Use of serial Mini-Mental State Examinations to diagnose and monitor delirium in elderly hospital patients.
OBJECTIVE
To determine the responsiveness of serial Mini-Mental State Examinations (MMSEs) for the diagnosis and monitoring of delirium in elderly hospital patients.


METHODS
Prospective study.


METHODS
University teaching hospital.


METHODS
One hundred sixty-five people admitted to an acute geriatric service.


METHODS
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)).


CONCLUSIONS
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.
O'Keeffe
Shaun T
ST
Department of Geriatric Medicine, Galway Regional Hospitals, Galway, Ireland. s.okeeffe@whb.ie
Mulkerrin
Eamon C
EC
Nayeem
Kayser
K
Varughese
Matthew
M
Pillay
Isweri
I
D000368:Aged / Q000523:psychology; D003693:Delirium / Q000175:diagnosis*; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D008609:Mental Status Schedule; D011446:Prospective Studies; D012680:Sensitivity and Specificity