Assessing cognitive function: The complexities of assessment of an individual's cognitive status are important in making an accurate and comprehensive evaluation

Abstract

To compare the Vulnerable Elders Survey-13 (VES-13) scale, a screening tool for older patients, with four other popular indicators that describe the physical and mental state of patients, the Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS), and to determine which cut-off points of the VES-13 scale will be useful for health services.The study included 864 older Caucasian people (mean age 80.9 ± 8.2 years, 615 female) who were hospitalized in the Geriatric University Clinic. The VES-13, ADL, IADL, MMSE and GDS were conducted in all the patients. A “gold standard” was created as a composite reference value assuming a non-vulnerable person with satisfactory results of all the reference tests: ADL (≥5), IADL (≥7), MMSE (≥24) and GDS (<6).Significant statistical correlations between the VES 13 and age (r = 0.59), ADL (r = −0.53), IADL (r = −0.66), MMSE (r = −0.47) and GDS (r = 0.37) were found. The sensitivity and specificity in detecting risk of functional vulnerability were 91.2% and 2.3%, 91.9% and 48.7%, 80.6% and 70.8%, 76.8% and 74.9%, and 71.6% and 82.2% for VES-13 scores of ≥3, ≥4, ≥5, ≥6, and ≥7, respectively. The Area Under the Curve (AUC) for the Receiver Operating Characteristic (ROC) was 82.6%.The VES-13 demonstrates high sensitivity and specificity in detecting functional deficits in older subjects. High correlations with other measures of Comprehensive Geriatric Assessment make it a valuable screening tool for older patients. A cut-off point of 6 seems optimal for screening purposes by health services.