Cognitive screening among acute respiratory failure survivors: a cross-sectional evaluation of the Mini-Mental State Examination.
BACKGROUND
The Mini-Mental State Examination (MMSE) is a common cognitive screening test, but its utility in identifying impairments in survivors of acute respiratory failure is unclear. The purpose of this study was to evaluate MMSE performance versus a concurrently administered detailed neuropsychological test battery in survivors of acute respiratory failure.


METHODS
This cross-sectional analysis used data from the ARDSNet Long Term Outcomes Study (ALTOS) and Awakening and Breathing Controlled Trial (ABC). Participants were 242 survivors of acute respiratory failure. The MMSE and detailed neuropsychological tests were administered at 6 and 12 months post-hospital discharge for the ALTOS study, and at hospital discharge, 3 and 12 months for the ABC study. Overall cognitive impairment identified by the MMSE (score <24) was compared to impairments identified by the neuropsychological tests. We also matched orientation, registration, attention, memory and language domains on the MMSE to the corresponding neuropsychological test. Pairwise correlations, sensitivity, specificity, positive and negative predictive values, and agreement were assessed.


RESULTS
Agreement between MMSE and neuropsychological tests for overall cognitive impairment was fair (42 to 80%). Specificity was excellent (≥93%), but sensitivity was poor (19 to 37%). Correlations between MMSE domains and corresponding neuropsychological tests were weak to moderate (6 months: r = 0.11 to 0.28; 12 months: r = 0.09 to 0.34). The highest correlation between the MMSE and neuropsychological domains was for attention at 6 months (r = 0.28) and language at 12 months (r = 0.34).


CONCLUSIONS
In acute respiratory failure survivors, the MMSE has poor sensitivity in detecting cognitive impairment compared with concurrently administered detailed neuropsychological tests. MMSE results in this population should be interpreted with caution.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. epfoh1@jhu.edu.
Elizabeth R
ER
Pfoh
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. kchan10@jhu.edu.
Kitty S
KS
Chan
Outcomes after Critical Illness and Surgery Group, Johns Hopkins University, 1830 E Monument Street, Baltimore, MD, 21205, USA. victor.dinglas@jhmi.edu.|Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 E Monument Street, Baltimore, MD, 21205, USA. victor.dinglas@jhmi.edu.
Victor D
VD
Dinglas
Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, D-3100, Medical Center North, Nashville, TN, 37232, USA. timothy.girard@vanderbilt.edu.|Center for Health Services Research, Department of Medicine, Vanderbilt University School of Medicine, 2215 Garland Ave, Nashville, TN, 37232, USA. timothy.girard@vanderbilt.edu.|Center for Quality of Aging, Department of Medicine, Vanderbilt University School of Medicine, 2215 Garland Ave, Nashville, TN, 37232, USA. timothy.girard@vanderbilt.edu.|Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, 1310 24th Ave. S, Nashville, TN, 37212, USA. timothy.girard@vanderbilt.edu.
Timothy D
TD
Girard
Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, D-3100, Medical Center North, Nashville, TN, 37232, USA. james.c.jackson@vanderbilt.edu.
James C
JC
Jackson
Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, School of Medicine, Wake Forest University, Winston-Salem, NC, 27157, USA. pemorris@wakehealth.edu.
Peter E
PE
Morris
Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Campus Box 356522, Seattle, WA, 98195, USA. cterrlee@u.washington.edu.
Catherine L
CL
Hough
Outcomes after Critical Illness and Surgery Group, Johns Hopkins University, 1830 E Monument Street, Baltimore, MD, 21205, USA. pmendez@jhmi.edu.|Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD, 21287, USA. pmendez@jhmi.edu.
Pedro A
PA
Mendez-Tellez
Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, D-3100, Medical Center North, Nashville, TN, 37232, USA. wes.ely@vanderbilt.edu.|Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, 1310 24th Ave. S, Nashville, TN, 37212, USA. wes.ely@vanderbilt.edu.
E Wesley
EW
Ely
Outcomes after Critical Illness and Surgery Group, Johns Hopkins University, 1830 E Monument Street, Baltimore, MD, 21205, USA. mhuang27@jhmi.edu.|Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 E Monument Street, Baltimore, MD, 21205, USA. mhuang27@jhmi.edu.
Minxuan
M
Huang
Outcomes after Critical Illness and Surgery Group, Johns Hopkins University, 1830 E Monument Street, Baltimore, MD, 21205, USA. dale.needham@jhmi.edu.|Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 E Monument Street, Baltimore, MD, 21205, USA. dale.needham@jhmi.edu.|Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, 1830 E Monument Street, Baltimore, MD, 21205, USA. dale.needham@jhmi.edu.
Dale M
DM
Needham
Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT, 84107, USA. mona.hopkins@imail.org.|Psychology Department and Neuroscience Center, Brigham Young University, 1022 SWKT, Provo, UT, 84602, USA. mona.hopkins@imail.org.|Center for Humanizing Critical Care, Intermountain Health Care, 5121 South Cottonwood Street, Murray, Utah, 84157, USA. mona.hopkins@imail.org.
Ramona O
RO
Hopkins
D060825:Cognitive Dysfunction / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D012680:Sensitivity and Specificity; D017741:Survivors