Feasibility of a multiple-choice mini mental state examination for chronically critically ill patients.
OBJECTIVE
Following treatment in an ICU, up to 70% of chronically critically ill patients present neurocognitive impairment that can have negative effects on their quality of life, daily activities, and return to work. The Mini Mental State Examination is a simple, widely used tool for neurocognitive assessment. Although of interest when evaluating ICU patients, the current version is restricted to patients who are able to speak. This study aimed to evaluate the feasibility of a visual, multiple-choice Mini Mental State Examination for ICU patients who are unable to speak.


METHODS
The multiple-choice Mini Mental State Examination and the standard Mini Mental State Examination were compared across three different speaking populations. The interrater and intrarater reliabilities of the multiple-choice Mini Mental State Examination were tested on both intubated and tracheostomized ICU patients.


METHODS
Mixed 36-bed ICU and neuropsychology department in a university hospital.


METHODS
Twenty-six healthy volunteers, 20 neurological patients, 46 ICU patients able to speak, and 30 intubated or tracheostomized ICU patients.


METHODS
None.


RESULTS
Multiple-choice Mini Mental State Examination results correlated satisfactorily with standard Mini Mental State Examination results in all three speaking groups: healthy volunteers: intraclass correlation coefficient = 0.43 (95% CI, -0.18 to 0.62); neurology patients: 0.90 (95% CI, 0.82-0.95); and ICU patients able to speak: 0.86 (95% CI, 0.70-0.92). The interrater and intrarater reliabilities were good (0.95 [0.87-0.98] and 0.94 [0.31-0.99], respectively). In all populations, a Bland-Altman analysis showed systematically higher scores using the multiple-choice Mini Mental State Examination.


CONCLUSIONS
Administration of the multiple-choice Mini Mental State Examination to ICU patients was straightforward and produced exploitable results comparable to those of the standard Mini Mental State Examination. It should be of interest for the assessment and monitoring of the neurocognitive performance of chronically critically ill patients during and after their ICU stay. The multiple-choice Mini Mental State Examination tool's role in neurorehabilitation and its utility in monitoring neurocognitive functions in ICU should be assessed in future studies.
1Intensive Care Unit, Department of Anesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland. 2Neurology Unit, University of Fribourg and Department of Clinical Neurosciences, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
Marta
M
Miguélez
Paolo
P
Merlani
Fabienne
F
Gigon
Mélanie
M
Verdon
Jean-Marie
JM
Annoni
Bara
B
Ricou
D000328:Adult; D002908:Chronic Disease / Q000523:psychology*; D003072:Cognition Disorders / Q000175:diagnosis*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005240:Feasibility Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007440:Intubation; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D014140:Tracheotomy