Maria C Duggan1,2, Madeline E Morrell3, Rameela Chandrasekhar4, Annachiara Marra3,5, Kwame Frimpong3,6, Deepanjali R Nair6, Timothy D Girard7,3,6, Pratik P Pandharipande8,9, E Wesley Ely7,3,6, James C Jackson3,6,10,11. 1. Geriatric Research Education and Clinical Center (GRECC), Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA, maria.e.carlo@vanderbilt.edu. 2. Division of Geriatric Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA, maria.e.carlo@vanderbilt.edu. 3. Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 4. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 5. Department of Neurosciences, Reproductive and Odontostomatological Sciences, Department of Public Health, University of Naples, Naples, Italy. 6. Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 7. Geriatric Research Education and Clinical Center (GRECC), Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA. 8. Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 9. Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA. 10. Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 11. Research Service, Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA.
Abstract
BACKGROUND/AIM: The diagnostic accuracy of brief informant screening instruments to detect dementia in critically ill adults is unknown. We sought to determine the diagnostic accuracy of the 2- to 3-min Ascertain Dementia 8 (AD8) completed by surrogates in detecting dementia among critically ill adults suspected of having pre-existing dementia by comparing it to the Clinical Dementia Rating Scale (CDR). METHODS: This substudy of BRAIN-ICU included a subgroup of 75 critically ill medical/surgical patients determined to be at medium risk of having pre-existing dementia (Informant Questionnaire on Cognitive Decline in the Elderly [IQCODE] score ≥3.3). We calculated the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and AUC for the standard AD8 cutoff of ≥2 versus the reference standard CDR score of ≥1 for mild dementia. RESULTS: By the CDR, 38 patients had very mild or no dementia and 37 had mild dementia or greater. For diagnosing mild dementia, the AD8 had a sensitivity of 97% (95% CI 86-100), a specificity of 16% (6-31), a PPV of 53% (40-65), an NPV of 86% (42-100), and an AUC of 0.738 (0.626-0.850). CONCLUSIONS: Among critically ill patients judged at risk for pre-existing dementia, the 2- to 3-min AD8 is highly sensitive and has a high NPV. These data indicate that the brief tool can serve to rule out dementia in a specific patient population.
BACKGROUND/AIM: The diagnostic accuracy of brief informant screening instruments to detect dementia in critically ill adults is unknown. We sought to determine the diagnostic accuracy of the 2- to 3-min Ascertain Dementia 8 (AD8) completed by surrogates in detecting dementia among critically ill adults suspected of having pre-existing dementia by comparing it to the Clinical Dementia Rating Scale (CDR). METHODS: This substudy of BRAIN-ICU included a subgroup of 75 critically ill medical/surgical patients determined to be at medium risk of having pre-existing dementia (Informant Questionnaire on Cognitive Decline in the Elderly [IQCODE] score ≥3.3). We calculated the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and AUC for the standard AD8 cutoff of ≥2 versus the reference standard CDR score of ≥1 for mild dementia. RESULTS: By the CDR, 38 patients had very mild or no dementia and 37 had mild dementia or greater. For diagnosing mild dementia, the AD8 had a sensitivity of 97% (95% CI 86-100), a specificity of 16% (6-31), a PPV of 53% (40-65), an NPV of 86% (42-100), and an AUC of 0.738 (0.626-0.850). CONCLUSIONS: Among critically ill patients judged at risk for pre-existing dementia, the 2- to 3-min AD8 is highly sensitive and has a high NPV. These data indicate that the brief tool can serve to rule out dementia in a specific patient population.
Authors: Mehrdad Razavi; Magdalena I Tolea; Jennifer Margrett; Peter Martin; Andrew Oakland; David W Tscholl; Sarah Ghods; Mazdak Mina; James E Galvin Journal: Alzheimer Dis Assoc Disord Date: 2014 Apr-Jun Impact factor: 2.703
Authors: Joost Witlox; Lisa S M Eurelings; Jos F M de Jonghe; Kees J Kalisvaart; Piet Eikelenboom; Willem A van Gool Journal: JAMA Date: 2010-07-28 Impact factor: 56.272
Authors: Alessandro Morandi; Daniel Davis; Donna M Fick; Renato Turco; Malaz Boustani; Elena Lucchi; Fabio Guerini; Sara Morghen; Tiziana Torpilliesi; Simona Gentile; Alasdair M MacLullich; Marco Trabucchi; Giuseppe Bellelli Journal: J Am Med Dir Assoc Date: 2014-02-22 Impact factor: 4.669
Authors: P P Pandharipande; T D Girard; J C Jackson; A Morandi; J L Thompson; B T Pun; N E Brummel; C G Hughes; E E Vasilevskis; A K Shintani; K G Moons; S K Geevarghese; A Canonico; R O Hopkins; G R Bernard; R S Dittus; E W Ely Journal: N Engl J Med Date: 2013-10-03 Impact factor: 91.245