Saint Louis University Mental Status Research Articles

A psychometric study of validation and cross-cultural adaptation of the Holden Communication Scale for elderly with dementia in care homes

Purpose This paper aims to validate and adapt the Arabic version of Holden Communication Scale (HCS) for assessing communication skills among old people with dementia in care home. Design/methodology/approach A study involving 210 elderly residents from Jordanian care homes was conducted, where they completed the Arabic version of the HCS. Internal consistency and factor analysis techniques were precisely used to assess the scale's reliability. Additionally, cognitive function evaluation used the Arabic iteration of the Saint Louis University Mental Status (SLUMS) questionnaire, while communication skills were comprehensively appraised using the HCS. Findings The Arabic HCS has strong content validity, with a one-component structure accounting for 60% of the variation and a three-factor structure accounting for 77.2% of the variance. The original three-subgroup structure of the scale was recreated, and internal consistency varied from 0.85 to 0.87, indicating good reliability. Originality/value This study aimed to assess the reliability and validity of the Arabic version of the HCS among old people with dementia residing in care homes. The authors conducted examination of its psychometric properties within this unique population.

Lifestyle and mood correlates of cardiometabolic risk in people with serious mental illness on second-generation antipsychotic medications.

Cardiovascular morbidity and mortality are high in people with serious mental illness (SMI). This problem is mediated, at least in part, by metabolic side effects of second-generation antipsychotics (SGAs) and by unhealthy lifestyle behaviors. We asked whether oral glucose tolerance testing (oGTT) or hemoglobin A1c (HbA1c) is superior in identifying people with SMI at high cardiometabolic risk and whether this risk is shaped by mood, cognition, or lifestyle habits. We evaluated 40 patients with schizophrenia, schizoaffective, or bipolar disorder receiving SGAs by oGTT, HbA1c, comprehensive metabolic and lipid panels, and CRP. Mood was assessed using the Patient Health Questionnaire (PHQ-9), and cognition was assessed using the Saint Louis University Mental Status examination. Diet was assessed using the UK Diabetes and Diet Questionnaire (UKDDQ), and physical activity was assessed using daily step counts. Most patients had prediabetes (preDM) or diabetes mellitus (DM), 72.5% by oGTT, and 52.5% by HbA1c criteria. Pulse rates and insulin resistance indices (Homeostatic Model Assessment of Insulin Resistance, HOMA IR; Matsuda) were significantly different between patients classified as normal or with preDM/DM, using either oGTT or HbA1c criteria. Patients with preDM/DM by HbA1c but not oGTT criteria also had higher waist/hip ratios, triglyceride, and CRP levels (p<0.05). A strong negative correlation was found between average daily step counts and CRP levels (rho = -0.62, p<0.001). Higher UKDDQ scores, or unhealthier diet habits, were associated with higher fasting plasma glucose (rho = 0.28, p = 0.08), triglyceride levels (rho = 0.31, p = 0.05), and insulin resistance (HOMA IR: rho = 0.31, p = 0.06). Higher PHQ-9 scores correlated with lower 2h-oGTT glucose levels (rho = -0.37, p<0.05). OGTT screening is superior to HbA1c screening in detecting preDM and DM early. Patients identified with preDM/DM by oGTT or HbA1c screening are insulin-resistant and have higher pulse rates. Abdominal obesity, unfavorable lipid profiles, and higher CRP levels were noted in patients screened by HbA1c, but not by oGTT. Low physical activity, low depression scores, and unhealthy diet habits were associated with higher CRP and higher glucose and triglyceride levels, respectively. Future studies should assess the impact of specifically tailored individual lifestyle counseling and medical management interventions in this high-risk population.

