The Six-Item Screener and AD8 for the Detection of Cognitive Impairment in Geriatric Emergency Department Patients

Abstract

Study objective We evaluate the diagnostic test characteristics of the Six-Item Screener and the AD8 to detect cognitive dysfunction in adults older than 65 years and using the emergency department (ED) for any reason. Methods We conducted an observational cross-sectional cohort study at a single academic urban university-affiliated hospital. Subjects were consenting, non-critically ill, English-speaking adults older than 65 years and receiving care in the ED. We quantitatively assessed the diagnostic test characteristics of the Six-Item Screener and AD8 by using the Mini-Mental State Examination score less than 24 as the criterion standard for cognitive dysfunction. Results The prevalence of cognitive dysfunction was 35%, but only 6% of charts noted a pre-existing deficit. The Six-Item Screener was superior to either the caregiver-administered AD8 or the patient-administered AD8 for the detection of cognitive dysfunction. Conclusion The Six-Item Screener was superior to the caregiver- or patient-administered AD8 to identify older adults at increased risk for occult cognitive dysfunction.

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

“…104 Third, various geriatric syndromes complicate the post-ED management of the vulnerable elder, including delirium, 105 standing-level falls, 106 and dementia. 107 For example, if assessed in non-medicated, non-critically ill older adults, researchers note abnormal cognitive function in 35% of older ED patients. However, this is only recognized by emergency physicians in 6% of cases.…”

Prevalence of Nonmedical Problems Among Older Adults Presenting to the Emergency Department

“…Although RAs were required to inform providers when they were going to screen a patient and typically informed providers when and why a patient was not eligible, it is possible that RAs did not report every case of cognitive impairment to the EPs. Given that EPs often fail to identify cognitive impairment among older ED patients, 67 requiring RAs to inform EPs of this finding might better serve these patients. As with reporting abuse, reporting cognitive impairment might compromise a patient's privacy, but in the case of cognitive impairment the consequence of compromising the patient's privacy are likely to be considerably less.…”

Validierung der deutschen Fassung des Six-Item Screeners

“…von 80,6 % (89,6 %) und 90,9 % (79,4 %) im Alzheimer-Zentrum. In anderen Studien [7,14,20] wurden z. T. stark abweichende Ergebnisse gefunden; die Vergleichbarkeit war durch die Wahl anderer Grenzwerte oder Referenztests oder einer differenten Zusammensetzung der Studienpopulation reduziert.…”