Razvoj i prediktivna vrijednost novog skrining instrumenta za ranu detekciju kognitivnih poremećaja kod osoba starije životne dobi/

Abstract

Uvod. Pravovremeno prepoznavanje kognitivnih poremećaja u primarnoj zdravstvenoj zaštiti (PZZ) nije adekvatno zastupljeno. Disertacija je imala dvostruki cilj: da razvije i validira novi, brzi skrining test za rano otkrivanje kognitivnog oštećenja, kao i da ispita njegovo podudaranje sa standardizovanim 6CIT testom, te da utvrdi ulogu socijalnih determinanti u riziku za kognitivne poremećaje kod osoba starijih od 65 godina. Metodologija. Studija je realizovana kao studija presjeka, validacijska, eksplorativna, sekvencijalna mixed methods studija (mixed methods research), koja je uključila primjenu kvalitativnog, a potom kvantitativnog istraživačkog pristupa. Istraživanje je sprovedeno u periodu od 15. juna 2023. do 25. aprila 2025. godine. Kvalitativno istraživanje je obuhvatilo 25 polustrukturisanih intervjua sa ljekarima, medicinskim sestrama i psiholozima analiziranih tematskom analizom unutar CFIR (konsolidovani okvir za istraživanje) okvira. Rezultati kvalitativne studije i pregled literature su predodredili konstrukciju novog testa. Prije kvantitativne studije sprovedeno je pilot testiranje novim testom (N = 20), a zlatni standard je bila objektivna psihološka procjena. Kvantitativno istraživanje provedeno je na uzorku od 480 ispitanika starosti ≥ 65 godina u četiri grada u Bosni i Hercegovini (BiH). Za procjenu kognitivnog statusa, pored novog testa korišćen je komparativni standardizovani 6CIT test. Statistička analiza uključivala je Spearmanovu korelaciju, Cohenov kapa test, Wilcoxonov test, analizu korespondencije i binarnu logističku regresiju. Podaci su prikazani tabelarno i grafički, a prag statističke značajnosti postavljen je na p < 0,05. Rezultati. Pilot studija (N = 20) potvrdila je prihvatljivu internu konzistenciju (α = 0,80) i visoko slaganje sa objektivnom psihološkom procjenom (κ = 0,78; r = 0,85; p < 0,001). U kvantitativnoj studiji u uzorku od 480 starijih osoba u BiH, prevalencija kognitivnog oštećenja (blago + značajno) iznosila je 33,5% prema novom testu, odnosno 31% prema 6CIT-u. Novi test i 6CIT pokazali su značajno slaganje (κ = 0,73); Spearmanova r = - 0,78, p < 0,001. Senzitivnost/ specifičnost novog testa iznosila je 93,4%/93,3%; PPV = 86,3%, NPV = 96,9%. Prosječno vrijeme za izvođenje novog testa je 2,51 min (6CIT = 1,93 min; Z = -18,2, p < 0,001). Multivarijantna regresija identifikovala je nezavisne prediktore kognitivnog poremećaja: starija životna dob, niže obrazovanje, nepostojanje bračnog partnera, nedostatak hobija i druženja sa prijateljima. Zaključak. Novi skrining test demonstrira visoku dijagnostičku tačnost i prihvatljivo vrijeme izvođenja, te ostvaruje značajno slaganje sa 6CIT-om. Sociodemografski faktori nezavisno utiču na rizik. Uvođenje validiranog testa u rutinsku PZZ moglo bi unaprijediti rano otkrivanje kognitivnih poremećaja i omogućiti pravovremenu intervenciju u starijoj populaciji Bosne i Hercegovine.

Introduction. Timely recognition of cognitive impairment in primary health care (PHC) is not adequately addressed. The dissertation had a dual objective: to develop and validate a new rapid screening test for the early detection of cognitive impairment, and to examine its agreement with the standardized 6CIT test, as well as to determine the role of social determinants in the risk of cognitive impairment among individuals aged ≥ 65 years. Methodology. The study was conducted as a cross-sectional, validation, exploratory, and sequential mixed methods research, which included the application of a qualitative approach followed by a quantitative research approach. The research was carried out from June 15, 2023, to April 25, 2025. The qualitative study included 25 semi-structured interviews with physicians, nurses, and psychologists, analyzed using thematic analysis within the CFIR (Consolidated Framework for Implementation Research) framework. The results of the qualitative study, along with a literature review, guided the development of a new test. Before the quantitative phase, a pilot test of the new instrument was conducted (N = 20), with objective psychological assessment serving as the gold standard. The quantitative study was conducted on a sample of 480 participants aged ≥ 65 years across four cities in Bosnia and Herzegovina. To assess cognitive status, alongside the new test, the standardized 6CIT test was used for comparison. Statistical analysis included Spearman’s correlation, Cohen’s kappa test, Wilcoxon test, correspondence analysis, and binary logistic regression. Data were presented in tables and graphs, with the threshold for statistical significance set at p < 0.05. Results. The pilot study (N = 20) confirmed acceptable internal consistency (α = 0.80) and high agreement with objective psychological assessment (κ = 0.78; r = 0.85; p < 0.001). In the quantitative study conducted on a sample of 480 older adults in Bosnia and Herzegovina, the prevalence of cognitive impairment (mild + significant) was 33.5% according to the new test, and 31% according to the 6CIT. The new test and 6CIT showed significant agreement (κ = 0.73); Spearman’s r = -0.78 p < 0.001. The sensitivity/specificity of the new test were 93.4% / 93.3%, respectively; PPV = 86.3%, NPV = 96.9%. The average time to administer the new test was 2.51 minutes (6CIT = 1.93 minutes; Z = -18.2, p < 0.001). Multivariate regression identified the following independent predictors of cognitive impairment: older age, lower education level, absence of a marital partner, lack of hobbies and social interaction with friends. Conclusion. The new screening test demonstrates high diagnostic accuracy and acceptable administration time, showing significant agreement with the 6CIT. Socio-demographic factors independently influence the risk of cognitive impairment. The implementation of this validated test in routine primary health care could improve early detection of cognitive disorders and enable timely intervention in the older population of Bosnia and Herzegovina.