USABILITY OF A TABLET-BASED HOME MEMORY TEST IN OLDER ADULTS WITH AND WITHOUT COGNITIVE IMPAIRMENT

Abstract Increasing Alzheimer’s and related disorders prevalence, highlights the need for accurate and reliable cognitive screening and diagnostic tools. We studied usability of LifeBio Brain, a prototype cognitive testing mobile application. We established baseline cognitive performance in volunteers from Brown University’s Geriatric Clinic using the Saint Louis University Mental Status (SLUMS). We asked volunteers to use the LifeBio Brain app at home on an iPad twice daily for 10 times, for about 15 minutes each time, followed by completion of a 10-question System Usability Scale on satisfaction that assesses the app and its ease of use. The LifeBio Brain app contains a mix of adapted cognitive tests such as clock draw and Trails A, and game-like experiences, presented in a randomized order. We analyzed a white non-hispanic sample (n=51) with a balanced distribution of age [79.6 (7.2) years, range 66-95] and sex (58.82% women). The median SLUMS score of 25, indicates cognitive impairment in most participants. Similarly, the median usability score on the 50-point System Usability Scale was 41. We found that 80% of participants had a usability score of 35 or greater, with a 95% CI of 31-38, and 67% had a usability score of 40 or greater. SLUMS score ≤14 correctly predicted study completion in 90% of participants. Most volunteers from an outpatient geriatrics clinic found LifeBio Brain usable. Volunteers leaving the study early tended to have lower SLUMS Scores. The LifeBio Brain app may have utility for measuring memory and thinking abilities in a white outpatient geriatrics population.

Development and validation of a natural language processing system that extracts cognitive test results from clinical notes

AbstractBackgroundCognitive test results from electronic health records (EHRs) are key information for assessing the severity and progression of patients with mild cognitive impairment (MCI) and Alzheimer’s’ disease (AD). However, such information is often recorded in unstructured clinical notes rather than in an administrative database. We developed and validated a natural language processing (NLP) system to extract cognitive test results from clinical notes in the Veterans Affair (VA) Healthcare System.MethodAn NLP system was developed using regular expression‐based rules and Python to extract results for six tests that have been used most frequently in VA: Mini‐Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA), Saint Louis University Mental Status Examination (SLUMS), Mini‐cog, Boston Naming Test (BNT), and Benton Visual Retention Test (BVRT). The system extracted test results from each note in two steps: (1) searched a test name, or variations and abbreviation of the test name and, if successful, (2) searched the quantitative results (e.g., 12/30 for MMSE, 74th percentile for BNT) and/or descriptive results (e.g., “borderline impairment” for BVRT) within 5 words or one sentence before or after the test name. To balance the system performance and speed, we developed 3‐8 extraction rules per test based on a manual review of 30‐50 notes for each test. We further validated NLP performance on 6 held‐out datasets (50‐200 notes/test). We automatically sampled the development and held‐out notes by searching the test name and its variations/abbreviation to increase positive cases, i.e., notes that contained the above test results.ResultThe NLP system achieved 0.72‐0.92 predictive positive values (PPV), 0.96‐1.00 recall, and 0.83‐0.95 F1 scores on the validation test sets (Table 1). In addition, it demonstrated a scalable performance (processed 200,000 notes in 7 min), allowing an extraction of millions of notes from ∼1 million patients within hours.ConclusionRule‐based NLP can extract cognitive test results with adequate performance and scalable capability for clinical notes from patients with MCI or AD within the VA Healthcare System.

Engagement in Meaningful Activities Among Residents with Dementia in Assisted Living

