Nursing home assessment of cognitive impairment: development and testing of a brief instrument of mental status.
OBJECTIVE
To test the accuracy of a brief cognitive assessment of nursing home (NH) residents and to determine whether facility nurses can reliably perform this assessment.


METHODS
Cross-sectional, independent cognitive screening tests with NH residents.


METHODS
Six Department of Veteran Affairs nursing facilities.


METHODS
Three hundred seventy-four residents from six regionally distributed Veteran Affairs NHs.


METHODS
Three cognitive assessment instruments: the Brief Interview of Mental Status (BIMS), created for this study; the Minimum Data Set (MDS) 2.0 Cognitive Performance Scale (CPS), and the Modified Mini-Mental State Examination (3MS) as the criterion standard. The 15-point BIMS tests memory and orientation and includes free and cued recall items. Research assistants administered the 3MS and BIMS to all subjects. Facility nurses administered the same BIMS to a subsample.


RESULTS
Three hundred seventy-four of 417 (89.7%) residents approached completed the 3MS and research assistant-administered BIMS (BIMS-R); 212 residents also received a facility nurse-administered BIMS (BIMS-N). The BIMS-R was more highly correlated with the 3MS than was the CPS (Pearson correlation coefficient (r)=0.79 vs 0.62; P<.01 for difference). For the subset who received facility assessments, the BIMS-N was also more highly correlated with the 3MS (Pearson r=0.74 vs 0.65; P<.01 for difference). For any impairment (3MS<78), the area under the receiver operator characteristic curve (AUC) was 0.86 for the BIMS, versus 0.77 for the CPS. For severe impairment (3MS<48) the AUC was 0.94, versus 0.85 for the CPS.


CONCLUSIONS
In this population, a brief cognitive test is a more accurate approach to cognitive assessment than the current observational methods employed using the MDS 2.0.
Chodosh
Joshua
J
Geriatric Research, Education and Clinical Center, Los Angeles, California, USA. JChodosh@mednet.ucla.edu
Edelen
Maria Orlando
MO
Buchanan
Joan L
JL
Yosef
Julia Ann
JA
Ouslander
Joseph G
JG
Berlowitz
Dan R
DR
Streim
Joel E
JE
Saliba
Debra
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000451:nursing*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D009735:Nursing Homes; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results