Costa Raquel Quimas Molina da, Pompeu José Eduardo, Viveiro Larissa Alamino Pereira de, Brucki Sonia Maria Dozzi
Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil.
Arq Neuropsiquiatr. 2020 Nov;78(11):713-723. doi: 10.1590/0004-282X20200043.
Spatial disorientation has been observed in mild cognitive impairment (MCI) and is associated with a higher risk of progression to Alzheimer's disease (AD). However, there is no gold standard assessment for spatial orientation and paper-and-pencil tests lack ecological validity. Recently, there has been an increasing number of studies demonstrating the role of spatial disorientation as a cognitive marker of pathological decline, shedding new light on its importance for MCI. This systematic review aimed to investigate the accuracy of spatial orientation tasks for the diagnosis of MCI by comparison with cognitively healthy elderly. The search was conducted in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Web of Science, Scopus, Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO). Only original studies reporting spatial orientation assessment in MCI patients compared to a healthy control group were included. Studies were excluded if the MCI classification did not follow well described criteria and/or if accuracy results of spatial orientation assessment were not provided. Seven studies met the eligibility criteria, describing a variety of spatial orientation assessments including questionnaires, paper-and-pencil, office-based route learning, and computer-based and virtual reality tasks. Spatial orientation tasks demonstrated moderate to high accuracy in detecting elderly with MCI compared to cognitively healthy elderly, with areas under the curve (AUC) ranging from 0.77 to 0.99. However, important methodological issues were found in the selected studies which should be considered when interpreting results. Although the inclusion of spatial orientation assessments in MCI evaluations seems to have significant value, further studies are needed to clarify their true capacity to distinguish pathological from non-pathological aging.
在轻度认知障碍（MCI）中已观察到空间定向障碍，且其与进展为阿尔茨海默病（AD）的较高风险相关。然而，对于空间定向尚无金标准评估方法，纸笔测试缺乏生态效度。最近，越来越多的研究表明空间定向障碍作为病理衰退认知标志物的作用，为其对MCI的重要性提供了新的认识。本系统评价旨在通过与认知健康的老年人比较，研究空间定向任务对MCI诊断的准确性。检索在医学文献分析与检索系统在线数据库（MEDLINE/PubMed）、科学引文索引数据库、Scopus数据库、医学文摘数据库（Embase）、拉丁美洲和加勒比卫生科学文献数据库（Lilacs）以及科学电子图书馆在线数据库（SciELO）中进行。仅纳入了报告MCI患者与健康对照组相比的空间定向评估的原始研究。如果MCI分类未遵循详细描述的标准和/或未提供空间定向评估的准确性结果，则排除相关研究。七项研究符合纳入标准，描述了多种空间定向评估方法，包括问卷调查、纸笔测试、基于办公室的路线学习以及基于计算机和虚拟现实的任务。与认知健康的老年人相比，空间定向任务在检测MCI老年人方面显示出中度到高度的准确性，曲线下面积（AUC）范围为0.77至0.99。然而，在所选择的研究中发现了重要的方法学问题，在解释结果时应予以考虑。尽管在MCI评估中纳入空间定向评估似乎具有重要价值，但仍需要进一步研究以阐明其区分病理性衰老和非病理性衰老的真正能力。
