Abstract

BackgroundCognitive impairment often goes undetected in older people in hospital. Efficient screening tools are required to improve detection.To determine diagnostic properties of two separate informant-based single screening questions for cognitive impairment (dementia and delirium) in hospitalised older people.MethodsPatients over 65 years non-electively admitted to medical or geriatric wards within a teaching hospital. Our index tests were single screening questions (SSQ), one for dementia (“How has your relative/friend’s memory changed over the past 5 years (up to just before their current illness)?”) and one for delirium (“How has your relative/friend’s memory changed with his/her current illness?”), which were assessed with informant response given on a five point Likert scale.Any deterioration on our index tests of SSQ-dementia and SSQ-delirium was accepted as a positive screen for cognitive impairment. Scores were compared to the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) >3.38 accepted as dementia, and Confusion Assessment Method (CAM) diagnosis of delirium. We also collected direct cognitive screening data using Mini Mental Status Examination (MMSE).ResultsInformant responses were obtained in 70/161 (43.5%) patients, median age 80.8 (range:67–97) years; mean MMSE score 18.5 (SD: 8.1). The SSQ-dementia when compared to the IQCODE had a sensitivity of 83.3% and specificity of 93.1%. The SSQ-delirium when compared to CAM diagnosis had sensitivity of 76.9% and a specificity of 56.1%.ConclusionsThese findings show promise for use of an informant single screening question tool as the first step in detection of dementia in older people in acute hospital care, although this approach appears to be less accurate in screening for delirium.

Highlights

  • Cognitive impairment often goes undetected in older people in hospital

  • The characteristics of the 161 participants recruited for this study are shown in Table 1, as well as separate analyses for patients with complete and incomplete single screening question data

  • A statistically significant difference in Mini Mental Status Examination (MMSE) scores was found between the different single screening questions (SSQ)-dementia outcomes (H(2) = 16.8, p < 0.001), with a median of 3.06 for patients identified as “no change or better”, 3.94 for patients identified as “a bit worse” and 4.88 for patients identified as “much worse”

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Summary

Introduction

Cognitive impairment often goes undetected in older people in hospital. To determine diagnostic properties of two separate informant-based single screening questions for cognitive impairment (dementia and delirium) in hospitalised older people. Cognitive impairment is a term covering a range of disorders representing a clinical deficit in cognitive ability with a significant deterioration from the person’s previous level of function [1]. It can present acutely with rapid onset and a fluctuating short-term course such. Cognitive screening tests that are quick and easy to administer are used to identify individuals at high risk of cognitive impairment, suitable for further assessment [6]. There is debate surrounding which screening test is the best to use due to the wide range available and lack of validation in hospital settings [9]

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