嗅覺評估是否能預測高齡者輕度認知障礙Can olfactory identification test for screening mild cognitive impairment in older adults?

740 2 97         DOI:doi.org/10.30131/TWNA_EBHC_Library.DB_2022040011A/Text

2023-01-18 已刊登
綜 整 診斷類型

作  者

陳俐君 廖御圻 王靜枝 胡芳文*

文章類別

A 類:實證健康照護綜整

問題類型

診斷性問題

健康狀況

老年醫學 (Geriatrics)  

治療/介入措施

其他(Others) - 嗅覺評估

專長類別

五官、皮膚及其他護理照護

中文關鍵詞

#高齡者 #輕度認知障礙 #嗅覺評估

英文關鍵詞

#older adults #mild cognitive impairment #olfactory testing

機構名稱

國立成功大學醫學院附設醫院

申請單位

護理部

中文摘要

形成臨床提問:
高齡者認知功能從正常進展至失智症間,有一過渡期稱為「輕度認知障礙」,定義為記憶功能退化但未達失智症標準,此特點為具可逆性。但目前輕度認知障礙的評估工具為心智評估量表或生物標誌檢測,易因教育程度、年齡等而影響結果,或需較高的成本花費。與此同時,過去文獻發現,高齡者嗅覺與認知功能存在關聯性。故本文希望了解嗅覺評估是否能預測高齡者輕度認知障礙,以更客觀且簡易方式,進行高齡者輕度認知障礙的高危險篩檢,以利早期發現且介入預防失智症。
文獻搜尋的方法與分析:
本文以實證手法,首先設定PICO關鍵字,並使用自然語言或醫學主題詞彙(MeSH term),依照布林邏輯 AND 及 OR 的方式做聯集及交集。搜尋Embase、Medline、Cochrane等資料庫,納入標題與摘要符合PICO者,共搜尋得453篇。刪除重複文獻、研究並非針對輕度認知障礙、非針對嗅覺評估、控制組非健康高齡者、受試者年齡小於65歲、醫學論述文、無完整全文等,剩餘4篇世代研究文章。
文獻的品質評讀:
依Oxford標準評定證據等級皆為Level 3,以JBI世代研究文獻評讀檢核表進行評讀,結果發現四篇研究符合評讀條件介於7-9項。此四篇研究皆為探討輕度認知障礙發生與嗅覺功能下降之間的相關性,收案對象皆為社區高齡者,與PICO所設立之研究目的及對象一致且具體明確。於研究設計方面,四篇研究所探討的問題皆屬診斷型問題,並皆為世代研究設計,且研究結果支持嗅覺功能下降可預測輕度認知障礙發生。
結果、結論與建議:
本文以實證手法統整過去研究結果,顯示高齡者嗅覺功能下降可預測輕度認知障礙發生。與常規的認知篩檢工具相較,嗅覺評估更為簡便、經濟實惠且無須經特殊訓練,建議未來可應用於高齡者輕度認知障礙的高危險篩檢。然因認知功能為多面向,目前嗅覺評估尚無法辨識大腦退化部位,仍建議輕度認知障礙需配合多面向的評估。此外,因影響嗅覺的干擾因素眾多,如氣候、過敏、鼻部疾病,未來研究亦需探討與分析此干擾因素對研究結果之影響。

英文摘要

Ask an answerable question (PICO):
Mild cognitive impairment is the transitional step between cognitive impairment and dementia in older adults, defined as memory deterioration that does not meet the criteria for dementia. The Cognitive Abilities Screening Instrument is a common screening tool for mild cognitive impairment, which is both expensive and time-consuming. However, the results of the screen are easily affected by educational level and age. Previous studies have shown a relationship between cognition and olfactory sensation in older adults. Therefore, this study aimed to determine whether olfactory testing could identify mild cognitive impairment in older adults. This testing may be helpful to identify more objective and easier ways to screen for cognitive impairment to detect and prevent dementia.
The Method and Analysis of Literature Review:
An evidence-based method was adopted to set the PICO question and keywords using synonymous and MeSH terms. Bollean logic “AND” and “OR” were used to search the English databases. A total of 453 articles were selected from the Embase, Medline, and Cochrane Library databases. After excluding repeated and irrelevant articles (studies not investigation mild cognitive impairment, lacking olfactory assessment, lacking a control group of non-healthy older adults, subjects younger than 65 years old, medical article, full text not available), four cohort studies were included.
Critical Appraisal:
Based on the Oxford Centre for Evidence-Based Medicine, four studies were identified as level 3, which met 7-9 requirements of the Joanna Briggs Institute checklist. All articles explored the relationship between decline in olfactory function and mild cognitive impairment. The population in all four articles was extracted from community and corresponded with our PICO setting. Finally, all of the articles involved diagnostic questions, and the results indicated a significant correlation between decline in olfactory function and mild cognitive impairment. Furthermore, the results support that a decline in olfactory function can predict the development of mild cognitive impairment.
Results, Conclusions and Recommendations:
The results of this study showed that a decline in olfactory function could predict the development of mild cognitive impairment. Olfactory assessment is more convenient, and the assessor does not require any special training. Therefore, olfactory assessment could be applied to screen for older adults with a high risk of mild cognitive impairment. However, cognition is a multi-dimensional concept, and olfactory testing alone cannot be comprehensive. Moreover, several factors may influence olfactory testing, such as the weather, allergic problems of the nose, and other diseases (nasopharyngeal carcinoma, chronic rhinitis, etc.). Further studies are therefore needed to explore the impact of related factors in identifying mild cognitive impairment.