Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada.
Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Am Geriatr Soc. 2021 Jun;69(6):1429-1440. doi: 10.1111/jgs.17190. Epub 2021 May 4.
BACKGROUND/OBJECTIVES: Virtual (i.e., telephone or videoconference) care was broadly implemented because of the COVID-19 pandemic. Our objectives were to compare the diagnostic accuracy of virtual to in-person cognitive assessments and tests and barriers to virtual cognitive assessment implementation.
Systematic review and meta-analysis.
MEDLINE, EMBASE, CDSR, CENTRAL, PsycINFO, and gray literature (inception to April 1, 2020).
Studies describing the accuracy or reliability of virtual compared with in-person cognitive assessments (i.e., reference standard) for diagnosing dementia or mild cognitive impairment (MCI), identifying virtual cognitive test cutoffs suggestive of dementia or MCI, or describing correlations between virtual and in-person cognitive test scores in adults.
Reviewer pairs independently conducted study screening, data abstraction, and risk of bias appraisal.
Our systematic review included 121 studies (15,832 patients). Two studies demonstrated that virtual cognitive assessments could diagnose dementia with good reliability compared with in-person cognitive assessments: weighted kappa 0.51 (95% confidence interval [CI] 0.41-0.62) and 0.63 (95% CI 0.4-0.9), respectively. Videoconference-based cognitive assessments were 100% sensitive and specific for diagnosing dementia compared with in-person cognitive assessments in a third study. No studies compared telephone with in-person cognitive assessment accuracy. The Telephone Interview for Cognitive Status (TICS; maximum score 41) and modified TICS (maximum score 50) were the only virtual cognitive tests compared with in-person cognitive assessments in >2 studies with extractable data for meta-analysis. The optimal TICS cutoff suggestive of dementia ranged from 22 to 33, but it was 28 or 30 when testing was conducted in English (10 studies; 1673 patients). Optimal modified TICS cutoffs suggestive of MCI ranged from 28 to 31 (3 studies; 525 patients). Sensory impairment was the most often voiced condition affecting assessment.
Although there is substantial evidence supporting virtual cognitive assessment and testing, we identified critical gaps in diagnostic certainty.
背景/目的：由于 COVID-19 大流行，虚拟（即电话或视频会议）护理得到了广泛的应用。我们的目标是比较虚拟与面对面认知评估的诊断准确性，以及实施虚拟认知评估的障碍。
系统评价和荟萃分析。
MEDLINE、EMBASE、CDSR、CENTRAL、PsycINFO 和灰色文献（从成立到 2020 年 4 月 1 日）。
描述虚拟与面对面认知评估（即参考标准）在诊断痴呆或轻度认知障碍（MCI）、确定提示痴呆或 MCI 的虚拟认知测试截止值，或描述成人虚拟和面对面认知测试分数之间相关性的研究。
审查员对研究进行了独立的筛选、数据提取和偏倚风险评估。
我们的系统综述包括 121 项研究（15832 名患者）。两项研究表明，与面对面认知评估相比，虚拟认知评估可以可靠地诊断痴呆：加权kappa 值分别为 0.51（95%置信区间 [CI] 0.41-0.62）和 0.63（95% CI 0.4-0.9）。第三项研究表明，与面对面认知评估相比，基于视频会议的认知评估对诊断痴呆具有 100%的敏感性和特异性。没有研究比较电话与面对面认知评估的准确性。电话认知状态测试（TICS；最高得分为 41）和改良 TICS（最高得分为 50）是仅有的两项与超过 2 项具有可提取数据进行荟萃分析的面对面认知评估进行比较的虚拟认知测试。提示痴呆的最佳 TICS 截止值范围为 22 至 33，但在英语测试中（10 项研究；1673 名患者）为 28 或 30。提示 MCI 的最佳改良 TICS 截止值范围为 28 至 31（3 项研究；525 名患者）。感觉障碍是影响评估的最常见状况。
尽管有大量证据支持虚拟认知评估和测试，但我们发现诊断确定性存在关键差距。
