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Published on: January 11, 2020
Diagnostic Accuracy of Cognitive Screening Instruments in Heart Failure: A Systematic Review
Jan Cameron1, Christina E Kure, Susan J Pressler
1Jan Cameron, PhD Senior Research Fellow, Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia. Christina E. Kure, PhD Research Fellow, Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia. Susan J. Pressler, PhD Professor, School of Nursing, University of Michigan, Ann Arbor. Chantal F. Ski, PhD Associate Professor, Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia. Alexander M. Clark, PhD Professor, Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne Victoria, Australia, Associate Dean (Research), Faculty of Nursing, University of Alberta, Edmonton, Canada. David R. Thompson, PhD Professor, Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
Insights
Cognitive impairment is common in heart failure (HF). While screening is recommended, current tools like the Mini Mental State Examination show low sensitivity for detecting mild cognitive impairment (MCI) in HF patients.
Area of Science:
- Cardiology
- Neurology
- Psychology
Background:
- Cognitive impairment significantly impacts heart failure (HF) patient outcomes, increasing mortality and hindering self-management.
- Early identification of cognitive impairment is crucial for effective HF management and addressing co-occurring cognitive deficits.
- The diagnostic accuracy of existing cognitive screening tools in HF populations remains insufficiently established.
Purpose of the Study:
- To systematically evaluate the diagnostic accuracy of cognitive screening instruments for identifying mild cognitive impairment (MCI) in patients with heart failure (HF).
Main Methods:
- A systematic review of major databases (January 1999-June 2013) identified studies on cognitive impairment in HF, using screening instruments and neuropsychological tests.
- Inclusion criteria focused on studies with cognitive impairment defined by neuropsychological test performance (≥1.5 SDs below normative data).
- Methodological quality was assessed using QUality Assessment of Diagnostic Accuracy Studies and STAndards for the Reporting of Diagnostic accuracy studies; Mini Mental State Examination accuracy was specifically computed.
Main Results:
- Of 593 identified citations, only 8 met inclusion criteria, with limitations including selective HF patient sampling and lack of diagnostic test accuracy examination.
- The Mini Mental State Examination, with a threshold score of ≤28, demonstrated low sensitivity (26%) but high specificity (95%) for screening MCI in HF.
- No included study definitively examined the diagnostic test accuracy of cognitive screening instruments within the HF population.
Conclusions:
- Routine screening for cognitive impairment in heart failure patients is advisable.
- Further research is imperative to rigorously establish the diagnostic accuracy of specific screening instruments for MCI in the heart failure population.
Background:
Cognitive impairment is prevalent in heart failure (HF) with severe consequences, including increased risk of mortality and reduced ability to self-manage HF symptoms. Identifying cognitive impairment through screening would assist clinicians in managing HF and comorbid cognitive impairment. However, the accuracy of cognitive screening instruments for HF has not been adequately determined.
Objective:
The aim of this study was to determine the diagnostic accuracy of cognitive screening instruments in screening for mild cognitive impairment (MCI) in HF patients.
Methods:
A systematic review of major electronic bibliographic databases was searched from January 1999 to June 2013. Inclusion criteria were as follows: primary studies examining cognitive impairment in HF, administration of a cognitive screening instrument and neuropsychological test battery, and cognitive impairment indicated by performance on neuropsychological tests 1.5 SDs less than that of normative data. Methodological rigor of included publications was evaluated using 2 bias risk instruments: QUality Assessment of Diagnostic Accuracy Studies and STAndards for the Reporting of Diagnostic accuracy studies. The precision, accuracy, and receiver operating characteristic curves of the Mini Mental State Examination were computed.
Results:
From 593 citations identified, 8 publications met inclusion criteria. Risk of bias included selective HF patient samples, and no study examined the diagnostic test accuracy of the cognitive screening instruments. The Mini Mental State Examination had low sensitivity (26%) and high specificity (95%) with a score of 28 or less as the optimal threshold for MCI screening.
Conclusions:
Screening for cognitive impairment in HF is recommended; however, future studies need to establish the diagnostic accuracy of screening instruments of MCI in this population.
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