Abstract
Objective
To compare the diagnostic accuracy of the interRAI Acute Care (AC) Cognitive Performance Scale (CPS2) and the Mini-Mental State Examination (MMSE), against independent clinical diagnosis for detecting dementia in older hospitalized patients.
Design, Setting, and Participants
The study was part of a prospective observational cohort study of patients aged ≥70 years admitted to four acute hospitals in Queensland, Australia, between 2008 and 2010. Recruitment was consecutive and patients expected to remain in hospital for ≥48 hours were eligible to participate. Data for 462 patients were available for this study.
Measurements
Trained research nurses completed comprehensive geriatric assessments and administered the interRAI AC and MMSE to patients. Two physicians independently reviewed patients’ medical records and assessments to establish the diagnosis of dementia. Indicators of diagnostic accuracy included sensitivity, specificity, predictive values, likelihood ratios and areas under receiver (AUC) operating characteristic curves.
Results
85 patients (18.4%) were considered to have dementia according to independent clinical diagnosis. The sensitivity of the CPS2 [0.68 (95%CI: 0.58–0.77)] was not statistically different to the MMSE [0.75 (0.64–0.83)] in predicting physician diagnosed dementia. The AUCs for the 2 instruments were also not statistically different: CPS2 AUC = 0.83 (95%CI: 0.78–0.89) and MMSE AUC = 0.87 (95%CI: 0.83–0.91), while the CPS2 demonstrated higher specificity [0.92 95%CI: 0.89–0.95)] than the MMSE [0.82 (0.77–0.85)]. Agreement between the CPS2 and clinical diagnosis was substantial (87.4%; κ=0.61).
Conclusion
The CPS2 appears to be a reliable screening tool for assessing cognitive impairment in acutely unwell older hospitalized patients. These findings add to the growing body of evidence supporting the utility of the interRAI AC, within which the CPS2 is embedded. The interRAI AC offers the advantage of being able to accurately screen for both dementia and delirium without the need to use additional assessments, thus increasing assessment efficiency.
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References
Lakhan P, Jones M, Wilson A, Courtney M, Hirdes J, Gray LC (2011) A prospective cohort study of geriatric syndromes among older medical patients admitted to acute care hospitals. J Am Geriatr Soc 59:2001–2008.
Mukadam N, Sampson EL. (2010) A systematic review of the prevalence, associations and outcomes of dementia in older general hospital inpatients. Int Psychogeriatr 18:1–12.
Sampson EL, Blanchard MR, Jones L, Tookman A, King M (2009) Dementia in the acute hospital: prospective cohort study of prevalence and mortality. Br J Psychiatry 195:61–66.
Hyde JH, Robert HI, Sinclair AJ. (2000) The effects of supporting discharge from hospital to home in older people. Age Ageing 29: 271–279.
Inouye SK, Wagner DR, Acampora D, Horwitz RI, Cooney LM Jr, Tinetii ME (1993) A controlled trial of nursing-centered intervention in hospitalized elderly medical patients: the Yale Geriatric Care Program. J Am Geriatr Soc 41:1353–1360.
Gray L, Bernabei R, Berg K, Finne-Soveri H, Fries BE, Hirdes JP et al. (2008) Standardizing assessment of elderly people in acute care: The interRAI Acute Care Instrument. J Am Geriatr Soc 56: 536–541.
Wellens NI, Flamaing J, Tournoy J, Hanon T, Moons P, Verbeke G et al. (2012) Convergent validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination. Am J Geriatr Psychiatry Apr 17 [Epub ahead of print]
Travers C, Byrne G, Pachana N, Klein K, Gray L. (2012) A prospective observational study of dementia and delirium in the acute hospital setting. Int Med J doi: 10.1111/j.1445-5994.2012.02962.x. [Epub ahead of print]
Wellens N, Van Lancker A, Flamaing J, Gray L, Moons P, Verbeke G et al. (2012) Interrater reliability of the interRAI Acute Care (interRAI AC). Archives Gerontol Geriatr 55:165–172.
Folstein MF, Folstein SE, McHugh PR. (1975) Mini-Mental State. J Psychiatr Res 12: 189–198.
Inouye SK (2003) The Confusion Assessment Method (CAM): Training Manual and Coding Guide. Yale University School of Medicine, New Haven.
Jorm AF. (1994) A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med 24:145–153.
SPSS Inc. (2010) SPSS advanced statistics 18.0. SPSS Inc., Chicago.
American Psychiatric Association (APA) (1994). Diagnostic and Statistical manual of mental disorders 4th edition. APA, Washington, DC.
Hartmaier SL, Sloane PD, Guess HA, Koch GG, Mitchell CM, Phillips CD (1995) Validation of the Minimum Data Set Cognitive Performance Scale: Agreement with the Mini-Mental State Examination. J Gerontol A Biol Sci Med Sci 50A(2): M128–M133.
Paquay L, De Lepeleire J, Schoenmakers B, Ylieff M, Fontaine O, Buntinx F (2007) Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents. Int J Geriatr Psychiatry 22:286–293.
Anthony JC, LeResche L, Niaz U, von Korff MR, Folstein MF (1982) Limits of the mini-mental state as a screening test for dementia and delirium among hospital patients. Psychol Med 12: 397–408.
Murden, RA, McRae TD, Kaner S, Bucknam ME (1991) Mini-mental state exam scores vary with education in blacks and whites. J Am Geriatr Soc 39:149–155.
Salih SA, Paul S, Klein K, Lakhan P, Gray L Screening for delirium within the interRAI Acute Care assessment system. J Nutr Health Aging (in press).
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Travers, C., Byrne, G.J., Pachana, N.A. et al. Validation of the interRAI cognitive performance scale against independent clinical diagnosis and the mini-mental state examination in older hospitalized patients. J Nutr Health Aging 17, 435–439 (2013). https://doi.org/10.1007/s12603-012-0439-8
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DOI: https://doi.org/10.1007/s12603-012-0439-8