Confusion Assessment Protocol (CAP)

Sherer,; Nakase-Thompson,; Yablon,; Gontkovsky,

doi:10.4324/9781003076391-16

Cited by 4 publications

(4 citation statements)

References 1 publication

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“…While it does not address DoC specifically, it can help monitor patient's progress across the continuum of care as they recover from a confusional state. 42 43…”

Section: Overview Of Disorders Of Consciousness Levelsmentioning

confidence: 99%

Altered Mental Status at the Extreme: Behavioral Evaluation of Disorders of Consciousness

Dhadwal,

Cunningham,

Pino

et al. 2024

Semin Neurol

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Disorders of consciousness represent altered mental status at its most severe, comprising a continuum between coma, the vegetative state/unresponsive wakefulness syndrome, the minimally conscious state, and emergence from the minimally conscious state. Patients often transition between these levels throughout their recovery, and determining a patient's current level can be challenging, particularly in the acute care setting. Although healthcare providers have classically relied on a bedside neurological exam or the Glasgow Coma Scale to aid with assessment of consciousness, studies have identified multiple limitations of doing so. Neurobehavioral assessment measures, such as the Coma Recovery Scale-Revised, have been developed to address these shortcomings. Each behavioral metric has strengths as well as weaknesses when applied in the acute care setting. In this review, we appraise common assessment approaches, outline alternative measures for fine-tuning these assessments in the acute care setting, and highlight strategies for implementing these practices in an interdisciplinary manner.

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“…While it does not address DoC specifically, it can help monitor patient's progress across the continuum of care as they recover from a confusional state. 42 43…”

Section: Overview Of Disorders Of Consciousness Levelsmentioning

confidence: 99%

Altered Mental Status at the Extreme: Behavioral Evaluation of Disorders of Consciousness

Dhadwal,

Cunningham,

Pino

et al. 2024

Semin Neurol

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“…Although outside the scope of this paper, there are tools available for assessing agitation, confusion, attention, orientation, language and communication in persons with DoC demonstrating MCS+ or emergence behaviors. These assessments can include the Confusion Assessment Protocol, Agitated Behavior Scale, Orientation Log and the Loewenstein Communication Scale (Bogner et al, 1999;Sherer et al, 2005;Frey et al, 2007;Spiteri et al, 2021;Aubinet et al, 2022). Figure 1 presents an overview of recommended strategies to optimize the patient and environment to ensure accuracy of assessment results.…”

Section: Multimodal Assessmentmentioning

confidence: 99%

Clinical application of recommendations for neurobehavioral assessment in disorders of consciousness: an interdisciplinary approach

Murtaugh

Rosenbaum

2023

Front. Hum. Neurosci.

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Accurate diagnosis, prognosis, and subsequent rehabilitation care planning for persons with Disorders of Consciousness (DoC) has historically posed a challenge for neurological care professionals. Evidence suggests rates of misdiagnosis may be as high as 40% when informal beside evaluations are used to determine level of consciousness. The presence of myriad medical, neurological, functional (motor, sensory, cognitive) and environmental confounds germane to these conditions complicates behavioral assessment. Achieving diagnostic certainty is elusive but critical to inform care planning, clinical decision making, and prognostication. Standardized neurobehavioral rating scales has been shown to improve accuracy in distinguishing between coma, unresponsive wakefulness syndrome/vegetative state and minimally consciousness state as compared to informal assessment methods. Thus, these scales are currently recommended for use as the informal “gold standard” for diagnostic assessment in DoC. The following paper will present an evidence-based approach to neurobehavioral assessment for use in clinical practice. Strategies for optimizing assessment and aiding in identification and management of confounds that can limit diagnostic accuracy will be provided. Finally, clinical application of an interdisciplinary approach to identifying and managing confounds will be discussed and how assessment results can be used to identify trends in performance and guide prognostic counseling with families.

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“…6 7 Although no currently available behavioral scales assess all symptoms of the confusional state, the Confusion Assessment Protocol (CAP), a composite measure of cognitive assessments and clinical signs, captures most aspects of the recently published PTCS case definition. 53 The CAP may therefore be used to fill the assessment gap for patients who are able to respond to basic yes/no questions, indicating eMCS, but are still in a confusional state and unable to participate in a full neuropsychological assessment.…”

Section: Standardized Scales For Assessment Of Docmentioning

confidence: 99%

Behavioral Assessment of Patients with Disorders of Consciousness

et al. 2022

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Severe brain injury is associated with a period of impaired level of consciousness that can last from days to months and results in chronic impairment. Systematic assessment of level of function in patients with disorders of consciousness (DoC) is critical for diagnosis, prognostication, and evaluation of treatment efficacy. Approximately 40% of patients who are thought to be unconscious based on clinical bedside behavioral assessment demonstrate some signs of consciousness on standardized behavioral assessment. This finding, in addition to a growing body of literature demonstrating the advantages of standardized behavioral assessment of DoC, has led multiple professional societies and clinical guidelines to recommend standardized assessment over routine clinical evaluation of consciousness. Nevertheless, even standardized assessment is susceptible to biases and misdiagnosis, and examiners should consider factors, such as fluctuating arousal and aphasia, that may confound evaluation. We review approaches to behavioral assessment of consciousness, recent clinical guideline recommendations for use of specific measures to evaluate patients with DoC, and strategies for mitigating common biases that may confound the examination.

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Confusion Assessment Protocol (CAP)

Cited by 4 publications

References 1 publication

Altered Mental Status at the Extreme: Behavioral Evaluation of Disorders of Consciousness

Altered Mental Status at the Extreme: Behavioral Evaluation of Disorders of Consciousness

Clinical application of recommendations for neurobehavioral assessment in disorders of consciousness: an interdisciplinary approach

Behavioral Assessment of Patients with Disorders of Consciousness

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