Detecting Cognitive Impairment and Dementia in the Emergency Department: A Scoping Review.
Armin Nowroozpoor, Jeff Dussetschleger, William Perry and 10 others
PMID 35940682WHAT IT FOUND
Ottawa 3DY and the Six-item Screener had the best reported test results for ED cognitive screening, but evidence was limited and heterogeneous.
These screens do not diagnose dementia.
Key findings
01The Ottawa 3DY had the highest pooled sensitivity of 0.90 (95% CI 0.71 to 0.97), and the Six-item Screener had the highest pooled specificity of 0.79 (95% CI 0.75 to 0.83).
02The Six-item Screener took a median of 1 minute to administer to patients in an Alzheimer’s clinic and had 94% and 86% sensitivity and specificity, respectively, with 98% negative predictive value, 68% positive predictive value, and an area under the ROC curve of 0.96.
03Patient race or ethnicity or language spoken were reported 33% and 31% of the time, and all reported were English-speaking except for 2 studies that enrolled French-speaking patients.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review mapped studies rather than testing a screening programme, so it cannot show that ED screening improves patient outcomes. Many included manuscripts were abstract-only, reviews, or editorials. Most included studies used English-speaking patients, and race, ethnicity, language, sexual orientation, and religious faith were rarely reported. The authors state the data were heterogeneous and more evidence is needed before best practices can be set. The paper cites the US Preventative Services Task Force statement that there is no trial evidence to support screening older adults for cognitive impairment.
Declared interests
Extramural NIH research support is listed in the publication types. The supplied text does not state author conflicts.
The easy way to misread this
Do not treat a positive Ottawa 3DY or Six-item Screener as a dementia diagnosis. The review found limited, heterogeneous evidence, and the authors state screening does not constitute diagnosis.