术前筛查轻度认知障碍的快速认知评估工具

术前筛查轻度认知障碍的快速认知评估工具：一项系统性回顾和Meta分析 

贵州医科大学  麻醉与心脏电生理课题组

翻译：潘志军  编辑;马艳燕  审校：曹莹

重要性：轻度认知障碍（MCI）是痴呆、术后谵妄和长期住院的高危前兆。需要术前快速认知筛查工具。

研究目的：评估快速MCI筛查工具在不同临床环境下的预测参数，以供术前应用。

试验设计：对Medline和其他数据库从建立到2021年5月26日的数据进行系统回顾和Meta分析。数据整理和质量评估遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。标题和摘要筛选通过Rayyan独立进行。数据通过随机效应模型进行整理，并使用R软件进行统计分析。  

范围设置：社区、记忆门诊、急诊、长期护理及住院患者。术前的患者并没有研究。

受试人群：23项研究，9973名患者(≥ 60岁）接受快速MCI筛查。

干预措施：迅速的(≤5分钟）MCI筛查工具。

测定方法：筛选试验的综合预测参数（敏感性、特异性）。   

主要结果     

与神经心理学测试相比，我们确定了18种筛查工具。在快速认知筛查（RCS）、六项筛查（SIS）、简易认知评估表和画钟测试（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具有61%的敏感性和89%的特异性。Mini-Cog具有52%的敏感性和80%的特异性。CDT具有56%的敏感性和59%的特异性。其他七种指数工具的高灵敏度为97%-82%，特异性为90%-73%，但只进行了一次研究。 

结论：没有在外科人群中验证过快速筛查工具。在其他人群中，RCS可能是一种很有前途的MCI筛查工具，其敏感性和特异性比Mini Cog、SIS和CDT更强。CDT单独对MCI检测无效。需要在术前环境中进行进一步验证，以确定这些筛查工具的有效性。

原始文献来源：Jason Tran, Tristen Nimojan, Aparna Saripella,et al.Rapid cognitive assessment tools for screening of mild cognitive impairment in the preoperative setting: A systematic review and meta-analysis [J]. (J Clin Anesth 2022 06;78 ).

英文原文      

Rapid cognitive assessment tools for screening of mild cognitive impairment in the preoperative setting: A systematic review and meta-analysis    

Importance: 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. 

Study objective: To evaluate the predictive parameters of rapid MCI screening tools in different clinical settings for preoperative application. 

Design: 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. 

Setting: Community, memory clinic, emergency, long-term care, and in-patient settings. There were no studies in the preoperative setting. 

Patients: Twenty-three studies with 9973 patients (≥ 60 years old) undergoing rapid MCI screening. 

Intervention: Rapid (≤ 5 min) MCI screening tools. 

Measurements: Pooled predictive parameters (sensitivity, specificity) of screening tests. 

Main results: 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. 

Conclusion: 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. 

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