Mark W Ketterer1, Yathreb Alaali2, Lenar Yessayan2, Jeff Jennings2. 1. Division of Consultation-Liaison Psychiatry & Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, Detroit, MI. Electronic address: MKetter1@hfhs.org. 2. Division of Consultation-Liaison Psychiatry & Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, Detroit, MI.
Abstract
BACKGROUND: Cognitive impairment has been found to be a predictor of adverse medical outcomes, including nonadherence, recurrent medical crises resulting in early readmissions, and death. OBJECTIVE: The Mini-Cog has been proposed for bedside/clinic cognitive testing. Its validity as a measure of central nervous system (CNS) impairment has never been tested against measures of CNS-medical history, CNS scans, selected laboratory findings, observed in-hospital nondelirious memory impairment, or collateral history from family. METHODS: We observed Mini-Cog performance in 107 post/nondelirious medical intensive care unit patients and tested its association with age, CNS-medical history, CNS scans, selected laboratory findings, and behavioral history (in-hospital observation of memory problems and collateral history from family or significant others). RESULTS: The overall Mini-Cog covaried with age, various measures of CNS impairment, abnormal laboratory findings, and measures of preadmission "forgetfulness" per family and by in-hospital staff observation. Unique variance in predicting overall Mini-Cog scores included age, positive CNS scan, and behavioral history. Of 91 patients found to be "alert and oriented × 3," 76% were impaired in immediate memory, short-term memory, or clock drawing. CONCLUSIONS: The Mini-Cog appears to be a brief, yet valid, measure of CNS dysfunction that significantly enhances sensitivity of evaluation at the bedside. Failure to evaluate patients with a formal examination like the Mini-Cog appears to miss up to 76% of patients with moderate cognitive impairment.
BACKGROUND:Cognitive impairment has been found to be a predictor of adverse medical outcomes, including nonadherence, recurrent medical crises resulting in early readmissions, and death. OBJECTIVE: The Mini-Cog has been proposed for bedside/clinic cognitive testing. Its validity as a measure of central nervous system (CNS) impairment has never been tested against measures of CNS-medical history, CNS scans, selected laboratory findings, observed in-hospital nondelirious memory impairment, or collateral history from family. METHODS: We observed Mini-Cog performance in 107 post/nondelirious medical intensive care unit patients and tested its association with age, CNS-medical history, CNS scans, selected laboratory findings, and behavioral history (in-hospital observation of memory problems and collateral history from family or significant others). RESULTS: The overall Mini-Cog covaried with age, various measures of CNS impairment, abnormal laboratory findings, and measures of preadmission "forgetfulness" per family and by in-hospital staff observation. Unique variance in predicting overall Mini-Cog scores included age, positive CNS scan, and behavioral history. Of 91 patients found to be "alert and oriented × 3," 76% were impaired in immediate memory, short-term memory, or clock drawing. CONCLUSIONS: The Mini-Cog appears to be a brief, yet valid, measure of CNS dysfunction that significantly enhances sensitivity of evaluation at the bedside. Failure to evaluate patients with a formal examination like the Mini-Cog appears to miss up to 76% of patients with moderate cognitive impairment.
Authors: Kimia Honarmand; Sabhyata Malik; Conor Wild; Laura E Gonzalez-Lara; Christopher W McIntyre; Adrian M Owen; Marat Slessarev Journal: PLoS One Date: 2019-04-12 Impact factor: 3.240