PDF(Pubmed)
Abstract：
UNASSIGNED: Current primary care cognitive assessment tools are either crude or time-consuming instruments that can only detect cognitive impairment when it is well established. This leads to unnecessary or late referrals to memory services, by which time the disease may have already progressed into more severe stages. Due to the COVID-19 pandemic, some memory services have adapted to the new environment by shifting to remote assessments of patients to meet service user demand. However, the use of remote cognitive assessments has been inconsistent, and there has been little evaluation of the outcome of such a change in clinical practice. Emerging research has highlighted computerized cognitive tests, such as the Integrated Cognitive Assessment (ICA), as the leading candidates for adoption in clinical practice. This is true both during the pandemic and in the post-COVID-19 era as part of healthcare innovation.
UNASSIGNED: The Accelerating Dementias Pathways Technologies (ADePT) Study was initiated in order to address this challenge and develop a real-world evidence basis to support the adoption of ICA as an inexpensive screening tool for the detection of cognitive impairment and improving the efficiency of the dementia care pathway.
UNASSIGNED: Ninety-nine patients aged 55-90 who have been referred to a memory clinic by a general practitioner (GP) were recruited. Participants completed the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome were compared with the specialist diagnosis obtained at the memory clinic.Participants were given the option to carry out a retest visit where they were again given the chance to take the ICA test either remotely or face-to-face.
UNASSIGNED: The primary outcome of the study compared GP referral with specialist diagnosis of mild cognitive impairment (MCI) and dementia. Of those the GP referred to memory clinics, 78% were necessary referrals, with ~22% unnecessary referrals, or patients who should have been referred to other services as they had disorders other than MCI/dementia. In the same population the ICA was able to correctly identify cognitive impairment in ~90% of patients, with approximately 9% of patients being false negatives. From the subset of unnecessary GP referrals, the ICA classified ~72% of those as not having cognitive impairment, suggesting that these unnecessary referrals may not have been made if the ICA was in use. ICA demonstrated a sensitivity of 93% for dementia and 83% for MCI, with a specificity of 80% for both conditions in detecting cognitive impairment. Additionally, the test-retest prediction agreement for the ICA was 87.5%.
UNASSIGNED: The results from this study demonstrate the potential of the ICA as a screening tool, which can be used to support accurate referrals from primary care settings, along with the work conducted in memory clinics and in secondary care. The ICA\'s sensitivity and specificity in detecting cognitive impairment in MCI surpassed the overall standard of care reported in existing literature.
UNASSIGNED: The Accelerating Dementias Pathways Technologies (ADePT) Study was initiated in order to address this challenge and develop a real-world evidence basis to support the adoption of ICA as an inexpensive screening tool for the detection of cognitive impairment and improving the efficiency of the dementia care pathway.
UNASSIGNED: Ninety-nine patients aged 55-90 who have been referred to a memory clinic by a general practitioner (GP) were recruited. Participants completed the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome were compared with the specialist diagnosis obtained at the memory clinic.Participants were given the option to carry out a retest visit where they were again given the chance to take the ICA test either remotely or face-to-face.
UNASSIGNED: The primary outcome of the study compared GP referral with specialist diagnosis of mild cognitive impairment (MCI) and dementia. Of those the GP referred to memory clinics, 78% were necessary referrals, with ~22% unnecessary referrals, or patients who should have been referred to other services as they had disorders other than MCI/dementia. In the same population the ICA was able to correctly identify cognitive impairment in ~90% of patients, with approximately 9% of patients being false negatives. From the subset of unnecessary GP referrals, the ICA classified ~72% of those as not having cognitive impairment, suggesting that these unnecessary referrals may not have been made if the ICA was in use. ICA demonstrated a sensitivity of 93% for dementia and 83% for MCI, with a specificity of 80% for both conditions in detecting cognitive impairment. Additionally, the test-retest prediction agreement for the ICA was 87.5%.
