Use of Serial Mini‐Mental State Examinations to Diagnose and Monitor Delirium in Elderly Hospital Patients

O'Keeffe, Shaun T; Mulkerrin, E.; Nayeem, Kayser; Varughese, Matthew; Pillay, Isweri

doi:10.1111/j.1532-5415.2005.53266.x

Cited by 67 publications

(39 citation statements)

References 18 publications

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“…Decreasing scores in these cognitive assessments, such as the Mini-Mental State Examination, may be diagnostic of delirium. 173 However, the Mini-Mental State Examination can take 5 -10 minutes to perform and may not be feasible to perform in the ED. 128 Brief cognitive assessments such as the Six-Item Screener 174,175 Mini-Cog, 175 Ottawa 3DY, 176 and Brief Alzheimer's Screen exist 176 but it is unclear how sensitive these assessments are in detecting changes in cognition observed in delirium.…”

Section: Improving Delirium Recognition In the Emergency Department -mentioning

confidence: 99%

Altered Mental Status in Older Emergency Department Patients

Wilber

2006

Emergency Medicine Clinics of North America

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SynopsisAltered mental status is a common chief complaint among older emergency department (ED) patients. Acute changes in mental status are more concerning and are usually secondary to delirium, stupor, and coma. These forms of acute brain dysfunction are commonly precipitated by an underlying medical illness that can be potentially life-threatening and are associated with a multitude of adverse outcomes. Though stupor and coma are easily identifiable, the clinical presentation of delirium can be subtle and is often missed without actively screening for it. For patients with acute brain dysfunction, the ED evaluation should focus on searching for the underlying etiology. Infection is one of the most common precipitants of delirium, but multiple etiologies may exist concurrently. Keywordsdelirium; coma; stupor emergency department; epidemiology; diagnosis; management IntroductionAltered mental status is a common chief complaint among older emergency department (ED) patients. Despite the frequency of this complaint, the term "altered mental status" is vague and has several synonyms such as confusion, not acting right, altered behavior, generalized weakness, lethargy, agitation, psychosis, disorientation, inappropriate behavior, inattention, and hallucination. 1 Such lack of standardized terminology not only hinders the assessment and appropriate management of patients with altered mental status, but also the advancement of knowledge through research.Altered mental status has varying time courses and degrees of severity. Acute changes in mental status are usually secondary to delirium, stupor, and coma, which are forms of acute brain dysfunction. These changes occur over a period of hours or days and are usually © 2012 Elsevier Inc. All rights reserved. Correspondence to: Jin H. Han, jin.h.han@vanderbilt.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript precipitated by an underlying medical illness that is potentially life threatening. Chronic alterations in mental status (e.g. dementia) occur over a period of months and years and are less likely to be precipitated by a life-threatening illness. 2 For these reasons, acute changes in mental status will be the focus of this review. Altered mental status is rarely caused by psychiatric illnesses such as depression or schizophrenia, and in elder patients, these should be diagnoses of exclusion. Acute brain dysfunction (delirium, stupor, and coma) and their underlying etiology should be ruled out prior to considering any psychiatric d...

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Section: Improving Delirium Recognition In the Emergency Department -mentioning

confidence: 99%

Altered Mental Status in Older Emergency Department Patients

Wilber

2006

Emergency Medicine Clinics of North America

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“…27,34 In particular, with repeated MMSE assessments, the diagnostic precision for detection of cognitive fluctuations increases, especially when patients can be assessed in the preoperative period. 35 The OBS Scale was used to detect delirium and to categorize delirium subtypes. The scale has 2 main parts, with subscales for disorientation and confusion.…”

Section: Measurementsmentioning

confidence: 99%

Validation of the Confusion Assessment Method in Detecting Postoperative Delirium in Cardiac Surgery Patients

Smulter¹,

Lingehall²,

Gustafson³

et al. 2015

American Journal of Critical Care

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“…Use of the Confusion Assessment Method (CAM) 7 or serial measurements of cognition can help to differentiate delirium from dementia or detect its onset during a hospital admission. 8 Delirium can be subdivided into hypoactive, hyperactive and mixed subtypes. It is important to recognise that hypoactive (quiet) delirium is the commonest type.…”

Section: Assessmentmentioning

confidence: 99%

The prevention, diagnosis and management of delirium in older people: concise guidelines

2006

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-Delirium (acute confusional state) is a common condition in older people, affecting up to 30% of all older patients admitted to hospital. Patients who develop delirium have high mortality, institutionalisation and complication rates, and have longer lengths of stay than non-delirious patients. Delirium is often not recognised by clinicians, and is often poorly managed. Delirium may be prevented in up to a third of older patients. The aim of this guideline update is to aid prevention as well as the recognition of delirium and to provide guidance on how to manage these complex and disadvantaged patients.KEY WORDS: acute confusion, clinical guideline, delirium, older people IntroductionThe aim of these guidelines is to aid recognition of delirium and to provide guidance on how to manage this complex and challenging condition. Delirium is characterised by a disturbance of consciousness and a change in cognition that develop over a short period of time. The disorder has a tendency to fluctuate during the course of the day, and there is evidence from the history, examination or investigations that the delirium is a direct consequence of a general medical condition, drug withdrawal or intoxication. Diagnostic and Statistical Manual of Mental Disorders (DSM IV) 1In order to be diagnosed with delirium, a patient must show all of the four features listed below. 1 A disturbance of consciousness (ie reduced clarity of awareness of the environment) is evident, with reduced ability to focus, sustain or shift attention. 2 There is a change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting or evolving dementia. 3 The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. 4 There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by the direct physiological consequences of a general medical condition, substance intoxication or substance withdrawal. 1 Delirium may have more than one causal factor (ie multiple aetiologies). A diagnosis of delirium can also be made when there is insufficient evidence to support criterion 4, if the clinical presentation is consistent with delirium, and the clinical features cannot be attributed to any other diagnosis, for example delirium due to sensory deprivation.Some older people come to hospital with delirium (prevalent) while others develop delirium during their hospital stay (incident). Hospital prevalence rates for delirium vary widely because of different patient characteristics in the different studies -the highest rates are seen in older patients in critical care settings. The average prevalence of delirium in older people in general hospitals is 20% (range 7% to 61%). 2 After fracture of the neck of the femur, the prevalence varies from 10% to 50%.Patients with delirium have increased length of stay, increased mortality and increased ...

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Use of Serial Mini‐Mental State Examinations to Diagnose and Monitor Delirium in Elderly Hospital Patients

Abstract: The MMSE is responsive to short-term changes in cognitive function in elderly patients. Serial MMSE tests should be helpful in monitoring the development and resolution of delirium in this population.

Cited by 67 publications

References 18 publications

Altered Mental Status in Older Emergency Department Patients

Altered Mental Status in Older Emergency Department Patients

Validation of the Confusion Assessment Method in Detecting Postoperative Delirium in Cardiac Surgery Patients

The prevention, diagnosis and management of delirium in older people: concise guidelines

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