Abstract
IntroductionAs the population ages, Alzheimer's disease and other subtypes of dementia are becoming increasingly prevalent. However, in recent years, diagnosis has often been delayed or not made at all. Thus, improving the rate of diagnosis has become an integral part of national dementia strategies. Although screening for dementia remains controversial, the case is strong for screening for dementia and other forms of cognitive impairment in hospital inpatients. For this reason, the objective of this systematic review was to provide clinicians, who wish to implement screening, an up-to-date choice of cognitive tests with the most extensive evidence base for the use in elective hospital inpatients.MethodsFor this systematic review, PubMed, PsycINFO and Cochrane Library were searched by using a multi-concept search strategy. The databases were accessed on April 10, 2019. All cross-sectional studies that utilized brief, multi-domain cognitive tests as index test and a reference standard diagnosis of dementia or mild cognitive impairment as comparator were included. Only studies conducted in the hospital setting, sampling from unselected, elective inpatients older than 64 were considered.ResultsSix studies met the inclusion criteria, with a total of 2112 participants. Diagnostic accuracy data for the Six-Item Cognitive Impairment Test, Cognitive Performance Scale, Clock-Drawing Test, Mini-Mental Status Examination, and Time & Change test were extracted and descriptively analyzed. Clinical and methodological heterogeneity between the studies precluded performing a meta-analysis.DiscussionThis review found only a small number of instruments and was not able to recommend a single best instrument for use in a hospital setting. Although it was not possible to estimate the pooled operating characteristics, the included description of instrument characteristics, the descriptive analysis of performance measures, and the critical evaluation of the reporting studies may contribute to clinician's choice of the screening instrument that fits best their purpose.
Highlights
As the population ages, Alzheimer’s disease and other subtypes of dementia are becoming increasingly prevalent
Screening for dementia remains controversial, the case is strong for screening for dementia and other forms of cognitive impairment in hospital inpatients
The most common dementia types include vascular dementia (VD), dementia with Lewy bodies (LBD), and Alzheimer’s disease (AD), which is in around 40% the neuropathological diagnosis in patients with clinically diagnosed dementia disorder [3,4,5,6]
Summary
Alzheimer’s disease and other subtypes of dementia are becoming increasingly prevalent. Given that the prevalence of dementia rises steeply after the age of 65, the number of people living with dementia is expected to increase significantly due to the growing elderly population in Switzerland [12]. A national study, commissioned by the Swiss Alzheimer’s Society, reported estimated annual costs of dementia at 6.3 billion CHF for 2007 and 6.96 billion CHF for 2009 [14, 15]. These findings are consistent with contemporary international studies, which predict rising global costs at similar rates until 2030 and beyond [10, 16, 17]. Switzerland and many other countries have recognized dementia as a public health priority [18,19,20] and developed national dementia strategies [21]
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