Aslam Rabeea'h W, Bates Vickie, Dundar Yenal, Hounsome Juliet, Richardson Marty, Krishan Ashma, Dickson Rumona, Boland Angela, Kotas Eleanor, Fisher Joanne, Sikdar Sudip, Robinson Louise
Liverpool Review and Implementation Group (LRiG), University of Liverpool, Liverpool, UK.
Community Mental Health Team, Mersey Care NHS Foundation Trust, Southport, UK.
Health Technol Assess. 2016 Oct;20(77):1-74. doi: 10.3310/hta20770.
Cognitive impairment is a growing public health concern, and is one of the most distinctive characteristics of all dementias. The timely recognition of dementia syndromes can be beneficial, as some causes of dementia are treatable and are fully or partially reversible. Several automated cognitive assessment tools for assessing mild cognitive impairment (MCI) and early dementia are now available. Proponents of these tests cite as benefits the tests' repeatability and robustness and the saving of clinicians' time. However, the use of these tools to diagnose and/or monitor progressive cognitive impairment or response to treatment has not yet been evaluated.
The aim of this review was to determine whether or not automated computerised tests could accurately identify patients with progressive cognitive impairment in MCI and dementia and, if so, to investigate their role in monitoring disease progression and/or response to treatment.
Five electronic databases (MEDLINE, EMBASE, The Cochrane Library, ISI Web of Science and PsycINFO), plus ProQuest, were searched from 2005 to August 2015. The bibliographies of retrieved citations were also examined. Trial and research registers were searched for ongoing studies and reviews. A second search was run to identify individual test costs and acquisition costs for the various tools identified in the review.
Two reviewers independently screened all titles and abstracts to identify potentially relevant studies for inclusion in the review. Full-text copies were assessed independently by two reviewers. Data were extracted and assessed for risk of bias by one reviewer and independently checked for accuracy by a second. The results of the data extraction and quality assessment for each study are presented in structured tables and as a narrative summary.
The electronic searching of databases, including ProQuest, resulted in 13,542 unique citations. The titles and abstracts of these were screened and 399 articles were shortlisted for full-text assessment. Sixteen studies were included in the diagnostic accuracy review. No studies were eligible for inclusion in the review of tools for monitoring progressive disease. Eleven automated computerised tests were assessed in the 16 included studies. The overall quality of the studies was good; however, the wide range of tests assessed and the non-standardised reporting of diagnostic accuracy outcomes meant that meaningful synthesis or statistical analysis was not possible.
The main limitation of this review is the substantial heterogeneity of the tests assessed in the included studies. As a result, no meta-analyses could be undertaken.
The quantity of information available is insufficient to be able to make recommendations on the clinical use of the computerised tests for diagnosing and monitoring MCI and early dementia progression. The value of these tests also depends on the costs of acquisition, training, administration and scoring.
Research is required to establish stable cut-off points for automated computerised tests that are used to diagnose patients with MCI or early dementia. Additionally, the costs associated with acquiring and using these tests in clinical practice should be estimated.
The study is registered as PROSPERO CRD42015025410.
The National Institute for Health Research Health Technology Assessment programme.
认知障碍是一个日益受到关注的公共卫生问题，也是所有痴呆症最显著的特征之一。及时识别痴呆综合征可能有益，因为某些痴呆病因是可治疗的，且能完全或部分逆转。目前有几种用于评估轻度认知障碍（MCI）和早期痴呆的自动化认知评估工具。这些测试的支持者认为其具有可重复性、稳健性以及能节省临床医生时间等优点。然而，这些工具用于诊断和/或监测进行性认知障碍或治疗反应的情况尚未得到评估。
本综述的目的是确定自动化计算机测试能否准确识别MCI和痴呆患者中的进行性认知障碍患者；如果可以，则研究其在监测疾病进展和/或治疗反应中的作用。
检索了五个电子数据库（MEDLINE、EMBASE、Cochrane图书馆、ISI科学网和PsycINFO）以及ProQuest，检索时间为2005年至2015年8月。还检查了检索到的参考文献的书目。检索试验和研究登记册以查找正在进行的研究和综述。进行了第二次检索以确定综述中确定的各种工具的单个测试成本和购置成本。
两名综述作者独立筛选所有标题和摘要，以确定可能相关的研究纳入综述。全文由两名综述作者独立评估。数据由一名综述作者提取并评估偏倚风险，另一名作者独立检查准确性。每项研究的数据提取和质量评估结果以结构化表格和叙述性总结的形式呈现。
包括ProQuest在内的数据库电子检索共得到13542条独特的参考文献。筛选了这些文献的标题和摘要，399篇文章入围全文评估。16项研究纳入了诊断准确性综述。没有研究符合纳入监测进行性疾病工具综述的条件。16项纳入研究中评估了11种自动化计算机测试。研究的总体质量良好；然而，评估的测试种类繁多以及诊断准确性结果的报告不标准化意味着无法进行有意义的综合或统计分析。
本综述的主要局限性是纳入研究中评估的测试存在实质性异质性。因此，无法进行荟萃分析。
现有信息量不足以就计算机测试在诊断和监测MCI及早期痴呆进展中的临床应用提出建议。这些测试的价值还取决于购置、培训、管理和评分成本。
需要开展研究以确定用于诊断MCI或早期痴呆患者的自动化计算机测试的稳定截断点。此外，应估计在临床实践中获取和使用这些测试的相关成本。
该研究注册为PROSPERO CRD42015025410。
英国国家卫生研究院卫生技术评估计划。
