Rapid cognitive assessment tools for screening of mild cognitive impairment in the preoperative setting: A systematic review and meta-analysis

• Published in: Journal of clinical anesthesia 2022-06, Vol.78, p.110682-110682, Article 110682
• Main Authors: Tran, Jason, Nimojan, Tristen, Saripella, Aparna, Tang-Wai, David F., Butris, Nina, Kapoor, Paras, Berezin, Linor, Englesakis, Marina, Chung, Frances
• Format: Article
• Language: English
• Subjects: Cognition; Cognition & reasoning; Cognitive ability; Cognitive assessment; Cognitive Dysfunction - diagnosis; Cognitive impairment; Cognitive screening tools; Collaboration; Delirium; Dementia; Dementia - diagnosis; Humans; Long term health care; Medical Subject Headings-MeSH; Memory; Mental Status and Dementia Tests; Meta-analysis; Middle Aged; Neuropsychological Tests; Neuropsychology; Older patients; Patients; Preoperative evaluation; Psychologists; Sensitivity and Specificity; Statistical analysis; Subject heading schemes; Systematic review; Systematic review and meta-analysis; Vocabularies & taxonomies
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2022.110682

Mild cognitive impairment (MCI) is a high-risk precursor to dementia, post-operative delirium, and prolonged hospitalization. There is a need for preoperative rapid cognitive screening tools. To evaluate the predictive parameters of rapid MCI screening tools in different clinical settings for preoperative application. Systematic review and meta-analyses searching Medline, and other databases from inception to May 26, 2021. The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines were followed for data curation and quality assessment. Title and abstract screening were conducted independently via Rayyan. Data was curated through a random-effects model and statistical analysis used R-software. Community, memory clinic, emergency, long-term care, and in-patient settings. There were no studies in the preoperative setting. Twenty-three studies with 9973 patients (≥ 60 years old) undergoing rapid MCI screening. Rapid (≤ 5 min) MCI screening tools. Pooled predictive parameters (sensitivity, specificity) of screening tests. Eighteen screening tools, compared to neuropsychological tests, were identified. The overall prevalence of MCI among the Rapid Cognitive Screen (RCS), Six-item Screener (SIS), Mini-Cog, and Clock Drawing Test (CDT) studies were 24.6%, 28.3%, 40.9%, and 20.7%, respectively. RCS has 82% sensitivity and 79% specificity in detecting MCI. SIS has 61% sensitivity and 89% specificity. Mini-Cog has 52% sensitivity and 80% specificity. CDT has 56% sensitivity and 59% specificity. Seven other index tools had high sensitivities of 97%–82% and specificities of 90%–73% but were studied only once. No rapid screening tools had been validated in the surgical population. In other populations, RCS may be a promising screening tool for MCI with stronger sensitivity and specificity than Mini-Cog, SIS, and CDT. CDT alone is ineffective for MCI detection. Further validation in the preoperative setting is required to determine the efficacy of these screening tools. •We reviewed brief (≤5 mins) index tools for screening mild cognitive impairment (MCI).•Rapid Cognitive Screen, Six-item Screener, and Mini-Cog require further validation.•Clock Drawing Test has low sensitivity and specificity for MCI screening.•No short MCI index tools have been validated in the preoperative setting