Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA.
Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA.
J Am Med Dir Assoc. 2022 Aug;23(8):1314.e31-1314.e88. doi: 10.1016/j.jamda.2022.03.019.
To identify research and practice gaps to establish future research priorities to advance the detection of cognitive impairment and dementia in the emergency department (ED).
Literature review and consensus-based rankings by a transdisciplinary, stakeholder task force of experts, persons living with dementia, and care partners.
Scoping reviews focused on adult ED patients.
Two systematic scoping reviews of 7 medical research databases focusing on best tools and approaches for detecting cognitive impairment and dementia in the ED in terms of (1) most accurate and (2) most pragmatic to implement. The results were screened, reviewed, and abstracted for relevant information and presented at the stakeholder consensus conference for discussion and ranked prioritization.
We identified a total of 1464 publications and included 45 to review for accurate tools and approaches for detecting cognitive impairment and dementia. Twenty-seven different assessments and instruments have been studied in the ED setting to evaluate cognitive impairment and dementia, with many focusing on sensitivity and specificity of instruments to screen for cognitive impairment. For pragmatic tools, we identified a total of 2166 publications and included 66 in the review. Most extensively studied tools included the Ottawa 3DY and Six-Item Screener (SIS). The SIS was the shortest to administer (1 minute). Instruments with the highest negative predictive value were the SIS (vs MMSE) and the 4 A's Test (vs expert diagnosis). The GEAR 2.0 Advancing Dementia Care Consensus conference ranked research priorities that included the need for more approaches to recognize more effectively and efficiently persons who may be at risk for cognitive impairment and dementia, while balancing the importance of equitable screening, purpose, and consequences of differentiating various forms of cognitive impairment.
The scoping review and consensus process identified gaps in clinical care that should be prioritized for research efforts to detect cognitive impairment and dementia in the ED setting. These gaps will be addressed as future GEAR 2.0 research funding priorities.
确定研究和实践差距，确定未来的研究重点，以提高急诊科（ED）认知障碍和痴呆的检测水平。
跨学科、利益相关者工作组的专家、痴呆症患者和护理伙伴进行文献回顾和基于共识的排名。
专注于成年 ED 患者的范围审查。
对 7 个医学研究数据库进行了两次系统范围审查，重点关注 ED 中用于检测认知障碍和痴呆的最佳工具和方法，具体包括（1）最准确和（2）最易于实施。对结果进行筛选、审查和提取相关信息，并在利益相关者共识会议上进行讨论和排名。
我们共确定了 1464 篇出版物，并纳入了 45 篇来审查用于检测认知障碍和痴呆的准确工具和方法。在 ED 环境中已经研究了 27 种不同的评估和工具来评估认知障碍和痴呆症，其中许多工具侧重于评估仪器筛查认知障碍的敏感性和特异性。对于实用工具，我们共确定了 2166 篇出版物，并纳入了 66 篇进行审查。研究最多的工具包括渥太华 3DY 和六项目筛查器（SIS）。SIS 的实施时间最短（1 分钟）。阴性预测值最高的仪器是 SIS（与 MMSE 相比）和 4A 测试（与专家诊断相比）。GEAR 2.0 推进痴呆护理共识会议确定了研究优先事项，其中包括需要更多的方法来更有效地识别可能有认知障碍和痴呆风险的人，同时平衡公平筛查、目的和区分各种形式的认知障碍的后果的重要性。
范围审查和共识过程确定了临床护理中的差距，这些差距应优先作为 ED 环境中检测认知障碍和痴呆的研究重点。这些差距将作为未来 GEAR 2.0 研究资金优先事项得到解决。
