- 期刊
AD8量表於社區及醫療院所篩檢認知障礙準確性之系統性文獻回顧
A Systematic Review of the Diagnostic Accuracy of the AD8 Questionnaire for Cognitive Impairment in the Community, Clinics and Hospitals
摘要
隨著台灣人口快速老化，罹患認知障礙疾病的長者也急速增加，但仍有許多潛藏在社區及醫院的長者未被確實診斷與治療，若能提早發現極早期的認知障礙患者並及早介入，則可以減緩疾病的惡化及所帶來的社會經濟負擔。目前針對極早期失智症有許多篩檢工具，但對於輕度認知障礙均有敏感度太低及教育程度的限制；而近幾年發展出的AD8量表已被翻譯成多國語言，具有施測時間短及個體內比較的優勢，也陸續在國內被使用及研究。而本次系統性文獻回顧即針對此診斷型的臨床問題搜尋了包括Cochrane library等九個資料庫，經由嚴格評讀包含英文及非英文的所有文獻後，最後納入五篇高品質的研究做整合評析。綜觀AD8敏感度優於特異度，特別是在篩檢出輕度認知障礙族群其敏感度優於MMSE，但較差的特異度及陽性預測值則暗示著可能造成偽陽性的發生，而優異的陰性預測值及陰性概似比顯示發生偽陰性的機會極低，而此特質為良好篩檢工具所必須具備，輔以施測時間小於三分鐘，適合繁忙臨床上的初步篩檢，若AD8≥2分則需轉介專科醫師做進一步確診。
並列摘要
The number of elderly people with cognitive impairment has grown rapidly as the population of Taiwan ages. However, many of the elderly with cognitive impairment in the community and hospitals remain undiagnosed and untreated. If we are able to detect the earlier stages of dementia and intervene, we can decrease the progression of the disease and its social and economic burden. There are many cognitive screening tools used to identify people with mild cognitive impairment, but each has its own limitations in sensitivity and education levels. The recently developed AD8 questionnaire has been translated into many languages and has the advantages of a short administration time and in-person comparison, which makes it ideal for practice and study in Taiwan. We searched nine databases including Cochrane library for the diagnostic question in this systematic review. We critically appraised all English and non-English articles and decided on five high-quality researches to include in our review. Overall, the AD8 has better sensitivity than specificity and has better sensitivity in screening for mild cognitive impairment than the MMSE. However, the lower specificity and positive predictive value make false positive results more likely to happen. The excellent negative predictive value and negative likelihood ratio make false negative results more unlikely to occur, which is a necessary factor in selecting an ideal screening tool. Moreover, the administration time of less than three minutes makes it easy to use in busy clinical settings. In conclusion, the AD8 is a good tool for detecting cognitive impairment. Elderly people with an AD8 score ≥2 need to be referred to a specialist for further diagnosis.