Cognitive screening instruments to identify vascular cognitive impairment: A systematic review

2019 ◽  
Vol 34 (8) ◽  
pp. 1114-1127 ◽  
Author(s):  
Mohd Zaquan Arif Abd Ghafar ◽  
Hayatul Nawwar Miptah ◽  
Rónán O'Caoimh
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Vascular Cognitive Impairment ◽  
Screening Instruments ◽  
Cognitive Screening

scholarly journals Screening instruments for cognitive impairment in older patients in the Emergency Department: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Agneta H Calf ◽  
Maaike A Pouw ◽  
Barbara C van Munster ◽  
Johannes G M Burgerhof ◽  
Sophia E de Rooij ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Cognitive Impairment ◽  
Older Patients ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Screening Instruments ◽  
Cognitive Screening ◽  
Review Protocol ◽  
Index Tests

Abstract Background cognitive impairment is highly prevalent among older patients attending the Emergency Department (ED) and is associated with adverse outcomes. Methods we conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of cognitive screening instruments to rule out cognitive impairment in older patients in the ED. A comprehensive literature search was performed in MEDLINE, EMBASE, CINAHL and CENTRAL. A risk of bias assessment using QUADAS-2 was performed. Results 23 articles, examining 18 different index tests were included. Only seven index tests could be included in the meta-analysis. For ruling out cognitive impairment irrespective of aetiology, Ottawa 3 Day Year (O3DY) (pooled sensitivity 0.90; (95% CI) 0.71–0.97) had the highest sensitivity. Fourteen articles focused on screening for cognitive impairment specifically caused by delirium. For ruling out delirium, the 4 A’s Test (4AT) showed highest sensitivity (pooled sensitivity 0.87, 95% confidence interval (95% CI) 0.74–0.94). Conclusions high clinical and methodological heterogeneity was found between included studies. Therefore, it is a challenge to recommend one diagnostic test for use as a screening instrument for cognitive impairment in the ED. The 4AT and O3DY seem most promising for ruling out cognitive impairment in older patients attending the ED. The review protocol was registered in PROSPERO (CRD42018082509).

scholarly journals A continuum of executive function deficits in early subcortical vascular cognitive impairment: A systematic review and meta-analysis

2017 ◽  
Vol 11 (4) ◽  
pp. 371-380 ◽  
Author(s):  
Felipe Kenji Sudo ◽  
Patricia Amado ◽  
Gilberto Sousa Alves ◽  
Jerson Laks ◽  
Eliasz Engelhardt
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Meta Analysis ◽  
Random Effect ◽  
Vascular Cognitive Impairment ◽  
Color Test ◽  
Meta Analyses ◽  
Subcortical Vascular Cognitive Impairment

ABSTRACT. Background. Subcortical Vascular Cognitive Impairment (SVCI) is a clinical continuum of vascular-related cognitive impairment, including Vascular Mild Cognitive Impairment (VaMCI) and Vascular Dementia. Deficits in Executive Function (EF) are hallmarks of the disorder, but the best methods to assess this function have yet to be determined. The insidious and almost predictable course of SVCI and the multidimensional concept of EF suggest that a temporal dissociation of impairments in EF domains exists early in the disorder. Objective: This study aims to review and analyze data from the literature about performance of VaMCI patients on the most used EF tests through a meta-analytic approach. Methods: Medline, Web of Knowledge and PsycINFO were searched, using the terms: “vascular mild cognitive impairment” OR “vascular cognitive impairment no dementia” OR “vascular mild neurocognitive disorder” AND “dysexecutive” OR “executive function”. Meta-analyses were conducted for each of the selected tests, using random-effect models. Results: Systematic review showed major discrepancies among the results of the studies included. Meta-analyses evidenced poorer performance on the Trail-Making Test part B and the Stroop color test by VaMCI patients compared to controls. Conclusion: A continuum of EF impairments has been proposed in SVCI. Early deficits appear to occur in cognitive flexibility and inhibitory control.