AbstractBackgroundEngagement in meaningful activities is beneficial for the physical and psychological well‐being of persons with Alzheimer’s disease or related dementia (ADRD). Meaningful activities are a critical dimension of person‐centered care, although challenges exist in providing them for persons with ADRD in long‐term care settings. The purpose of this study was to describe engagement in meaningful activities among residents with ADRD in assisted living.MethodThis study included baseline data collected from the first cohort of the randomized controlled trial, Meaningful Activities for Managing Behavioral Symptoms of Distress (MAC‐4‐BSD). Assisted living residents were eligible if they were ≥55 years old, live in a participating setting, and screen positive for dementia based on the Saint Louis University Mental Status exam (SLUMS) and AD8 Dementia Screening Interview. Residents were excluded if they were enrolled in hospice, admitted for short term respite, or had a significant neurological condition not related to ADRD. Residents’ engagement in meaningful activities was evaluated based on the Engagement in Meaningful Activities Survey (EMAS). Descriptive statistics were used to summarize sample characteristics and describe engagement in meaningful activities.ResultA total of 38 residents from 3 assisted living communities were included in the sample. Most participants were female (71%), White (82%), and mean age was 81 years old (SD = 7.9). Average score on the SLUMS was 4.5 (SD = 4.9). The EMAS mean score was 43.57 (SD = 10.9) with a range of 25 to 60. Participation was endorsed most frequently for activities that give them pleasure (60.7%) and a sense of satisfaction (64.3%). Participation was endorsed least frequently for activities that help other people (35.7%), contribute to feeling competent (42.9%), and have the right amount of challenge (42.8%).ConclusionFindings from this study offer preliminary insights into residents’ engagement in meaningful activities in assisted living and suggest there is limited participation in activities that help others, help with feeling competent, and have the right challenge level for those with ADRD. Although limited by small sample size, this study highlights the need for increasing engagement in meaningful volunteer activities to help others which recent research demonstrates could positively impact physical and cognitive health outcomes.

Clinical Manifestations.

Digital cognitive assessment solutions can overcome some barriers to cognitive screening in primary care by providing rapidly-obtained objective insights without requiring specialty-trained examiners. The Linus Health Digital Clock and Recall (DCR™) is a three-part test consisting of three-word immediate verbal acquisition, the Digital Clock Test (DCTclock™), and delayed recall of the three words. Our objective was to compare performance on the DCR to the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) and the Saint Louis University Mental Status (SLUMS; Tariq et al., 2006), two commonly used screening tests in primary care. Comparative analyses of DCR, MoCA (Total Score and Memory Index Score [MIS]), and SLUMS results were conducted among 80 primary care patients - 65 years and older presenting for any reason - whose DCR performance was indicative of cognitive impairment. Of the 80 patients (mean age 74.0 [±7.8]; 60% female) performing as impaired or borderline impaired on the DCR, 67 completed the MoCA and 13 completed the SLUMS. Comparison between the DCR and MoCA Total Score included 78% (52/67) concordance for identifying impairment (cutoff <26). While the remaining 15 of 67 patients (22%) had normal MoCA Total Scores (≥26), 13 (87%) missed points in at least one MoCA cognitive domain and 8 (53%) missed points in multiple MoCA domains (often language and delayed recall). Comparison between DCR and SLUMS revealed that all 13 patients receiving SLUMS assessment had DCR scores 0-1 and SLUMS scores <27 (indicating cognitive impairment). See Tables 1 and 2 for breakdown of MoCA, MIS, and SLUMS stratified by DCR performance. Logistic regression found that DCTclock metrics of information processing (z = 2.00, p = .045) and spatial reasoning (z = 2.82 p = .005) discriminated cognitive impairment on MoCA Total Score (cutoff <26). Overall, ROC analysis revealed good accuracy of DCR to identify MoCA performance (AUC = .84; Figure 1). Screening in primary care using the DCR is feasible, takes less time to administer than MoCA or SLUMS, and shows concordant results with these more established screening tools in detecting cognitive impairment. Future research aims to investigate the criterion validity of the DCR among biomarkers for neurodegenerative disease.