UNASSIGNED: The results from this study demonstrate the potential of the ICA as a screening tool, which can be used to support accurate referrals from primary care settings, along with the work conducted in memory clinics and in secondary care. The ICA\'s sensitivity and specificity in detecting cognitive impairment in MCI surpassed the overall standard of care reported in existing literature.
摘要：
■当前的初级保健认知评估工具要么是粗糙的，要么是耗时的工具，只有在建立良好的情况下才能检测到认知障碍。这导致对内存服务的不必要或延迟引用，到那时，疾病可能已经发展到更严重的阶段。由于COVID-19大流行，一些记忆服务已经适应了新的环境，转向远程评估患者，以满足服务用户的需求。然而,远程认知评估的使用一直不一致，在临床实践中，对这种变化的结果几乎没有评估。新兴的研究强调了计算机化的认知测试，如综合认知评估(ICA)，作为临床实践中采用的主要候选人。无论是在大流行期间，还是在后COVID-19时代，作为医疗保健创新的一部分，这都是如此。
■为了应对这一挑战并开发现实世界的证据基础，启动了加速痴呆途径技术（ADEPT）研究，以支持采用ICA作为一种廉价的筛查工具来检测认知障碍并提高痴呆护理途径的效率。
■招募了99名55-90岁的患者，这些患者已被全科医生（GP）转诊到记忆诊所。参与者在家中或诊所完成了ICA，以及病史和可用性问卷。将GP转诊和ICA结果与在记忆诊所获得的专家诊断进行比较。参与者可以选择进行重新测试访问，再次有机会远程或面对面进行ICA测试。
■该研究的主要结果比较了全科医生转诊与专家诊断的轻度认知障碍（MCI）和痴呆。在全科医生提到记忆诊所的那些人中，78%是必要的转介，约22%的不必要推荐，或由于患有MCI/痴呆以外的疾病而应转诊至其他服务的患者。在同一人群中，ICA能够正确识别约90％的患者的认知障碍，大约9%的患者是假阴性。从不必要的GP推荐的子集，ICA将约72%的人归类为没有认知障碍，这表明，如果使用ICA，这些不必要的转介可能不会发生。ICA对痴呆症的敏感性为93％，对MCI的敏感性为83％，对两种疾病的特异性均为80％。此外,ICA的测试-重测预测一致性为87.5%。
■这项研究的结果证明了ICA作为筛选工具的潜力，可以用来支持初级保健机构的准确转诊，以及在记忆诊所和二级保健中进行的工作。ICA检测MCI认知障碍的敏感性和特异性超过了现有文献报道的整体护理标准。
■为了应对这一挑战并开发现实世界的证据基础，启动了加速痴呆途径技术（ADEPT）研究，以支持采用ICA作为一种廉价的筛查工具来检测认知障碍并提高痴呆护理途径的效率。
■招募了99名55-90岁的患者，这些患者已被全科医生（GP）转诊到记忆诊所。参与者在家中或诊所完成了ICA，以及病史和可用性问卷。将GP转诊和ICA结果与在记忆诊所获得的专家诊断进行比较。参与者可以选择进行重新测试访问，再次有机会远程或面对面进行ICA测试。
■该研究的主要结果比较了全科医生转诊与专家诊断的轻度认知障碍（MCI）和痴呆。在全科医生提到记忆诊所的那些人中，78%是必要的转介，约22%的不必要推荐，或由于患有MCI/痴呆以外的疾病而应转诊至其他服务的患者。在同一人群中，ICA能够正确识别约90％的患者的认知障碍，大约9%的患者是假阴性。从不必要的GP推荐的子集，ICA将约72%的人归类为没有认知障碍，这表明，如果使用ICA，这些不必要的转介可能不会发生。ICA对痴呆症的敏感性为93％，对MCI的敏感性为83％，对两种疾病的特异性均为80％。此外,ICA的测试-重测预测一致性为87.5%。
■这项研究的结果证明了ICA作为筛选工具的潜力，可以用来支持初级保健机构的准确转诊，以及在记忆诊所和二级保健中进行的工作。ICA检测MCI认知障碍的敏感性和特异性超过了现有文献报道的整体护理标准。
