Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya 461-8673, Japan.
Department of Rehabilitation, Nagoya Ekisaikai Hospital, 4-66 Syonen-cho, Nakagawa-ku, Nagoya 454-8502, Japan.
Eur J Cardiovasc Nurs. 2022 Nov 23;21(8):840-847. doi: 10.1093/eurjcn/zvac017.
Cognitive decline is prevalent among patients with cardiovascular disease (CVD). Cognitive measurement has been considered as a standard assessment for secondary prevention; however, standard cognitive tests are sometimes infeasible due to time constraints. This study aimed to examine the association between the Rapid Dementia Screening Test (RDST), a brief screening tool for cognitive function, and clinical events in elderly patients with CVD.
This retrospective cohort study included 140 hospitalized patients with CVD who participated in inpatient cardiac rehabilitation (median age, 75 years; male, 67%). Cognitive function for each patient was assessed using the RDST and Montreal Cognitive Assessment (MoCA), a standard test of mild cognitive impairment. The clinical events assessed as outcomes included all-cause mortality and unplanned rehospitalization. Receiver-operating characteristic (ROC) curve analysis showed similar predictive accuracy for the study outcome (P = 0.337) between the RDST [area under the curve, 0.651; 95% confidence interval (CI), 0.559-0.743] and MoCA (0.625; 0.530-0.720). The ROC analysis identified a cut-off value of 9 points for the RDST (sensitivity, 77.8%; specificity, 50.5%). Patients with RDST ≤9 showed a poor survival rate compared with those with ≥10 points (log-rank test, P = 0.002; hazard ratio, 2.94, 95% CI, 1.46-5.94). This result was consistent even after adjusting for potential confounders.
The RDST was associated with clinical events in elderly patients with CVD and its predictive capability was comparable with that of MoCA, a standard cognitive test. The RDST may be useful in CVD as an alternative screening tool for cognitive decline.
认知能力下降在心血管疾病（CVD）患者中较为常见。认知能力评估已被视为二级预防的标准评估方法；然而，由于时间限制，标准认知测试有时并不适用。本研究旨在探讨快速痴呆筛查测试（RDST）与老年 CVD 患者临床事件之间的关联，RDST 是一种用于评估认知功能的简短筛查工具。
本回顾性队列研究纳入了 140 名住院 CVD 患者，这些患者参与了住院心脏康复治疗（中位年龄为 75 岁，男性占 67%）。每位患者的认知功能均使用 RDST 和蒙特利尔认知评估（MoCA）进行评估，MoCA 是一种用于评估轻度认知障碍的标准测试。作为评估结果的临床事件包括全因死亡率和非计划性再住院。受试者工作特征（ROC）曲线分析显示，RDST 和 MoCA 对研究结果的预测准确性相当（P = 0.337）[RDST 的曲线下面积为 0.651（95%置信区间为 0.559-0.743），MoCA 的曲线下面积为 0.625（95%置信区间为 0.530-0.720）]。ROC 分析确定 RDST 的截断值为 9 分（敏感性为 77.8%，特异性为 50.5%）。RDST≤9 的患者的生存率明显低于 RDST≥10 的患者（对数秩检验，P = 0.002；风险比为 2.94，95%置信区间为 1.46-5.94）。即使在调整了潜在混杂因素后，这一结果仍然成立。
RDST 与老年 CVD 患者的临床事件相关，其预测能力与 MoCA 相当，MoCA 是一种标准认知测试。RDST 可能作为认知能力下降的替代筛查工具，在 CVD 中具有一定的应用价值。
