title: MMSE items that predict incident delirium and hypoactive subtype in older medical inpatients.
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 χ(2) 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.
authors.affiliation: Faculty of Medicine, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia; Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV, Carretera del Pere Mata, unnumbered, Reus (Tarragona) 43206, Spain. Electronic address: josefranco11@hotmail.com.
authors.forename: José
authors.initials: J
authors.lastname: Gabriel Franco
authors.affiliation: Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV, Carretera del Pere Mata, unnumbered, Reus (Tarragona) 43206, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Santesteban
authors.affiliation: Lilly Research Laboratories, Indianapolis, IN, USA; University of Mississippi Medical School, Jackson, MS, USA; Tufts University School of Medicine, Boston, MA, USA; Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Trzepacz
authors.affiliation: Faculty of Medicine, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia.
authors.forename: Carolina
authors.initials: C
authors.lastname: Bernal
authors.affiliation: Faculty of Medicine, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia.
authors.forename: Camila
authors.initials: C
authors.lastname: Valencia
authors.affiliation: Faculty of Medicine, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia.
authors.forename: María Victoria
authors.initials: MV
authors.lastname: Ocampo
authors.affiliation: Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV, Carretera del Pere Mata, unnumbered, Reus (Tarragona) 43206, Spain.
authors.forename: Joan de
authors.initials: Jd
authors.lastname: Pablo
authors.affiliation: Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV, Carretera del Pere Mata, unnumbered, Reus (Tarragona) 43206, Spain.
authors.forename: Ana Milena
authors.initials: AM
authors.lastname: Gaviria
authors.affiliation: Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV, Carretera del Pere Mata, unnumbered, Reus (Tarragona) 43206, Spain.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Vilella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D010054:Brief Psychiatric Rating Scale / Q000592:standards; D016022:Case-Control Studies; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors
keywords: Cognitive impairment; Delirium; Dementia; Elderly; Mini Mental State Exam