MMSE items that predict incident delirium and hypoactive subtype in older medical inpatients

José Gabriel Franco, Olga Santesteban, Paula Trzepacz, Carolina Bernal, Camila Valencia, María Victoria Ocampo, Joan de Pablo, Ana Milena Gaviria, Elisabet Vilella

    Research output: Contribution to journalArticlepeer-review

    8 Scopus citations

    Abstract

    Because hypoactive delirium is especially under-recognized, we analyzed which Mini-Mental State Examination (MMSE) items predicted incident delirium and its hypoactive motor presentation. Over a 1-year period, older medical inpatients (n=291) were consecutively screened on admission with the Confusion Assessment Method-Spanish (CAM-S) to exclude prevalent delirium. Nondelirious patients were evaluated the same day with the MMSE, followed by daily ratings with the CAM-S. Those who became CAM-S positive were rated using the Delirium Rating Scale-Revised-98 to assess severity and motor subtype. Disorientation to time (OR 4.4, 95% CI 1.7-11.1) and place (OR 3.8, 95% CI 1.7-8.2) at admission were risk factors for delirium at follow-up and together correctly classified 88.3% of subjects as to delirium status. Disorientation to time and place, and visuoconstructional impairment were each associated with either hypoactive or mixed subtype (p<0.05 χ2 test). Simple bedside evaluation of cognitive function in nondelirious patients revealed deficits that detected patients at risk for developing incident delirium at follow-up (especially hypoactive or mixed). We recommend patients with orientation deficits be monitored closely for emergence of delirium. A separate evaluation for possible dementia or other causes of cognitive impairment at admission should be considered too.

    Original languageEnglish
    Pages (from-to)975-981
    Number of pages7
    JournalPsychiatry Research
    Volume220
    Issue number3
    DOIs
    StatePublished - 30 Dec 2014

    Bibliographical note

    Publisher Copyright:
    © 2014 Elsevier Ireland Ltd.

    Keywords

    • Cognitive impairment
    • Delirium
    • Dementia
    • Elderly
    • Mini Mental State Exam

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