Diagnostic tools for alzheimer's disease dementia and other dementias: an overview of diagnostic test accuracy (DTA) systematic reviews
BMC Neurology
Diagnostic tools for alzheimer's disease dementia and other dementias: an overview of diagnostic test accuracy (DTA) systematic reviews
Ingrid Arevalo-Rodriguez 0 1
Omar Segura 1
Ivan Sol
Xavier Bonfill
Erick Sanchez
Pablo Alonso-Coello
0 Pediatrics, Obstetrics & Gynecology and Preventive Medicine Department, Universitat Autonoma de Barcelona , Barcelona , Spain
1 Division of Research, Fundacion Universitaria de Ciencias de la Salud, Hospital de San Jose/Hospital Infantil de San Jose , Bogota, DC , Colombia
Background: Dementia includes a group of neurodegenerative disorders characterized by progressive loss of cognitive function and a decrease in the ability to perform activities of daily living. Systematic reviews of diagnostic test accuracy (DTA) focus on how well the index test detects patients with the disease in terms of figures such as sensitivity and specificity. Although DTA reviews about dementia are essential, at present there is no information about their quantity and quality. Methods: We searched for DTA reviews in MEDLINE (1966-2013), EMBASE (1980-2013), The Cochrane Library (from its inception until December 2013) and the Database of Abstracts of Reviews of Effects (DARE). Two reviewers independently assessed the methodological quality of the reviews using the AMSTAR measurement tool, and the quality of the reporting using the PRISMA checklist. We describe the main characteristics of these reviews, including basic characteristics, type of dementia, and diagnostic test evaluated, and we summarize the AMSTAR and PRISMA scores. Results: We selected 24 DTA systematic reviews. Only 10 reviews (41.6%), assessed the bias of included studies and few (33%) used this information to report the review results or to develop their conclusions Only one review (4%) reported all methodological items suggested by the PRISMA tool. Assessing methodology quality by means of the AMSTAR tool, we found that six DTA reviews (25%) pooled primary data with the aid of methods that are used for intervention reviews, such as Mantel-Haenszel and separate random-effects models (25%), while five reviews (20.8%) assessed publication bias by means of funnel plots and/or Egger's Test. Conclusions: Our assessment of these DTA reviews reveals that their quality, both in terms of methodology and reporting, is far from optimal. Assessing the quality of diagnostic evidence is fundamental to determining the validity of the operating characteristics of the index test and its usefulness in specific settings. The development of high quality DTA systematic reviews about dementia continues to be a challenge.
Diagnosis; Dementia; Alzheimer's disease dementia; Systematic review; PRISMA checklist; AMSTAR tool
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Background
Population ageing is generating a considerable increase in
chronic and neurodegenerative diseases, as well as severe
consequences for global public health [1,2]. Dementia
includes a group of neurodegenerative disorders
characterized by progressive loss of cognitive function as well as
the ability to perform activities of daily living, sometimes
accompanied by neuropsychiatric symptoms [3]. Criteria
for dementia diagnosis include a deficit in one or more
cognitive domains that is severe enough to impair
functional activities, and is progressive over a period of at least
six months and not attributable to any other brain disease
[4,5]. The presence of cognitive impairment, a fundamental
part of the dementia profile, could be detected through a
combination of history, clinical examination, and objective
cognitive assessment such as a brief mental assessment or
comprehensive neuropsychological testing [6,7]. At present,
there is a trend towards incorporating biomarker tests into
dementia diagnosis criteria, such as amyloid- protein
accumulation, neuronal injury, synaptic dysfunction, and
neuronal degeneration [8-10].
Systematic reviews of diagnostic test accuracy (DTA)
focus on how well an index test detects patients with the
disease in terms of figures such as sensitivity and
specificity. DTA reviews present summarized information to
consumers (such as clinicians, stakeholders, guideline
developers and patients) about which test should be
used over another as the initial step in a diagnostic
pathway or as an add-on element to confirm the presence of
the target disease. Although the methodology for
performing DTA reviews is constantly evolving,
organizations such as the Cochrane Collaboration have published
methodological guidance with basic requirements to
develop these kinds of reviews [11].
Recently, we evaluated the quality of clinical practice
guidelines for diagnosing dementia and found a wide
variety in terms of quality of evidence as well as the
strength of the recommendations provided [12]. Although
DTA reviews are an essential part of any clinical
guidelines, at present there is no information about the quantity
and quality of dementia DTA reviews. This information
could help clinicians and stakeh (...truncated)