MMSE items that predict incident delirium and hypoactive subtype in older medical inpatients

• Published in: Psychiatry research Vol. 220; no. 3; pp. 975 - 981
• Main Authors: Gabriel Franco, José, Santesteban, Olga, Trzepacz, Paula, Bernal, Carolina, Valencia, Camila, Ocampo, María Victoria, Pablo, Joan de, Gaviria, Ana Milena, Vilella, Elisabet
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ireland Ltd 30.12.2014; Elsevier
• Subjects: Adult and adolescent clinical studies; Aged; Aged, 80 and over; Biological and medical sciences; Brief Psychiatric Rating Scale - standards; Case-Control Studies; Cognitive impairment; Cohort Studies; Delirium; Delirium - diagnosis; Delirium - psychology; Dementia; Elderly; Female; Geriatric Assessment - methods; Humans; Incidence; Inpatients - psychology; Longitudinal Studies; Male; Medical sciences; Middle Aged; Mini Mental State Exam; Organic mental disorders. Neuropsychology; Predictive Value of Tests; Prospective Studies; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Delirium; Elderly; Mini Mental State Exam; Cognitive impairment; Dementia; Human; Mini Mental State Examination Folstein et al; Cognitive disorder; Neuropsychological test; Psychometrics; Hospital environment; Organic mental disorder; Degenerative disease; Predictive factor; Subtype; Mental confusion
• ISSN: 0165-1781; 1872-7123; 1872-7123
• DOI: 10.1016/j.psychres.2014.09.003

Because hypoactive delirium is especially under-recognized, we analyzed which Mini-Mental State Examination (MMSE) items predicted incident delirium and its hypoactive motor presentation. Over a 1-year period, older medical inpatients (n=291) were consecutively screened on admission with the Confusion Assessment Method-Spanish (CAM-S) to exclude prevalent delirium. Nondelirious patients were evaluated the same day with the MMSE, followed by daily ratings with the CAM-S. Those who became CAM-S positive were rated using the Delirium Rating Scale—Revised-98 to assess severity and motor subtype. Disorientation to time (OR 4.4, 95% CI 1.7–11.1) and place (OR 3.8, 95% CI 1.7–8.2) at admission were risk factors for delirium at follow-up and together correctly classified 88.3% of subjects as to delirium status. Disorientation to time and place, and visuoconstructional impairment were each associated with either hypoactive or mixed subtype (p<0.05 χ2 test). Simple bedside evaluation of cognitive function in nondelirious patients revealed deficits that detected patients at risk for developing incident delirium at follow-up (especially hypoactive or mixed). We recommend patients with orientation deficits be monitored closely for emergence of delirium. A separate evaluation for possible dementia or other causes of cognitive impairment at admission should be considered too. •Early recognition of risk factors might help to diminish underdiagnosis of delirium.•We delineated a small subset of MMSE items that predict delirium during hospitalization.•We found that temporal and spatial disorientation are risk factors for incident delirium.•These same domains also are predictive of hypoactive and mixed motor subtypes.•Those two domains evaluated upon admission are useful to detect patients who could become delirious.