Enhancing apathy treatment in Jordanian people living with dementia residing in care homes using virtual reality reminiscence therapy

PurposeThis paper aims to explore examine the therapeutic potential of head-mounted display (HMD)-based Virtual Reality Relaxation Therapy (VRRT) sessions for people individuals with dementia in Jordan.Design/methodology/approachThis cross-sectional survey recruited 75 dementia-diagnosed elderly individuals from three Jordanian care homes. A VRRT intervention comprising 10 tailored RT sessions held over the course of five weeks was administered to the participants. Apathy, cognitive performance, anxiety and depression were evaluated before and after the intervention to determine any changes. The Person-Environment Apathy Rating Scale's (PEARS) Arabic translation's validity and reliability were also evaluated.FindingsThe VRRT intervention yielded noteworthy results in reducing apathy, as indicated by a substantial decrease in PEARS scores from 17.20 to 11.15. The findings of the study revealed that the participants demonstrated enhanced cognitive abilities, as evidenced by a significant rise in their Saint Louis University Mental Status ratings, which increased from 15.11 to 19.70. The levels of anxiety and depression exhibited a significant decrease subsequent to the implementation of VRRT, with anxiety levels decreasing from 13.66 to 8.23 and depression levels decreasing from 13.62 to 9.33. Furthermore, a notable 70% of participants demonstrated statistically significant decreases in indifference.Practical implicationsThis study makes a significant contribution to the advancement of innovative treatment approaches aimed at addressing the needs of the aging population, hence enhancing health outcomes and raising the quality of care in Jordan.Originality/valueThe effectiveness of VRRT in reducing apathy among Jordanian senior citizens residing in nursing homes has not yet been fully investigated. Therefore, this paper seeks to assess the effectiveness of HMD-based VRRT by conducting pre- and post-intervention evaluations. This research aims to provide valuable insights into the applicability and significance of VRRT in the Jordanian context, contributing to the development of culturally appropriate and cutting-edge therapeutic interventions for older individuals in Jordan. Through this study, the authors aim to promote improved health and elevated standards of care for this population.

Performance of illiterate and low-educated Egyptian elderly in SLUMS (Saint Louis University Mental Status) Examination.

Performance of illiterate and low-educated Egyptian elderly in SLUMS (Saint Louis University Mental Status) Examination.

The impact of cognitive impairment in urologic implants: a narrative review.

With the general population aging and thus more patients developing bothersome erectile dysfunction, stress urinary incontinence and overactive bladder, there will likely be a higher demand for three common interactive implants in urology, the penile prosthesis, artificial urinary sphincter (AUS) and sacral neuromodulation (SNM). Further, the prevalence of mild and major neurocognitive disorders (also known as mild cognitive impairment and dementia, respectively) is expected to increase. While the aforementioned urologic implants have excellent short and long term outcomes, there are also known device issues such as malfunction or misuse that may require surgical removal and/or revision. The objective of this narrative review is to describe the association of cognitive impairment and urologic implants. We performed a search on PubMed between the years 1975-2023 for English language articles that reported on any type or severity of cognitive impairment and its association with penile prosthesis, AUS and/or SNM. While peer-reviewed published manuscripts were prioritized, abstracts that fit our search criteria were also included. Data assessing outcomes of patients with cognitive impairment who undergo placement of a urologic implant are limited. There is an association between AUS failure or misuse with cognitive impairment. SNM is efficacious in this population in the short term. In patients who develop dementia, an inflatable penile prosthesis can be deflated via in-office needle puncture and an AUS can be deactivated. The Memory Alteration Test, Quick Screen for Mild Cognitive Impairment and the Saint Louis University Mental Status Examination are relatively quick screening tests with good sensitivity and specificity for mild cognitive impairment. While data on the association between urologic implants and cognitive impairment are sparse, there are tools that urologists can use to screen patients for cognitive impairment. With screening, urologists can provide appropriate preoperative counseling (including recommending against implantation) and can provide closer postoperative monitoring. Further study is required to assess which patients should be excluded from device implantation and how to properly assess for cognitive impairment in a manner that is both beneficial for the patient and convenient and efficient for a urologist.

