title: Validation of the interRAI Cognitive Performance Scale against independent clinical diagnosis and the Mini-Mental State Examination in older hospitalized patients.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of the interRAI Acute Care (AC) Cognitive Performance Scale (CPS2) and the Mini-Mental State Examination (MMSE), against independent clinical diagnosis for detecting dementia in older hospitalized patients.
  
  
  METHODS
  The study was part of a prospective observational cohort study of patients aged ≥70 years admitted to four acute hospitals in Queensland, Australia, between 2008 and 2010. Recruitment was consecutive and patients expected to remain in hospital for ≥48 hours were eligible to participate. Data for 462 patients were available for this study.
  
  
  METHODS
  Trained research nurses completed comprehensive geriatric assessments and administered the interRAI AC and MMSE to patients. Two physicians independently reviewed patients' medical records and assessments to establish the diagnosis of dementia. Indicators of diagnostic accuracy included sensitivity, specificity, predictive values, likelihood ratios and areas under receiver (AUC) operating characteristic curves.
  
  
  RESULTS
  85 patients (18.4%) were considered to have dementia according to independent clinical diagnosis. The sensitivity of the CPS2 [0.68 (95%CI: 0.58-0.77)] was not statistically different to the MMSE [0.75 (0.64-0.83)] in predicting physician diagnosed dementia. The AUCs for the 2 instruments were also not statistically different: CPS2 AUC = 0.83 (95%CI: 0.78-0.89) and MMSE AUC = 0.87 (95%CI: 0.83-0.91), while the CPS2 demonstrated higher specificity [0.92 95%CI: 0.89-0.95)] than the MMSE [0.82 (0.77-0.85)]. Agreement between the CPS2 and clinical diagnosis was substantial (87.4%; κ=0.61).
  
  
  CONCLUSIONS
  The CPS2 appears to be a reliable screening tool for assessing cognitive impairment in acutely unwell older hospitalized patients. These findings add to the growing body of evidence supporting the utility of the interRAI AC, within which the CPS2 is embedded. The interRAI AC offers the advantage of being able to accurately screen for both dementia and delirium without the need to use additional assessments, thus increasing assessment efficiency.
authors: Centre for Research in Geriatric Medicine, The University of Queensland, Level 2, Building 33, The Princess Alexandra Hospital, Ipswich Rd., Woolloongabba Q 4102, Australia. catherine.travers@qut.edu.au
authors: C
authors: C
authors: Travers
authors: G J
authors: GJ
authors: Byrne
authors: N A
authors: NA
authors: Pachana
authors: K
authors: K
authors: Klein
authors: L
authors: L
authors: Gray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis*; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards*; D015995:Prevalence; D011446:Prospective Studies; D036301:Qualitative Research; D011793:Queensland / Q000453:epidemiology; D012372:ROC Curve; D015203:Reproducibility of Results
references: Int J Geriatr Psychiatry. 2007 Apr;22(4):286-93
references: 17022109
references: J Psychiatr Res. 1975 Nov;12(3):189-98
references: 1202204
references: Int Psychogeriatr. 2011 Apr;23(3):344-55
references: 20716393
references: Arch Gerontol Geriatr. 2012 Jul-Aug;55(1):165-72
references: 21862147
references: Am J Geriatr Psychiatry. 2013 Jul;21(7):636-45
references: 23567408
references: Psychol Med. 1994 Feb;24(1):145-53
references: 8208879
references: J Gerontol A Biol Sci Med Sci. 1995 Mar;50(2):M128-33
references: 7874589
references: J Am Geriatr Soc. 2011 Nov;59(11):2001-8
references: 22092231
references: J Am Geriatr Soc. 1991 Feb;39(2):149-55
references: 1991947
references: J Am Geriatr Soc. 1993 Dec;41(12):1353-60
references: 8227919
references: Intern Med J. 2013 Mar;43(3):262-9
references: 22998322
references: Psychol Med. 1982 May;12(2):397-408
references: 7100362
references: J Am Geriatr Soc. 2008 Mar;56(3):536-41
references: 18179498
references: Age Ageing. 2000 May;29(3):271-9
references: 10855913
references: J Nutr Health Aging. 2012 Aug;16(8):695-700
references: 23076511
references: Br J Psychiatry. 2009 Jul;195(1):61-6
references: 19567898