Cognitive Tests to Detect Dementia A Systematic Review and Meta-analysis
Cognitive Tests to Detect Dementia A Systematic Review and Meta-analysis
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DOI：
10.1001/jamainternmed.2015.2152
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发表时间：
2015-09-01
影响因子：
39
通讯作者：
Kwok, Timothy C. Y.
中科院分区：
文献类型：
--
作者：
Tsoi, Kelvin K. F.;Chan, Joyce Y. C.;Kwok, Timothy C. Y.
重要性痴呆症是一个全球性的公共卫生问题。简易智力状态检查(MMSE)是一种专有的痴呆症检测工具，但也有许多其他测试可用。目的评估所有认知测试对痴呆症的诊断性能。DATA来源文献搜索从个别数据库中最早的可用日期到2014年9月1日在MEDLINE、EMBASE和JunchoINFO中搜索痴呆症筛查测试列表。由于Google Scholar在每篇文章中使用引用计数和关键词的组合排名算法来搜索文献，因此我们的文献搜索扩展到Google Scholar，使用个人测试名称和痴呆症筛查作为辅助搜索。如果参与者与各自的筛查测试面对面交谈，并将结果与痴呆的标准诊断标准进行比较，则符合条件的STUDY选择研究符合条件。采用双变量随机效应模型，用受试者-操作特征曲线下的面积来表示总体表现，主要结果为MAIN结果和测量灵敏度、特异度和正负似然比。结果在149项研究中，超过49000人参与了11项筛选试验。大多数研究使用MMSE(n=102)，包括10263名痴呆症患者。联合检测痴呆的敏感度和特异度分别为0.81(95%CI，0.78~0.84)和0.89(95%CI，0.87~0.91)。在其他10项测试中，Mini-Cog测验和Addenbrooke认知测验修订版(ACE-R)的诊断效果最好，与MMSE相当(Mini-Cog，0.91敏感性和0.86特异性；ACE-R，0.92敏感性和0.89特异性)。亚组分析显示，只有蒙特利尔认知评估在检测轻度认知障碍方面的表现与MMSE相当，灵敏度为0.89，特异度为0.75。结论除MMSE外，还有许多其他测试对痴呆的诊断性能与MMSE相当。Mini-Cog测试和ACE-R是痴呆症的最佳替代筛查测试，蒙特利尔认知评估是轻度认知障碍的最佳替代测试。
IMPORTANCE Dementia is a global public health problem. The Mini-Mental State Examination (MMSE) is a proprietary instrument for detecting dementia, but many other tests are also available.OBJECTIVE To evaluate the diagnostic performance of all cognitive tests for the detection of dementia.DATA SOURCES Literature searches were performed on the list of dementia screening tests in MEDLINE, EMBASE, and PsychoINFO from the earliest available dates stated in the individual databases until September 1, 2014. Because Google Scholar searches literature with a combined ranking algorithm on citation counts and keywords in each article, our literature search was extended to Google Scholar with individual test names and dementia screening as a supplementary search.STUDY SELECTION Studies were eligible if participants were interviewed face to face with respective screening tests, and findings were compared with criterion standard diagnostic criteria for dementia. Bivariate random-effects models were used, and the area under the summary receiver-operating characteristic curve was used to present the overall performance.MAIN OUTCOMES AND MEASURES Sensitivity, specificity, and positive and negative likelihood ratios were the main outcomes.RESULTS Eleven screening tests were identified among 149 studies with more than 49 000 participants. Most studies used the MMSE (n = 102) and included 10 263 patients with dementia. The combined sensitivity and specificity for detection of dementia were 0.81 (95% CI, 0.78-0.84) and 0.89 (95% CI, 0.87-0.91), respectively. Among the other 10 tests, the Mini-Cog test and Addenbrooke's Cognitive Examination-Revised (ACE-R) had the best diagnostic performances, which were comparable to that of the MMSE (Mini-Cog, 0.91 sensitivity and 0.86 specificity; ACE-R, 0.92 sensitivity and 0.89 specificity). Subgroup analysis revealed that only the Montreal Cognitive Assessment had comparable performance to the MMSE on detection of mild cognitive impairment with 0.89 sensitivity and 0.75 specificity.CONCLUSIONS AND RELEVANCE Besides the MMSE, there are many other tests with comparable diagnostic performance for detecting dementia. The Mini-Cog test and the ACE-R are the best alternative screening tests for dementia, and the Montreal Cognitive Assessment is the best alternative for mild cognitive impairment.