Prevalence of Cognitive Impairment among Elderly in Primary Health Care Centers in Cairo, Egypt

Abstract Background Cognitive impairment (CI) in the elderly is a growing worldwide public health problem. Symptomatic CI is under-diagnosed, even though early detection in dementia care is of great significance and allowing the person to be involved in future care planning. Objectives To measure the prevalence of CI among elderly patients attending primary health care centers in Elsharabya, Egypt and to identify different risk factors associated with CI. Methods A cross-sectional study was performed among 154 elderly using an interview questionnaire including socio-demographic data, Saint – Louis – University – Mental – Status (SLUMS), Test your memory (TYM)) and General practitioner Assessment of Cognition (GPCOG) questionnaires. Results 51.3% of the studied elderly suffered from mild CI compared to 32.5% suffered from marked CI by SLUM. 68.8% suffered from CI by TYM. 83.3% and 13.0% of them were classified as CI by patient assessment and caregiver interview of GPCOG respectively. The most significant factors associated with CI were being older, non-married, and low educational levels. Conclusions and Recommendations The prevalence of CI is high among the studied elderly. Early identification of CI is important to delay the progression to Alzheimer’s disease and achieve a better quality of life.

Differences in Medication Use by Gender and Race in Hospitalized Persons Living with Dementia.

The purpose of this study was to describe differences in treatment of White versus Black older adults, males versus females, and those living at home, assisted living, or nursing home communities with regard to the use of psychotropic, pain, and cardiovascular medications. Baseline data from the first 352 participants in the study, implementation of Function-Focused Care for Acute Care Using the Evidence Integration Triangle, were used. Data included age, gender, race, comorbidities, admission diagnosis, and living location prior to hospitalization, the Saint Louis University Mental Status exam, the modified Charlson Comorbidity Index, the Pain Assessment in Advanced Dementia scale, the Confusion Assessment Method, and medications prescribed. Generalized linear mixed model analyses were done, controlling for race or gender (depending on which comparison analysis was being done), age, cognitive status, hospital, delirium, and comorbidities. Medication use was significantly higher for White older adults, compared to Black older adults, for antidepressants, anxiolytics, non-opioid pain medications, and opioids and lower for antihypertensives. Females received more anxiolytics than their male counterparts. There were differences in medication use by living location with regard to non-opioid pain medication, antipsychotics, statins, and anticoagulants. The findings provide some current information about differences in medication use across groups of individuals and can help guide future research and hypothesis testing for approaches to minimizing these differences in treatment.

#5742 MID-ARM CIRCUMFERENCE AS A CORRELATE TO DIFFERENT: ASPECT NEUROCOGNITIVE IMPAIRMENT IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Malnutrition is associated with poor cognitive function (CI) in Hemodialysis (HD) patients. Both have multiple ways of assessment scaled from simple bedside screening tests to more sophisticated time- and cost-consuming measures. This work aims to define the best nutritive assessment measure that correlates to the degree of CI. Method A cross-sectional study was carried out on 116 patients in 4 different HD units from Delta Nile, Egypt. The nutritional status was examined after the dialysis session in euvolemic patients using (1) anthropometric measurements, including body mass index (BMI), mid-arm circumference (MAC), skin fold thickness (SFT), and mid-arm muscle circumference (MAMC); (2) bioelectrical impedance analysis for assessment of skeletal muscle mass (SMM), skeletal muscle index (SMI), free fat mass (FFM), body fat mass (BFM), and total body water (TBW); (3) Hand grip strength was used to assess muscle power. The assessment of cognition was made using (1) a mini-mental state examination (MMSE) for orientation, registration, attention, recall, language, and copying; (2) Saint Louis University Mental Status Exam (SLUMS) for early CI and executive functioning; (3) Arabic version of Penn Web-Based Computerized Neurocognitive Battery (WebCNP) for those who scored no CI in the previous two tests. Results The results of MMSE and SLUMS tests showed that 34.5% of our cohort (n = 40) had no CI, 34.5% (n = 40) had mild to moderate degrees of CI, and 31% (n = 36) had a severe form of CI. Comparing the nutritional assessment parameters between the categories of cognitive scores revealed that there were no significant differences except in significantly lower median values of MAC (P 0.01), SMI in bioelectrical impedance analysis (P0.01), and hand grip strength (P 0.002) in severe CI group than the normal to patients without CI. In correlation statistics, MAC and hand grip strength were negatively correlated to the degree of CI (r = -0.3, P 0.006 and r = -0.26, P 0.009, respectively). MAC was the only parameter correlated with attention, emotional recognition, and differentiation functioning in the forty patients with no CI who underwent computerized neurocognitive assessment. The highest reported positive correlations reported were between the MAC and response time of both emotion recognition (r = 0.57, P &amp;lt;0.001) and differentiation (r = 0.55, P &amp;lt;0.001). Conclusion Of the different parameters of nutritional state assessment, MAC, the simple bedside measurement, was the best correlate with the degree of cognitive impairment in HD patients, even in its mild primitive forms.

