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Use of Serial Mini‐Mental State Examinations to Diagnose and Monitor Delirium in Elderly Hospital Patients
Author(s) -
O'Keeffe Shaun T.,
Mulkerrin Eamon C.,
Nayeem Kayser,
Varughese Matthew,
Pillay Isweri
Publication year - 2005
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2005.53266.x
Subject(s) - delirium , medicine , confidence interval , prospective cohort study , mini–mental state examination , confusion , mental state , population , geriatrics , cognitive impairment , dementia , cognition , intensive care medicine , psychiatry , psychology , environmental health , disease , psychoanalysis
Objectives: To determine the responsiveness of serial Mini‐Mental State Examinations (MMSEs) for the diagnosis and monitoring of delirium in elderly hospital patients. Design: Prospective study. Setting: University teaching hospital. Participants: One hundred sixty‐five people admitted to an acute geriatric service. Measurements: Subjects were assessed using the MMSE and the Confusion Assessment Method on hospital Days 1 and 6. Changes in scores were compared between patients who remained free of delirium (n=124) and those who by Day 6 had developed delirium (n=14) or had resolution of delirium present on admission (n=22). Results: A number of measures of responsiveness confirmed that serial MMSE scores were responsive to resolution and to development of delirium. A fall of 2 or more points on the MMSE was the best determinant for detecting development of delirium (93% sensitivity, 90% specificity, positive likelihood ratio (LR)=8.9 (95% confidence interval (CI)=5.2–15.1) and negative LR=0.08 95% CI=0.01–0.53)). A rise of 3 or more points was the best determinant for detecting resolution of delirium (77% sensitivity, 75% specificity, positive LR=3.1 (95% CI=2.1–4.5) and negative LR=0.30 (95% CI=0.14–0.66)). Conclusion: The MMSE is responsive to short‐term changes in cognitive function in elderly patients. Serial MMSE tests should be helpful in monitoring the development and resolution of delirium in this population.