Dyer Suzanne M, Laver Kate, Friel Margeret, Whitehead Craig, Crotty Maria
Department of Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, Adelaide, SA, and; NHMRC Partnership Centre in Cognitive and Functional Decline, The University of Sydney, Sydney, NSW, Australia.
Alzheimer's Australia Consumer Dementia Research Network, Canberra, ACT, Australia.
Australas Psychiatry. 2017 Jun;25(3):282-287. doi: 10.1177/1039856216684735. Epub 2017 Jan 10.
The objective of this study was to conduct a systematic review of evidence for the accuracy of the Kimberley Indigenous Cognitive Assessment (KICA) tool in supporting the diagnosis of dementia in Indigenous Australian populations.
Cross-sectional diagnostic accuracy studies of the KICA with an appropriate reference standard published to November 2015 were included. Comparison to an alternative cognitive assessment tool was required in non-remote populations. Case control analyses were excluded.
Four studies were included: one of the KICA-Cog and KICA-Carer, one of the KICA Screen, and two of the modified-KICA. All tools developed for remote populations had a sensitivity of ≥76% and a specificity of ≥71% for the diagnosis of dementia. The KICA-Cog and KICA-Carer conducted in series had the highest sensitivity and specificity (91% and 94% respectively). In an urban and regional population, the mKICA had similar accuracy to the Mini-Mental State Examination (MMSE) (AUC 0.93, 95% CI 0.88-0.99 vs 0.94, 95% CI 0.89-0.99). Key risk of bias limitations related to lack of pre-determined cut-points and population selection methods.
The use of the KICA in remote Indigenous Australians may assist in timely diagnosis of dementia in this population. Using the KICA-Cog and KICA-Carer in series may maximise specificity, decreasing false positive results without compromising sensitivity.
本研究的目的是对金伯利原住民认知评估（KICA）工具在支持澳大利亚原住民痴呆症诊断准确性方面的证据进行系统评价。
纳入截至2015年11月发表的、采用适当参考标准对KICA进行的横断面诊断准确性研究。非偏远地区人群需要与另一种认知评估工具进行比较。排除病例对照分析。
纳入四项研究：一项关于KICA-Cog和KICA-Carer，一项关于KICA筛查，两项关于改良KICA。所有为偏远地区人群开发的工具在痴呆症诊断方面的敏感性≥76%，特异性≥71%。串联使用的KICA-Cog和KICA-Carer具有最高的敏感性和特异性（分别为91%和94%）。在城市和地区人群中，改良KICA的准确性与简易精神状态检查表（MMSE）相似（曲线下面积0.93，95%置信区间0.88 - 0.99，对比0.94，95%置信区间0.89 - 0.99）。主要的偏倚风险限制与缺乏预先确定的切点和人群选择方法有关。
在偏远的澳大利亚原住民中使用KICA可能有助于及时诊断该人群中的痴呆症。串联使用KICA-Cog和KICA-Carer可使特异性最大化，减少假阳性结果，同时不影响敏感性。
