Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
PLoS One. 2023 Sep 12;18(9):e0291291. doi: 10.1371/journal.pone.0291291. eCollection 2023.
The Ascertain Dementia 8-item Questionnaire (AD8) is a screening tool for cognitive impairment that can be administered to older persons and/or their informants.
To evaluate the diagnostic accuracy and compare the predictive parameters of the informant and participant-completed Ascertain Dementia 8-item Questionnaire (iAD8 and pAD8, respectively) in older adults with cognitive impairment.
METHODS/DESIGN: We searched ten electronic databases (including MEDLINE (Ovid), Embase) from tool inception to March 2022. We included studies with patients ≥60 years old that were screened for cognitive impairment using AD8 in any healthcare setting. Predictive parameters were assessed against reference standards to estimate accuracy and diagnostic ability using bivariate random-effects meta-analyses. We used QUADAS-2 criteria to assess risk of bias.
A cut-off of ≥2/8 was used to classify mild cognitive impairment (MCI), dementia, and cognitive impairment (MCI or dementia). Seven studies using the iAD8 (n = 794) showed a sensitivity of 80% and specificity of 79% to detect MCI. Nine studies using the iAD8 (n = 2393) established 91% sensitivity and 64% specificity to detect dementia. To detect MCI using the pAD8, four studies (n = 836) showed 57% sensitivity and 71% specificity. To detect dementia using the pAD8, four studies (n = 3015) demonstrated 82% sensitivity and 75% specificity. Recurring high or unclear risk of bias was noted in the domains of "Index test" and "reference standard".
The diagnostic accuracy of iAD8 is superior to that of pAD8 when screening for cognitive impairment. The AD8 may be an acceptable alternative to screen for cognitive impairment in older adults when there are limitations to formal testing.
认知障碍筛查工具——“8 项确证痴呆问卷”（AD8），可用于对老年人及其照料者进行认知障碍的筛查。
评估认知障碍老年人中，由照料者和/或患者完成的“确证痴呆 8 项问卷”（iAD8 和 pAD8）的诊断准确性，并比较其预测参数。
我们检索了从工具创建开始到 2022 年 3 月的 10 个电子数据库（包括 MEDLINE（Ovid）、Embase）。纳入研究的患者年龄均≥60 岁，在任何医疗保健环境中均使用 AD8 进行认知障碍筛查。使用双变量随机效应荟萃分析评估预测参数，根据参考标准评估准确性和诊断能力。我们使用 QUADAS-2 标准评估偏倚风险。
我们使用≥2/8 的截断值将轻度认知障碍（MCI）、痴呆和认知障碍（MCI 或痴呆）分类。7 项使用 iAD8（n = 794）的研究显示，该工具对 MCI 的敏感度为 80%，特异度为 79%。9 项使用 iAD8（n = 2393）的研究确定，该工具对痴呆的敏感度为 91%，特异度为 64%。4 项使用 pAD8（n = 836）的研究显示，该工具对 MCI 的敏感度为 57%，特异度为 71%。4 项使用 pAD8（n = 3015）的研究显示，该工具对痴呆的敏感度为 82%，特异度为 75%。“索引测试”和“参考标准”两个领域存在高风险或不明确的偏倚。
筛查认知障碍时，iAD8 的诊断准确性优于 pAD8。当正式测试存在局限性时，AD8 可能是筛查老年人认知障碍的一种可接受的替代方法。
