Test cognitivos breves como herramienta de decisión en Atención Primaria. Estudio poblacional y de validación

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY Neurologia Pub Date : 2024-11-01 DOI:10.1016/j.nrl.2022.05.006

M. Tainta , A. Iriondo , M. Ecay-Torres , A. Estanga , M. de Arriba , M. Barandiaran , M. Clerigue , M. Garcia-Sebastian , J. Villanua , A. Izagirre , J. Saldias , A. Aramburu , J. Taboada , J. Múgica , A. Barandiaran , A. Arrospide , J. Mar , P. Martinez-Lage

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Abstract

Introduction and objectives

Brief cognitive tests (BCT) are used in primary care (PC) for the detection of cognitive impairment (CI). Still, there are little data on their diagnostic utility (DU) in a community setting. This work evaluates the DU at the population level of Fototest, T@M, AD8 questionnaire and MMSE. It provides new cut-off points (CoP) validated in a CI early detection program.

Material and methods

In the population and validation samples, the evaluation was carried out in 2 phases, a first of screening and administration of BCT and a second of clinical diagnosis, blinded to the results of the BCT, applying the current NIA-AA criteria. The DU of BCT in the population sample was evaluated with the area under the ROC curve (aROC). Youden index and the CoP with the best specificity that ensured a sensitivity of 80% were used to decide on the most appropriate CoP. The sensitivity, specificity, and predictive values for these CoP were calculated in the validation sample.

Results

260 participants (23.1% with CI) from the population sample and 177 (42.4% with CI) from the validation sample were included. The Fototest has the best UD at the population level (aROC 0.851), which improves with the combination of Fototest and AD8 (aROC 0.875). The proposed CoP are AD8≥1, Fototest≤35, T@M≤40, and MMSE≤26.

Conclusion

BCT are helpful in detecting CI in PC. This work supports the use of more demanding PoC.

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作为初级保健决策工具的简短认知测试。人口研究和验证

简介和目的简短认知测试（BCT）被用于初级保健（PC）中认知障碍（CI）的检测。然而，有关其在社区环境中的诊断效用（DU）的数据仍然很少。这项研究评估了 Fototest、T@M、AD8 问卷和 MMSE 在人群中的诊断效用。材料和方法在人群和验证样本中，评估分两个阶段进行，第一阶段是筛查和实施 BCT，第二阶段是临床诊断，在对 BCT 结果保密的情况下，采用现行的 NIA-AA 标准。用 ROC 曲线下面积（aROC）评估了人群样本中 BCT 的 DU 值。尤登指数和特异性最好且能确保灵敏度达到 80% 的 CoP 被用来决定最合适的 CoP。在验证样本中计算了这些CoP的灵敏度、特异性和预测值。结果 260名参与者（23.1%，含CI）来自人群样本，177名参与者（42.4%，含CI）来自验证样本。在群体水平上，Fototest 的 UD 最佳（aROC 0.851），而 Fototest 和 AD8 的组合（aROC 0.875）则提高了 UD。建议的 CoP 为 AD8≥1、Fototest≤35、T@M≤40 和 MMSE≤26。这项工作支持使用要求更高的 PoC。

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来源期刊

Neurologia 医学-临床神经学

CiteScore

5.90

自引率

2.60%

发文量

135

审稿时长

48 days

期刊介绍： Neurología es la revista oficial de la Sociedad Española de Neurología y publica, desde 1986 contribuciones científicas en el campo de la neurología clínica y experimental. Los contenidos de Neurología abarcan desde la neuroepidemiología, la clínica neurológica, la gestión y asistencia neurológica y la terapéutica, a la investigación básica en neurociencias aplicada a la neurología. Las áreas temáticas de la revistas incluyen la neurologia infantil, la neuropsicología, la neurorehabilitación y la neurogeriatría. Los artículos publicados en Neurología siguen un proceso de revisión por doble ciego a fin de que los trabajos sean seleccionados atendiendo a su calidad, originalidad e interés y así estén sometidos a un proceso de mejora. El formato de artículos incluye Editoriales, Originales, Revisiones y Cartas al Editor, Neurología es el vehículo de información científica de reconocida calidad en profesionales interesados en la neurología que utilizan el español, como demuestra su inclusión en los más prestigiosos y selectivos índices bibliográficos del mundo.