轻度认知障碍(MCI)是痴呆的高危前兆,术后谵妄,和长期住院。需要术前快速认知筛查工具。
评估不同临床环境下快速MCI筛查工具的预测参数,以利于术前应用。
搜索Medline的系统评价和荟萃分析,和其他数据库从成立到2021年5月26日。遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目进行数据分析和质量评估。标题和摘要筛选通过Rayyan独立进行。通过随机效应模型收集数据,并使用R软件进行统计分析。
社区,记忆诊所,紧急情况,长期护理,和住院设置。术前没有研究。
23项研究涉及9973名患者(≥60岁)接受快速MCI筛查。
快速(≤5分钟)MCI筛选工具。
汇集的预测参数(灵敏度,特异性)筛查试验。
18种筛选工具,与神经心理学测试相比,已确定。MCI在快速认知筛查(RCS)中的总体患病率,六项筛选器(SIS),迷你齿轮,时钟绘制测试(CDT)研究为24.6%,28.3%,40.9%,和20.7%,分别。RCS在检测MCI方面具有82%的灵敏度和79%的特异性。SIS具有61%的灵敏度和89%的特异性。Mini-Cog具有52%的灵敏度和80%的特异性。CDT具有56%的灵敏度和59%的特异性。其他七种指数工具具有97%-82%的高灵敏度和90%-73%的特异性,但只进行了一次研究。
在手术人群中没有验证快速筛查工具。在其他人群中,RCS可能是MCI的一个有前途的筛选工具,具有比Mini-Cog更强的敏感性和特异性,SIS,和CDT。单独的CDT对于MCI检测是无效的。需要在术前设置中进一步验证以确定这些筛查工具的功效。
Mild cognitive impairment (MCI) is a high-risk precursor to dementia, post-operative delirium, and prolonged hospitalization. There is a need for preoperative rapid cognitive screening tools.
To evaluate the predictive parameters of rapid MCI screening tools in different clinical settings for preoperative application.
Systematic
review and meta-analyses searching Medline, and other databases from inception to May 26, 2021. The Preferred Reporting Items for Systematic
Review and Meta-analyses (PRISMA) guidelines were followed for data curation and quality assessment. Title and abstract screening were conducted independently via Rayyan. Data was curated through a random-effects model and statistical analysis used R-software.
Community, memory clinic, emergency, long-term care, and in-patient settings. There were no studies in the preoperative setting.
Twenty-three studies with 9973 patients (≥ 60 years old) undergoing rapid MCI screening.
Rapid (≤ 5 min) MCI screening tools.
Pooled predictive parameters (sensitivity, specificity) of screening tests.
Eighteen screening tools, compared to neuropsychological tests, were identified. The overall prevalence of MCI among the Rapid Cognitive Screen (RCS), Six-item Screener (SIS), Mini-Cog, and Clock Drawing Test (CDT) studies were 24.6%, 28.3%, 40.9%, and 20.7%, respectively. RCS has 82% sensitivity and 79% specificity in detecting MCI. SIS has 61% sensitivity and 89% specificity. Mini-Cog has 52% sensitivity and 80% specificity. CDT has 56% sensitivity and 59% specificity. Seven other index tools had high sensitivities of 97%-82% and specificities of 90%-73% but were studied only once.
No rapid screening tools had been validated in the surgical population. In other populations, RCS may be a promising screening tool for MCI with stronger sensitivity and specificity than Mini-Cog, SIS, and CDT. CDT alone is ineffective for MCI detection. Further validation in the preoperative setting is required to determine the efficacy of these screening tools.