#6917 IMPACT OF FUNCTIONAL IRON DEFICIENCY IN NON-ANEMIC HEMODIALYSIS PATIENT ON NEUROCOGNITIVE AND QUALITY OF LIFE: A SINGLE CENTER CROSS-SECTION STUDY

Abstract Background and Aims The clinical paradox of high ferritin levels and low TSAT is a condition known as "functional iron deficiency." This occurs when the body has adequate iron stores, as indicated by high ferritin levels, but the iron is not available for use in the body, as indicated by low TSAT levels. This can be caused by inflammation, chronic disease, or other conditions that interfere with the body's ability to absorb and utilize iron. Hemodialysis patients may suffer from both absolute and functional iron deficiency. Most studies was directed to study effect of absolute iron deficiency even without anemia, and the important of supplementing with oral or intravenous iron ; however, impact of functional iron deficiency without anemia and subsequently decision of iron supplementation especially in presence of high ferritin is still undetermined. Our aim is to assess the impact of functional iron deficiency without anemia in neurocognitive function and quality of life among hemodialysis patients in dialysis unit in urology and nephrology center Mansoura University. Method Patients on regular haemodialysis were screened using complete blood picture, transferrin saturation (TSAT) and serum ferritin to determine iron status. The Saint Louis University Mental Status assessed cognitive function. (SLUMS) Examination used for detecting mild cognitive impairment and dementia. Quality of life was assessed by 36-item short-form (SF-36). The SF-36 measures eight scales: physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). Results Among 70 patients maintained on regular hemodialysis, A 42 patients have normal hemoglobin level (above 12 mg/dl with high serum ferritin &amp;gt;300 ng/mL). They classified into two group: A 26 patients with high ferritin, high TSAT &amp;gt;20%, and normochromic red blood cells, A 16 patients with high ferritin level,low TSAT&amp;lt;20% and hypochromic red blood cells. Among the 26 patients, 17 male and 9 female, and among the 16 patients, 11 male and 5 female. The 26 patients have mean age of (41 +/- 13) and the 16 patients have mean age of (39 +/- 10). No significant difference between the two groups regarding sex and age with p value (0.5 and 0.1 respectively). Assessment of cognitive function by SLUM score revealed regarding normal group (4 have normal score, 18 have mild impairment of cognitive function and 4 have dementia score) and the iron deficient group (4 have normal score, 9 have mild impairment of cognitive function and 3 have dementia score) with no statistically different between the two group (P = .6).requarding quality of life, no statistically difference was fond between the two group regarding : physical functioning (p= 0.18), role physical (P = .11), bodily pain (p = 0.33), general health (p= 0.5), vitality (P = .41), social functioning (P = .2), role emotional (P = .4), and mental health (P = .21 ). Conclusion Non-anemic hemodialysis Patients with Functional iron deficiency has no statistically difference regarding neurocognitive function and quality of life from normal iron non-anemic patients.