P2-027: Systematic Review of RCTS of Interventions for Vascular Cognitive Impairment

2016 ◽  
Vol 12 ◽  
pp. P619-P619
Author(s):  
Alicja Cieslak ◽  
Philip Barber ◽  
Sandra E. Black ◽  
Jerry Chen ◽  
Jodi D. Edwards ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Vascular Cognitive Impairment

scholarly journals Cognitive screening instruments for dementia: comparing metrics of test limitation

2021 ◽  
Vol 15 (4) ◽  
pp. 458-463
Author(s):  
Andrew J. Larner
Keyword(s):  
Cognitive Impairment ◽  
High Sensitivity ◽  
Misclassification Rate ◽  
Test Accuracy ◽  
Screening Instruments ◽  
Cognitive Screening ◽  
Net Benefit ◽  
Likelihood Ratios ◽  
Sensitivity Specificity ◽  
State Examination

ABSTRACT Cognitive screening instruments (CSIs) for dementia and mild cognitive impairment are usually characterized in terms of measures of discrimination such as sensitivity, specificity, and likelihood ratios, but these CSIs also have limitations. Objective: The aim of this study was to calculate various measures of test limitation for commonly used CSIs, namely, misclassification rate (MR), net harm/net benefit ratio (H/B), and the likelihood to be diagnosed or misdiagnosed (LDM). Methods: Data from several previously reported pragmatic test accuracy studies of CSIs (Mini-Mental State Examination, the Montreal Cognitive Assessment, Mini-Addenbrooke’s Cognitive Examination, Six-item Cognitive Impairment Test, informant Ascertain Dementia 8, Test Your Memory test, and Free-Cog) undertaken in a single clinic were reanalyzed to calculate and compare MR, H/B, and the LDM for each test. Results: Some CSIs with very high sensitivity but low specificity for dementia fared poorly on measures of limitation, with high MRs, low H/B, and low LDM; some had likelihoods favoring misdiagnosis over diagnosis. Tests with a better balance of sensitivity and specificity fared better on measures of limitation. Conclusions: When deciding which CSI to administer, measures of test limitation as well as measures of test discrimination should be considered. Identification of CSIs with high MR, low H/B, and low LDM, may have implications for their use in clinical practice.

Abstract TP459: Higher Coated-Platelet Levels in Patients with Acute Stroke are Associated with Lower Cognitive Performance at 3 Months

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Angelia C Kirkpatrick ◽  
Julie A Stoner ◽  
Eleanor Mathews ◽  
George L Dale ◽  
Calin I Prodan
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Brain Infarction ◽  
Pearson Correlation ◽  
Vascular Cognitive Impairment ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Large Artery ◽  
Cognitive Screening ◽  
Lacunar Stroke

Introduction: Coated-platelets, a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin, support a robust prothrombinase activity and provide a unique measure of platelet thrombotic potential. Coated-platelet levels are increased in non-lacunar stroke compared to healthy controls, and higher levels are associated with stroke recurrence. In prior studies, we have shown that coated-platelet levels in patients with carotid atherosclerosis and cognitive impairment are elevated as compared to those with normal cognition. Hypothesis: To examine whether coated-platelet levels measured at the time of the stroke correlate with cognitive performance at 3 months following the brain infarction. Methods: Consecutive patients with a diagnosis of non-lacunar stroke were enrolled in this pilot study over 12 months. Coated-platelets were determined at the time of the stroke and reported as percent of platelets converted to coated-platelets. Cognitive screening was performed using the Mini-Mental State Examination (MMSE) during a stroke clinic visit 3 months after hospital discharge. Patients with prior dementia or significant aphasia were excluded. The linear correlation between initial coated-platelet levels and MMSE scores at 3 months was examined using the Pearson correlation coefficient. Results: We enrolled 66 patients, 97% male, with a mean age of 66.7 years (range 49-88) and mean NIHSS score of 4.4 points (range 0-11). Mean MMSE was 26.3 points (range 18-30) and mean coated-platelet levels were 41.4% (range 15.4-76.2). 34 patients (52%) had MMSE scores of ≤26, suggestive of a degree of cognitive impairment. An inverse relationship was found between coated-platelet levels and MMSE score, with higher levels seen in patients with lower MMSE scores (r=-0.45, R 2 =0.21, p=0.0001). This association remained despite adjustment for presence of large-artery disease and stroke severity. Conclusions: Higher initial coated-platelet levels are associated with lower cognitive performance at 3 months post stroke. These findings support a link between increased platelet procoagulant potential and development of vascular cognitive impairment following cerebral infarction.

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