高齢者の認知障害のスクリーニング:米国予防サービスタスクフォースの最新証拠報告と体系的レビュー
Carrie D Patnode1, Leslie A Perdue1, Rebecca C Rossom2
1Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon.
JAMA
|February 26, 2020
まとめ
認知障害の早期スクリーニングは 病状を正確に検知しますが 患者の状態を改善しません 介入は患者や介護者にとって わずかな不確実な利益をもたらし さらなる研究が必要であることを強調しています
科学分野:
- ゲロントロジー
- 神経科学
- 予防 医療
背景:
- 認知障害の早期発見は 高齢者とその介護者の健康状態を改善するために不可欠です
- 認知障害は,軽度の認知障害 (MCI) と認知症を含む,高齢者の大きな部分に影響します.
研究 の 目的:
- 高齢者 (≥65歳) の認知検査器具の精度を体系的に検討する.
- 高齢者の認知障害の治療のための介入の利害を評価する.
- 予防サービス・タスクフォースの勧告を参考にすること.
主な方法:
- MEDLINE,PubMed,PsycINFO,Cochrane 統制試験中央登録書の体系的なレビュー
- MCIや軽度から中等度の認知症のスクリーニング用具と治療法に関する英語での適度から質の高い研究を含める.
- ランダム効果メタ解析と定性合成を用いたデータ抽出と合成
主要な成果:
- 28万人を超える高齢者を対象とした287件の研究が検討されました.
- 認知スクリーニング装置は適切な精度を示した (例えば,ミニメンタルステート試験:感度0.89,特異性0.89).
- スクリーニングでは患者や介護者に対する有意な改善は認められず,介入はわずかな不確実な臨床効果を示した.
結論:
- 認知のスクリーニング装置は 認知障害を効果的に検出します
- 現在の証拠は,スクリーニングが患者や介護者を改善するか,害を防ぐことを支持していません.
- 早期発見された認知障害に対する介入の臨床的意義は不明である.
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