[Evaluation of cognitive disorders and screening of delirium in cancer patients receiving morphine. Comparison of the use of the Elementary Test of Concentration, Orientation and Memory (TELECOM)and of the Mini-Mental State Examination (MMSE)].

OBJECTIVE: The Mini Mental State Examination (MMSE) is the gold standard cognitive test for screening delirium in cancer patients on opioids. But the MMSE is long and requires writing, reading and drawing from patients with various degrees of physical inability. Age and educational level affect the MMSE score. The Blessed Orientation-Memory-Concentration (BOMC) test is strictly oral and brief. This six item test is not affected by age or educational level. PATIENTS AND METHODS: We conducted a validation study of BOMC for screening delirium in cancer patients taking opioids. One physician examined 25 advanced cancer patients 34 times with MMSE and BOMC. Diagnosis of delirium was made by the same examiner according to the DSM IV criteria. The MMSE score was used for diagnosis of cognitive failure.
RESULTS: Seventy-six percent of the patients completed the MMSE and 100% the BOMC. Scores of the two tests were correlated (0.71). An average 4 min 12 sec was gained with BOMC compared with MMSE. For a 10/11 cutoff, the BOMC had 83% sensitivity and 95% specificity for delirium diagnosis. Positive and negative predictive values were 91%. The time for the BOMC was correlated with BOMC score (0.6). A BOMC time of 3 min 20 sec had 91% sensitivity and specificity for delirium diagnosis.
CONCLUSION: BOMC is more applicable than MMSE for screening delirium in cancer patients. The relationship between BOMC time and delirium deserves further investigations.