Abstract
IntroductionThe Mini-Mental State Examination (MMSE) is a common cognitive screening test, but its utility in identifying impairments in survivors of acute respiratory failure is unclear. The purpose of this study was to evaluate MMSE performance versus a concurrently administered detailed neuropsychological test battery in survivors of acute respiratory failure.MethodsThis cross-sectional analysis used data from the ARDSNet Long Term Outcomes Study (ALTOS) and Awakening and Breathing Controlled Trial (ABC). Participants were 242 survivors of acute respiratory failure. The MMSE and detailed neuropsychological tests were administered at 6 and 12 months post-hospital discharge for the ALTOS study, and at hospital discharge, 3 and 12 months for the ABC study. Overall cognitive impairment identified by the MMSE (score <24) was compared to impairments identified by the neuropsychological tests. We also matched orientation, registration, attention, memory and language domains on the MMSE to the corresponding neuropsychological test. Pairwise correlations, sensitivity, specificity, positive and negative predictive values, and agreement were assessed.ResultsAgreement between MMSE and neuropsychological tests for overall cognitive impairment was fair (42 to 80%). Specificity was excellent (≥93%), but sensitivity was poor (19 to 37%). Correlations between MMSE domains and corresponding neuropsychological tests were weak to moderate (6 months: r = 0.11 to 0.28; 12 months: r = 0.09 to 0.34). The highest correlation between the MMSE and neuropsychological domains was for attention at 6 months (r = 0.28) and language at 12 months (r = 0.34).ConclusionsIn acute respiratory failure survivors, the MMSE has poor sensitivity in detecting cognitive impairment compared with concurrently administered detailed neuropsychological tests. MMSE results in this population should be interpreted with caution.
Highlights
The Mini-Mental State Examination (MMSE) is a common cognitive screening test, but its utility in identifying impairments in survivors of acute respiratory failure is unclear
This study explored whether the timing of patient follow-up assessment after hospital discharge or patient characteristics influenced the relationship between the MMSE and the neuropsychological test battery
To examine generalizability of the primary ARDSNet Long Term Outcomes Study (ALTOS) study analyses, we evaluated the ability of the MMSE to detect overall cognitive impairment compared to a similar neuropsychological test battery in the ABC study [31]
Summary
The Mini-Mental State Examination (MMSE) is a common cognitive screening test, but its utility in identifying impairments in survivors of acute respiratory failure is unclear. The purpose of this study was to evaluate MMSE performance versus a concurrently administered detailed neuropsychological test battery in survivors of acute respiratory failure. Many survivors of acute respiratory failure experience long-term cognitive impairments across a variety of cognitive domains, including attention, memory, mental processing speed and executive function [1,2,3,4,5,6] To evaluate such impairments, comprehensive neuropsychological test. As a result of these favorable performance characteristics, the MMSE has been commonly used to assess cognitive outcomes in critical care populations [17,18,19,20,21,22,24]. The objective of this study is to assess whether the MMSE can detect cognitive impairment, as assessed by a concurrently administered, detailed neuropsychological test battery, in survivors of acute respiratory failure. This study explored whether the timing of patient follow-up assessment after hospital discharge or patient characteristics influenced the relationship between the MMSE and the neuropsychological test battery
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