Cognitive Function Among Rural People in Nineveh: A Cross-Sectional Survey

Background: Early identification of cognitive weakening in previously undetected cases could help deal by starting programs for rehabilitation. Aim: The aim of this survey was to evaluate the prevalence and degree of cognitive impairment among adults of rural area in Nineveh, Iraq. Method: A cross-sectional study with convenient sampling technique was conducted to enroll subjects from a rural area in Nineveh. Cognitive function was examined in all the patients by the Saint Louis University Mental Status (SLUMS) is a screening tool for the cognitive state. A total of 213 agreed to participate in the survey with a mean age of 52.1 ± 11.8 years and higher percentage of participants were with primary level of education 125 (58.7%). Results: The mean score for the cognitive function examination was 18.85 ± 4.55 with significant differences were found between cognitive function and educational level, employment, and monthly income. Cognitive score was negatively correlated with age of participants (r= - 0.128, p value = 0.031). Although it was not significantly associated with level of education but around 43% of the study population suffered from mild cognitive impairment to dementia. Conclusion: The study concludes that there have been strong calls for program from the Ministry of Health to improve dementia care and support for societies with dementia and their occupations that will stay a life of that means and dignity. Efforts to make societies greater cognitively functioned, as well as, actively attractive patients will improve cost, the sustainable, treatment and care methods for diseases and quality of life.

Patient-specific cognitive profiles in the detection of dementia subtypes: A proposal.

Many physicians rely on sum score cognitive screening tests to evaluate patients for cognitive decline. Because the vast majority of cognitively impaired patients never receive more extensive testing, the results of these screening tests impact patients and their family members profoundly. No previous study has examined whether the metrics used by the popular Mini-Mental State Examination, Montreal Cognitive Assessment, and Saint Louis University Mental Status tests reliably identify single-domain deficits or allow clinicians to adequately track disease progression. We compare side by side the metrics used by these three tests to highlight the differences in the ways they measure domain impairments. We then contrast the sum score approach to cognitive screening with brief domain-specific tests that use extended metrics in each domain examined. Last, we suggest that moderate-to-severe domain-specific deficits on these tests should lead physicians to anticipate specific functional problems and alert family members.

A Descriptive Study of Treatment of Pain in Acute Care for Patients Living With Dementia

BackgroundDuring the hospital stay pain is very common among patients living with dementia. MethodsDescriptive data was obtained from chart review and included age, gender, race, comorbidities and admitting diagnosis. AimsThe purpose of this study was to describe pain among patients living with dementia, the use of pharmacologic and nonpharmacologic treatment, and to compare treatments among those with and without pain. DesignThis was a descriptive study using baseline data from the first 233 participants from the study “Testing the Implementation of Function Focused Care for Acute Care Using the Evidence Integration Triangle (FFC-AC-EIT)”. Participants/SubjectsThe mean age of participants was 83 (SD=5) and the majority was female (65%) and White (67%) with evidence of dementia (based on a mean Saint Louis University Mental Status Test = 7.23, SD=5.85). ResultsOverall 98 (42%) participants had pain and 135 (58%) no pain. Only 14 (6%) participants received no nonpharmacologic or pharmacologic interventions for pain and five of these individuals had pain. The most frequently used pharmacologic intervention among all participants was acetaminophen (n = 121, 52%), then tramadol (n = 19, 8%). Comfort measures and general nonpharmacologic approaches were the most frequently used non-pharmacologic approaches, then physical activity and therapeutic communication. From admission to discharge, there was a trend towards a decrease in pain. There was more use of opioids, physical activity, and therapeutic communication in the no pain group versus the pain group. ConclusionsThe majority of hospitalized medical patients living with dementia were treated for pain, but an ongoing focus is needed to assure optimal pain management for all patients.

