Diagnostic test accuracy of informant-based tools to diagnose dementia in older hospital patients with delirium: a prospective cohort study
Diagnostic test accuracy of informant-based tools to diagnose dementia in older hospital patients with delirium: a prospective cohort study
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DOI：
10.1093/ageing/afw065
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发表时间：
2016-07-01
期刊：
影响因子：
6.7
通讯作者：
Sheehan, Bart
中科院分区：
文献类型：
--
作者：
Jackson, Thomas A.;MacLullich, Alasdair M. J.;Sheehan, Bart
背景：谵妄与痴呆在医院中普遍共存。患有谵妄的老年人未确诊痴呆的比例很高，但谵妄影响认知测试在痴呆诊断中的使用。需要新的检测谵妄痴呆的方法。该研究的目的是调查信息工具在诊断患有谵妄的住院老年人痴呆症方面的诊断测试准确性。方法：采用老年认知能力下降简易问卷（IQCODE-SF）和70岁以上谵妄患者阿尔茨海默病8 （AD8）评估入院时痴呆的存在。参照标准诊断在3个月时使用精神障碍诊断与统计手册第四版（DSM-IV）标准。主要观察指标为IQCODE-SF和AD8在诊断DSM-IV痴呆中的诊断准确性。结果：3个月痴呆患病率为61%。入院IQCODE-SF的受试者工作特征曲线下面积为0.93 (P < 0.0005)，入院AD8的受试者工作特征曲线下面积为0.91 （P < 0.0005）。入院时IQCODE-SF测试结果bbb3.82，检测痴呆的敏感性为0.91(0.79-0.97)，特异性为0.93（0.76-0.99）。bbbb6的AD8检测痴呆的敏感性为0.83(0.69-0.92)，特异性为0.90（0.72-0.97）。结论：IQCODE-SF和AD8是检测老年谵妄患者既往痴呆的敏感和特异性工具。在实践中常规使用任何一种工具都可以通过提高对痴呆症患者的认识和管理来产生重要的临床影响。
Background: delirium and dementia co-exist commonly in hospital. Older people with delirium have high rates of undiagnosed dementia, but delirium affects the use of cognitive testing in dementia diagnosis. Novel methods to detect dementia in delirium are needed. The purpose of the study was to investigate the diagnostic test accuracy of informant tools to detect dementia in hospitalised older people with delirium.Methods: the presence of dementia on admission was assessed using the short form of the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE-SF) and Alzheimer's Disease 8 (AD8) in people over 70 years old with delirium. Reference standard diagnosis was made using Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria at 3 months. The main outcome measures were the diagnostic test accuracy of the IQCODE-SF and the AD8 in diagnosing DSM-IV dementia.Results: dementia prevalence at 3 months was 61%. The area under the receiver operating characteristic curve (AUROC) was 0.93 (P < 0.0005) for admission IQCODE-SF and 0.91 (P < 0.0005) for admission AD8. An IQCODE-SF test result of > 3.82 on admission had a sensitivity of 0.91 (0.79-0.97) and specificity of 0.93 (0.76-0.99) for detecting dementia. An AD8 of > 6 had a sensitivity of 0.83 (0.69-0.92) and specificity of 0.90 (0.72-0.97) for detecting dementia.Conclusion: the IQCODE-SF and AD8 are sensitive and specific tools to detect prior dementia in older people with delirium. The routine use of either tool in practice could have important clinical impact, by improving the recognition and hence management of those with dementia.