geographical
location or clinical site (i.e. it was as effective for hospital patients as community
patients).
Finally they looked at the accuracy of diagnosing mild cognitive impairment (MCI); a
risk state that precedes dementia. They didn’t really go into much detail in the methods
of how they found the studies or how they defined MCI.
 Only 21 studies using MMSE were used to assess diagnostic accuracy for MCI giving:
o a sensitivity of only 62%
o and a specificity of 87%.
 An alternative test, the MoCA, was found to perform better (in 9 studies) with:
o a sensitivity of 89%
o and a specificity of 75%
 No data was provided on the other tests presumably because there weren’t enough
studies.
Conclusions
In short, the MMSE is not a bad screening tool for dementia but it is not miles better
than the rest; it’s just really commonly used, probably for historical reasons. The ACE-
R and the Mini-Cog are both free to use and may be viable alternatives.
The MMSE is less good in mild cognitive impairment.
Final thoughts
It’s important to add that whilst this paper focussed on cognitive screening tests, which
play an important part in diagnosis, a full clinical assessment of someone with
suspected dementia requires a much more detailed approach. Combining information
from the history, examination, investigations and cognitive tests greatly improve the
diagnostic accuracy. Also where the screening tests are not clear, patients can be
referred for much more detailed assessments of cognition performed by
neuropsychologists.
Also it is important to remember that the diagnosis of dementia requires evidence of a
progressive illness. This means that repeating cognitive tests and looking for change is
often more helpful than just a snapshot. This aspect was not covered in this systematic
review.
2.6. Critical Appraisal
1. Validity Pada penelitian ini, variable yang diukur yaitu
berdasarkan skrinning untuk mendapatkan
kriteria diagnostik dementia dengan
menggunakan beberapa instrumen.
Pengumpulan data dilakukan dengan
melakukan wawancara tatapmuka secara
langsung.
Kesimpulan: Penelitian ini dapat dikatakan
valid dan baik.
2. Importance Penelitian ini penting karena hasil uji
diagnostik ini menunjukkan hasil bahwa
sensitivitas Mini-Cog dan ACE-R lebih tinggi
daripada MMSE. Sedangkan, spesifisitas Mini-
Cog lebih rendah dibandingkan MMSE dan
sama dengan ACE-R.
Kesimpulan: Melihat tujuan penelitian
maka dapat disimpulkan bahwa penelitian
ini penting dilakukan.
3. Applicability Penelitian ini dapat diterapkan dalam praktik
klinis untuk skrinning dementia karena
berdasarkan hasil penelitian, Mini-Cog dan
ACE-R lebih sensitive dan bisa dijadikan
alternatif MMSE.
Kesimpulan: Hasil penelitian dapat
diterapkan.
 LEMBAR TELAAH UJI DIAGNOSIS

Judul artikel :

Penulis utama :

Jurnal :

A. A. VALIDITAS; Apakah Uji diagnostik ini valid?

(Are the results of this diagnostic study valid?)

Apakah pemeriksaan uji dan baku emas Tidak, pemeriksaan uji dan baku emas
dilakukan secara tersamar? dilakukan secara jelas dan sesuai dengan
metode yang ada.

Apakah uji diagnostik ini mencakup spektrum Iya uji diagnostic ini mencakup spektrum
yg sesuai seperti dalam praktek? yang sesuai seperti praktek.

Apakah baku emas tetap diperiksa tanpa Iya, baku emas tetap diperiksa tanpa
melihat hasil uji diagnostik? melihat hasil uji diagnostik

A. B. IMPORTANCE (Apakahh uji diagnstik ini penting?

(Are the valid results of this diagnostic study important?)

Sensitivity = a/(a+c) 118/ 262=0.4503= 45,03%

Specificity = d/(b+d)
Positive Predictive Value = a/(a+b)
Negative Predictive Value = d/(c+d)
Likelihood ratio for a positive test result
= LR+ = sens/(1-spec)
Likelihood ratio for a negative test
result = LR - = (1-sens)/spec
Pre-test probability (prevalence) = (a+c)/
(a+b+c+d)
Pre-test odds = prevalence/(1-
prevalence)
Post-test odds = pre-test odds  LR
Post-test probability = post-test odds/
(post-test odds +1)
128/194=0,6597= 65,97%
118/184= 0,6413= 64,3%
128/272= 0,4705= 47,05%
0,4503/(1-0,6597)= 1,3232= 132,32%
1-0,4503/0,6597=0,8332=83,32%
262/456= 0,5745=57,45%
0,5475/(1-0,5475)= 1,2099=120,99%
1,2099 x0,8332= 1,0081= 100,81%
1,0081/(1,0081+1)=0.5020= 50,2%
 CALCULATIONS

Target disorder Totals

Present Absent
118 66 184
Diagnostic test result
144 128 272
Totals 262 164 456

C.APLICABILITY:
DAPATKAN KITA MENERAPKAN HASIL STUDI INI PADA PASIEN KITA?

Apakah pasien kita mirip dengan pasien pada studi Iya pasien kita mirip dengan pasien
diagnostik ini? pada studi diagnostic ini, yaitu infant
berusia kurang dari 2 bulan
Apakah kita dapat memperkkirakan prevalensi (pre- Iya
test probability) pasien kita?(berdasakan pengalaman,
pustaka, dll)

Apakaha hasil uji diagnostik ini, khususnya nilai Iya

rediksi positif (NPP) nya membantu tata laksana
terhadap pasien kita?

Apakah secara keseluruhan uji ini membantu pasien Iya, keseluruhan uji ini dapat
kita? membantu pasien kita terutama
apabila pasien sedang dalam
serangan infeksi saluran nafas
dengan gejala nafas yang cepat
Lampiran Jurnal
Nomor 3.
Data Diagnostik