Penfold Rose S, Bowman Emily, Vardy Emma R L C, Sampson Elizabeth L, Anand Atul, Guthrie Bruce, MacLullich Alasdair M J
Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, NINE 9 Little France Road Edinburgh BioQuarter City, Edinburgh EH16 4UX, UK.
Department of Psychiatry, University of Oxford, Oxford, UK.
Age Ageing. 2025 May 31;54(6). doi: 10.1093/ageing/afaf144.
Overall dementia diagnosis rates are substantially below true rates. Hospital admissions of older people involve cognitive and functional assessments relevant to dementia diagnosis. These assessments could be harnessed to contribute to identifying patients for further assessment. Yet relationships of inpatient cognitive tests with known dementia are unclear. The 4AT (www.the4AT.com) assesses for delirium (Scores 4-12) and also cognitive impairment via embedded cognitive tests (Scores 1-3). We investigated relationships between 4AT scores and clinical dementia diagnoses.
We included participants aged ≥65 years admitted as a medical emergency to three hospitals from 4 January 2016 to 4 January 2020, who had the 4AT performed on admission. Clinical dementia diagnosis was ascertained from linked primary care, hospital discharge and community prescribing data.
Of 75 221 admissions, 62 188 (82.7%; 33 625 unique patients; mean age 80.2 years; 55.8% female) had a 4AT on admission. Of these, 9948 (16.0%) had a recorded clinical dementia diagnosis at the time of admission, with a further 1197 (1.9%) receiving a new diagnosis at discharge. Of admissions with dementia, 9669/11 145 (86.8%) had a 4AT score ≥1 on admission, compared to 14 994/51 043 (29.4%) without dementia.4AT ≥1 had a sensitivity of 0.87 (95% CI 0.86-0.87) and a specificity of 0.71 (0.70-0.71) in relation to clinical dementia diagnosis. 4AT ≥4 showed sensitivity of 0.50 (0.50-0.51) and a specificity of 0.88 (0.88-0.88).
4AT scores were associated with clinically diagnosed dementia. These results suggest that routinely collected 4AT scores could be leveraged in conjunction with other clinical indicators to identify patients with possible undiagnosed dementia who could undergo further inpatient diagnostic assessment and/or post-discharge specialist follow-up.
痴呆症的总体诊断率远低于实际发病率。老年人住院时会进行与痴呆症诊断相关的认知和功能评估。这些评估可用于帮助识别需要进一步评估的患者。然而，住院认知测试与已知痴呆症之间的关系尚不清楚。4AT（www.the4AT.com）可评估谵妄（得分4 - 12），并通过嵌入式认知测试评估认知障碍（得分1 - 3）。我们研究了4AT得分与临床痴呆症诊断之间的关系。
我们纳入了2016年1月4日至2020年1月4日因医疗紧急情况入住三家医院的年龄≥65岁的参与者，他们在入院时进行了4AT测试。临床痴呆症诊断通过关联的初级保健、医院出院和社区处方数据确定。
在75221例入院病例中，62188例（82.7%；33625例不同患者；平均年龄80.2岁；55.8%为女性）在入院时进行了4AT测试。其中，9948例（16.0%）在入院时记录有临床痴呆症诊断，另有1197例（1.9%）在出院时获得新诊断。在患有痴呆症的入院病例中，9669/11145例（86.8%）入院时4AT得分≥1，而在无痴呆症的病例中这一比例为14994/51043例（29.4%）。4AT≥1对于临床痴呆症诊断的敏感性为0.87（95%CI 0.86 - 0.87），特异性为0.71（0.70 - 0.71）。4AT≥4的敏感性为0.50（0.50 - 0.
