Tran Jason, Nimojan Tristen, Saripella Aparna, Tang-Wai David F, Butris Nina, Kapoor Paras, Berezin Linor, Englesakis Marina, Chung Frances
Department of Medicine, University of Ottawa, Ottawa, Canada.
Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Canada.
J Clin Anesth. 2022 Jun;78:110682. doi: 10.1016/j.jclinane.2022.110682. Epub 2022 Feb 19.
Mild cognitive impairment (MCI) is a high-risk precursor to dementia, post-operative delirium, and prolonged hospitalization. There is a need for preoperative rapid cognitive screening tools.
To evaluate the predictive parameters of rapid MCI screening tools in different clinical settings for preoperative application.
Systematic review and meta-analyses searching Medline, and other databases from inception to May 26, 2021. The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines were followed for data curation and quality assessment. Title and abstract screening were conducted independently via Rayyan. Data was curated through a random-effects model and statistical analysis used R-software.
Community, memory clinic, emergency, long-term care, and in-patient settings. There were no studies in the preoperative setting.
Twenty-three studies with 9973 patients (≥ 60 years old) undergoing rapid MCI screening.
Rapid (≤ 5 min) MCI screening tools.
Pooled predictive parameters (sensitivity, specificity) of screening tests.
Eighteen screening tools, compared to neuropsychological tests, were identified. The overall prevalence of MCI among the Rapid Cognitive Screen (RCS), Six-item Screener (SIS), Mini-Cog, and Clock Drawing Test (CDT) studies were 24.6%, 28.3%, 40.9%, and 20.7%, respectively. RCS has 82% sensitivity and 79% specificity in detecting MCI. SIS has 61% sensitivity and 89% specificity. Mini-Cog has 52% sensitivity and 80% specificity. CDT has 56% sensitivity and 59% specificity. Seven other index tools had high sensitivities of 97%-82% and specificities of 90%-73% but were studied only once.
No rapid screening tools had been validated in the surgical population. In other populations, RCS may be a promising screening tool for MCI with stronger sensitivity and specificity than Mini-Cog, SIS, and CDT. CDT alone is ineffective for MCI detection. Further validation in the preoperative setting is required to determine the efficacy of these screening tools.
轻度认知障碍（MCI）是痴呆、术后谵妄和长期住院的高危前驱症状。术前快速认知筛查工具很有必要。
评估快速MCI筛查工具在不同临床环境中用于术前的预测参数。
系统评价和荟萃分析，检索Medline及其他数据库，时间跨度从建库至2021年5月26日。数据整理和质量评估遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。通过Rayyan独立进行标题和摘要筛选。数据通过随机效应模型进行整理，使用R软件进行统计分析。
社区、记忆门诊、急诊科、长期护理机构和住院环境。术前环境中没有相关研究。
23项研究，共9973名（≥60岁）接受快速MCI筛查的患者。
快速（≤5分钟）MCI筛查工具。
筛查试验的合并预测参数（敏感性、特异性）。
与神经心理学测试相比，识别出18种筛查工具。在快速认知筛查（RCS）、六项筛查量表（SIS）、简易认知评估量表（Mini-Cog）和画钟试验（CDT）研究中，MCI的总体患病率分别为24.6%、28.3%、40.9%和20.7%。RCS检测MCI的敏感性为82%，特异性为79%。SIS的敏感性为61%，特异性为89%。Mini-Cog的敏感性为52%，特异性为80%。CDT的敏感性为56%，特异性为59%。其他七种指标工具的敏感性为97%-82%，特异性为90%-73%，但仅被研究过一次而已。
尚无快速筛查工具在手术人群中得到验证。在其他人群中，RCS可能是一种有前景的MCI筛查工具，其敏感性和特异性比Mini-Cog、SIS和CDT更强。单独使用CDT检测MCI无效。需要在术前环境中进一步验证，以确定这些筛查工具的有效性。
