Main Outcomes and Measures Sensitivity, specificity patient, caregiver, and clinician decision-making patient function, quality of life, and neuropsychiatric symptoms caregiver burden and well-being. Study Selection Fair- to good-quality English-language studies of cognitive impairment screening instruments, and pharmacologic and nonpharmacologic treatments aimed at persons with mild cognitive impairment (MCI), mild to moderate dementia, or their caregivers.ĭata Extraction and Synthesis Independent critical appraisal and data abstraction random-effects meta-analyses and qualitative synthesis. Objective To systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (≥65 years) to inform the US Preventive Services Task Force.ĭata Sources MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials through January 2019, with literature surveillance through November 22, 2019. Importance Early identification of cognitive impairment may improve patient and caregiver health outcomes. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.Pooled Analysis of Change in Caregiver Depression (Standardized Mean Difference), Caregiver and Caregiver-Patient Dyad Interventions Compared with Controls, by Intervention Type Pooled Analysis of Change in Caregiver Burden (Standardized Mean Difference), Caregiver and Caregiver-Patient Dyad Interventions Compared With Controls, by Intervention TypeĮFigure 13. Pooled Analysis of Change in Global Cognitive Function (measured by ADAS-Cog-11), Patient-Level Nonpharmalogic Interventions Compared With Controls, by Intervention TypeĮFigure 12. Pooled Analysis of Change in Global Cognitive Function (measured by MMSE), Patient-Level Nonpharmalogic Interventions Compared With Controls, by Intervention TypeĮFigure 11. Pooled Analysis of Risk of Improvement or Maintenance in Global Function, AChEIs and Memantine Compared with Placebo, by Medication TypeĮFigure 10. Pooled Analysis of Change in Global Cognitive Function (Measured by MMSE), AChEIs and Memantine Compared with Placebo, by Medication TypeĮFigure 9. Pooled Analysis of Change in Global Cognitive Function (Measured by ADAS-Cog-11), AChEIs and Memantine Compared with Placebo, by Medication TypeĮFigure 8. Test Accuracy of Longer, Self-Administered Tests (KQ 2)ĮFigure 7. Test Accuracy of Brief Screening Tests Reported in 1 Study (KQ 2)ĮFigure 6. Test Accuracy of Very Brief Screening Tests Reported in 1 Study (KQ 2)ĮFigure 5. Test Accuracy of Brief Screening Tests Reported in More Than 1 Study (KQ 2)ĮFigure 4. Bivariate Pooled Analysis of Test Accuracy of the MMSE to Detect Dementia at a Cut-off of ≥23 or ≥24 (KQ)ĮFigure 3. Test Accuracy of Very Brief Screening Tests Reported in More Than 1 Study (KQ 2)ĮFigure 2. Caregiver and Caregiver-Patient Dyad Interventions: Summary of Results, by Intervention (KQ 4 and 5)ĮFigure 1. Patient-Level Nonpharmacologic Interventions: Summary of Results, by Intervention (KQ 4 and 5)ĮTable 8. Other Medications and Supplements: Summary of Results, by Agent (KQ 4 and 5)ĮTable 7. AChEIs and Memantine: Summary of Results, by Medication Type (KQ 4 and 5)ĮTable 6. Trial and Population Characteristics: Summary Across All Intervention Types (KQ 4 and 5)ĮTable 5. Study and Population Characteristics of Included Diagnostic Accuracy Studies (KQ 2)ĮTable 4. Study Design-Specific Quality Rating Criteria*ĮTable 3. Literature Search Strategies for Primary LiteratureĮTable 2. Publication type: Ancillary study to excluded primary study.ĮMethods. Quality: Study did not meet criteria for fair or good quality. Study design: Not an included study design comparative effectiveness follow-up less than 3 months (does not apply to harms) case-control design (KQ2 only) cohort or case-control (with n<1000) (KQ5 only). Intervention: Study used an excluded intervention or screening approach or intervention aim irrelevant. Population: Study population not relevant (age <65 years exclusively populations with mental health illnesses or chronic disease severe dementia professional caregivers otherwise not representative community-dwelling population). Outcomes: Study did not report relevant outcomes. Setting: Study was not conducted in a country relevant to US practice or study was conducted in intermediate care facility or otherwise unrepresentative setting. AArticles could be assessed for more than 1 KQ.īReasons for exclusion: Aim: Study aim not relevant.
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