Fage Bruce A, Chan Calvin Ch, Gill Sudeep S, Noel-Storr Anna H, Herrmann Nathan, Smailagic Nadja, Nikolaou Vasilis, Seitz Dallas P
Department of Psychiatry, University of Toronto, Toronto, Canada.
School of Medicine, Queen's University, Kingston, Canada.
Cochrane Database Syst Rev. 2021 Jul 14;7(7):CD010860. doi: 10.1002/14651858.CD010860.pub3.
Alzheimer's disease and related forms of dementia are becoming increasingly prevalent with the aging of many populations. The diagnosis of Alzheimer's disease relies on tests to evaluate cognition and discriminate between individuals with dementia and those without dementia. The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings.
The primary objective of this review was to determine the accuracy of the Mini-Cog for detecting dementia in a community setting. Secondary objectives included investigations of the heterogeneity of test accuracy in the included studies and potential sources of heterogeneity. These potential sources of heterogeneity included the baseline prevalence of dementia in study samples, thresholds used to determine positive test results, the type of dementia (Alzheimer's disease dementia or all causes of dementia), and aspects of study design related to study quality. Overall, the goals of this review were to determine if the Mini-Cog is a cognitive screening test that could be recommended to screen for cognitive impairment in community settings.
We searched MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (Ovid SP), Science Citation Index (Web of Science), BIOSIS previews (Web of Science), LILACS (BIREME), and the Cochrane Dementia Group's developing register of diagnostic test accuracy studies to March 2013. We used citation tracking (using the database's 'related articles' feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data.
We included all cross-sectional studies that utilized the Mini-Cog as an index test for the diagnosis of dementia when compared to a reference standard diagnosis of dementia using standardized dementia diagnostic criteria. For the current review we only included studies that were conducted on samples from community settings, and excluded studies that were conducted in primary care or secondary care settings. We considered studies to be conducted in a community setting where participants were sampled from the general population.
Information from studies meeting the inclusion criteria were extracted including information on the characteristics of participants in the studies. The quality of the studies was assessed using the QUADAS-2 criteria and summarized using risk of bias applicability and summary graphs. We extracted information on the diagnostic test accuracy of studies including the sensitivity, specificity, and 95% confidence intervals of these measures and summarized the findings using forest plots. Study specific sensitivities and specificities were also plotted in receiver operating curve space.
Three studies met the inclusion criteria, with a total of 1620 participants. The sensitivities of the Mini-Cog in the individual studies were reported as 0.99, 0.76 and 0.99. The specificity of the Mini-Cog varied in the individual studies and was 0.93, 0.89 and 0.83. There was clinical and methodological heterogeneity between the studies which precluded a pooled meta-analysis of the results. Methodological limitations were present in all the studies introducing potential sources of bias, specifically with respect to the methods for participant selection.
AUTHORS' CONCLUSIONS: There are currently few studies assessing the diagnostic test accuracy of the Mini-Cog in community settings. The limited number of studies and the methodological limitations that are present in the current studies make it difficult to provide recommendations for or against the use of the Mini-Cog as a cognitive screening test in community settings. Additional well-designed studies comparing the Mini-Cog to other brief cognitive screening tests are required in order to determine the accuracy and utility of the Mini-Cog in community based settings.
随着许多人口老龄化，阿尔茨海默病及相关形式的痴呆症正变得越来越普遍。阿尔茨海默病的诊断依赖于评估认知功能以及区分痴呆患者和非痴呆患者的测试。简易认知筛查量表（Mini-Cog）是一种简短的认知筛查测试，常用于在各种环境中评估老年人的认知功能。
本综述的主要目的是确定在社区环境中，简易认知筛查量表检测痴呆症的准确性。次要目的包括调查纳入研究中测试准确性的异质性以及异质性的潜在来源。这些潜在的异质性来源包括研究样本中痴呆症的基线患病率、用于确定测试阳性结果的阈值、痴呆症的类型（阿尔茨海默病性痴呆或所有病因导致的痴呆）以及与研究质量相关的研究设计方面。总体而言，本综述的目的是确定简易认知筛查量表是否是一种可推荐用于在社区环境中筛查认知障碍的认知筛查测试。
我们检索了MEDLINE（OvidSP）、EMBASE（OvidSP）、PsycINFO（Ovid SP）、科学引文索引（Web of Science）、BIOSIS预评（Web of Science）、拉丁美洲和加勒比地区健康科学数据库（LILACS，BIREME）以及Cochrane痴呆症小组截至2013年3月正在编制的诊断测试准确性研究登记册。我们使用引文跟踪（在可用的情况下，使用数据库的“相关文章”功能）作为额外的检索方法，并联系符合条件的研究的作者获取未发表的数据。
我们纳入了所有横断面研究，这些研究将简易认知筛查量表用作诊断痴呆症的指标测试，并与使用标准化痴呆诊断标准的痴呆症参考标准诊断进行比较。对于本次综述，我们仅纳入了对社区环境样本进行的研究，并排除了在初级保健或二级保健环境中进行的研究。我们认为在社区环境中进行的研究是指从普通人群中抽取参与者的研究。
提取符合纳入标准的研究中的信息，包括研究中参与者的特征信息。使用QUADAS-2标准评估研究质量，并通过偏倚风险适用性和汇总图表进行总结。我们提取了研究的诊断测试准确性信息，包括这些测量的敏感性、特异性和95%置信区间，并使用森林图总结结果。还在接受者操作特征曲线空间中绘制了研究特定的敏感性和特异性。
三项研究符合纳入标准，共有1620名参与者。简易认知筛查量表在各项研究中的敏感性分别报告为0.99、0.76和0.99。简易认知筛查量表的特异性在各项研究中有所不同，分别为0.93、0.89和0.83。研究之间存在临床和方法学异质性，这使得无法对结果进行汇总的荟萃分析。所有研究都存在方法学局限性，引入了潜在的偏倚来源，特别是在参与者选择方法方面。
目前很少有研究评估简易认知筛查量表在社区环境中的诊断测试准确性。现有研究数量有限且存在方法学局限性，这使得难以就是否在社区环境中使用简易认知筛查量表作为认知筛查测试给出建议。需要进行更多设计良好的研究，将简易认知筛查量表与其他简短认知筛查测试进行比较，以确定简易认知筛查量表在社区环境中的准确性和实用性。
