Comparing performance on the Months of the Year Backwards test in hospitalised patients with delirium, dementia, and no cognitive impairment: an exploratory study

Abstract

Purpose To investigate performance of the Months of the Year Backwards (MOTYB) test in older hospitalised patients with delirium, dementia, and no cognitive impairment. Methods Secondary analysis of data from a case–control study of 149 hospitalised patients aged ≥ 65 years with delirium [with or without dementia (N = 50)], dementia [without delirium (N = 46)], and no cognitive impairment (N = 53). Verbatim transcripts of MOTYB audio recordings were analysed to determine group differences in response patterns. Results In the total sample [median age 85y (IQR 80–88), 82% female], patients with delirium were more often unable to recite months backward to November (36/50 = 72%) than patients with dementia (21/46 = 46%; p < 0.01) and both differed significantly from patients without cognitive impairment (2/53 = 4%; p’s < 0.001). 121/149 (81%) of patients were able to engage with the test. Patients with delirium were more often unable to engage with MOTYB (23/50 = 46%; e.g., due to reduced arousal) than patients with dementia (5/46 = 11%; p < 0.001); both groups differed significantly (p’s < 0.001) from patients without cognitive impairment (0/53 = 0%). There was no statistically significant difference between patients with delirium (2/27 = 7%) and patients with dementia (8/41 = 20%) in completing MOTYB to January, but performance in both groups differed (p < 0.001 and p < 0.02, respectively) from patients without cognitive impairment (35/53 = 66%). Conclusion Delirium was associated with inability to engage with MOTYB and low rates of completion. In patients able to engage with the test, error-free completion rates were low in delirium and dementia. Recording of engagement and patterns of errors may add useful information to MOTYB scoring.

Comparison of delirium detection tools in acute care

“…It is included in many assessments that combine testing for different aspects of delirium, such as the CAM. Several studies have evaluated its singular use in the context of delirium reporting high sensitivity and specificity [ 24 ]. Efforts have been made to further simplify the scoring method while maintaining good psychometric properties [ 23 ].…”

Cognitive Trajectories Following Acute Infection in Older Patients With and Without Cognitive Impairment: An 1-Year Follow-Up Study

“…Both DEM, DSD and D groups presented with significantly higher mortality rates at 12-months compared with the cognitively healthy group (C) and this largely explained the highest values dropout rates at 12-months within these groups (50 and 55%, respectively, corresponding to mortality rates and inability to be reassessed due to communication/functional problems). Not surprisingly, other researchers reported that pre-existing dementia and delirium superimposed on dementia strongly predict worse outcomes at 12 and 24 months ( 37 , 47 , 48 ), with little variation between these different cognitive spectrum disorders.…”

“…Moreover, older patients with normal cognitive function and those with dementia prior to hospitalization (but no delirium) presented with deficits in attention (as assessed with MoCA) during hospital stay. Therefore, even with specific attention tests, such as the Months of the Year Backwards Test, differentiation between dementia and delirium can be challenging ( 36 ) supporting the concept of “cognitive spectrum disorders” as a generic term for older patients admitted to hospital presenting with cognitive impairment irrespective of the specific diagnosis ( 37 ).…”

Detecting delirium in nursing home residents using the Informant Assessment of Geriatric Delirium (I-AGeD): a validation pilot study

“…When the I-AGeD was validated in the Emergency Department (ED) setting with family members, the authors did not give any formal training concerning the I-AGeD. This may have led to a low sensitivity of the I-AGeD in the ED according to a forthcoming publication of Hasemann et al [ 48 ]. This finding is not consistent with the study by Bellelli et al [ 16 ].…”

“…This protocol includes the following two items: the MOTYB and the question about the day of the week [ 47 ]. The drawback of this Two-Step Delirium Detection Protocol is that people with dementia are not able to answer these two items [ 48 ]. Since approximately 65% of nursing home residents in Switzerland are either diagnosed with or suspected to have dementia [ 49 ], this Protocol does not seem suitable for detecting delirium in residents in nursing homes by untrained care workers.…”