OVERCOMING RECRUITMENT APPROACHES TO IDENTIFY PARTICIPANTS WITH DEMENTIA

Abstract Clinically the work up for dementia often includes a history and physical, neuropsychiatric screening measures and neuroimaging. These assessments are neither practical nor realistic when identifying participants for research studies. To confirm a diagnosis of dementia for study participants in the FFC-AC-EIT study we developed a measurement model. The model included four measures: the AD8, the Functional Activities Questionnaire, the Clinical Dementia Rating Scale, and the Saint Louis University Mental Status Examination. In the first 346 patients consented, 176 were enrolled and 158 were ineligible. The mean age of the participants was 80.70 (SD=9.60) and the majority were female (64%) and white (66%). There was evidence of reliability based on internal consistency and construct validity based on model fit using Rasch analysis and Structural Equation Modeling. All four measures are recommended as a pragmatic way in which to comprehensively determine evidence of dementia for research studies.

Performance Comparisons on the Saint Louis University Mental Status Examination Between Black and White Veterans and Education Classification in a Large Outpatient Sample from the Southern United States.

An increasing scientific literature recognizes that traditional cut-off scores for cognitive screeners may not be optimal for use in patients who differ in race/ethnicity from the screeners' normative/reference group. There is also literature on how racial/ethnic contextual factors, such as stereotype threat or perceived discrimination, may influence performance on cognitive testing. The current study examined the characteristics of SLUMS (a cognitive screening measure) performance in a large (n = 602) sample of Black (n = 229) and White (n = 373) veterans in a VA hospital located in the Southern United States. SLUMS data were gathered from retrospective electronic chart review between January 2013 and February 2020. Race/ethnicity of veterans was gathered by chart review and race of hospital providers who administered the SLUMS by personal communication. Black veterans were 1.99 times more likely to be classified by total SLUMS score as being within the dementia range compared with White veterans. Differences in item level performance were only found between Black and White veterans with ≥ high school education. Race of clinical provider (i.e., Black or White) administering the SLUMS did not significantly impact veteran performance on the SLUMS. This is the first large sample study of differences in SLUMS performance between Black and White veterans. Findings replicate earlier research on Black and White performance differences on individual SLUMS items and provide an analysis of examiner-examinee racial discordance. This study underscores the importance of researching cognitive measures in groups who differ from the original normative/references samples.

Optimal Approach for Assessing Evidence of Dementia for Research Studies.

The purpose of this study was to describe a process to determine the presence of dementia and test the psychometric properties of the proposed measurement model for dementia. The model included the AD8, the Functional Activities Questionnaire, the Clinical Dementia Rating Scale, and the Saint Louis University Mental Status Examination. A total of 346 patients consented and 176 of those were determined to be eligible as a result of screening with this measurement model. The mean age of the participants was 80.70 (SD = 9.60) and the majority were female (64%), white (66%), not Latinx (99%), and not married (67%). There was evidence of reliability based on the internal consistency of the items on all measures and the limited error associated with each item. There was evidence of construct validity based on model fit. All four measures are recommended as a pragmatic way in which to comprehensively determine evidence of dementia for research studies.

Reliability and Factor Structure of the Saint Louis University Mental Status (SLUMS) Examination

ABSTRACT Objectives Compared to its alternatives (e.g., Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]), little is known about the psychometric properties and factor structure of the Saint Louis University Mental Status (SLUMS) Examination. The purpose of the current study is to describe the internal consistency, factor structure, and temporal stability of the SLUMS, a widely used cognitive screening measure. Methods We examined the SLUMS of 108 mostly White male Veterans seen for home-based primary care services, 101 of whom had complete data and 28 who completed retesting approximately one year later. Results At time one, Veterans averaged 76.44 (SD = 9.88) years of age and 13.07 (SD = 2.26) years of formal education. Results indicated that the SLUMS had acceptable internal consistency (α = .709) and temporal stability (ρ =.723), with strongest evidence for a one-factor structure. Conclusions The SLUMS appears to have adequate reliability and clear one-factor structure in this sample. Additional research with diverse samples is needed to characterize the psychometrics of the SLUMS more comprehensively. Clinical Implications The SLUMS appears to be an efficient method for approximating global cognitive functioning among medically complex older adults.