Christopher R. Carpenter|Elizabeth R. Bassett|Grant M. Fischer|Jonathan Shirshekan|James E. Galvin|John C. Morris
Four Sensitive Screening Tools to Detect Cognitive Dysfunction in Geriatric Emergency Department Patients: Brief Alzheimer’s Screen, Short Blessed Test, Ottawa 3DY, and the Caregiver-completed AD8
Washington University in St. Louis|NYU Langone Health|Washington University in St. Louis|NYU Langone Health|Washington University in St. Louis|NYU Langone Health|Washington University in St. Louis|NYU Langone Health|Washington University in St. Louis|NYU Langone Health|Washington University in St. Louis|NYU Langone Health
cognitive dysfunction including dementia delirium prevalent geriatric emergency department ed patients often remains undetected one barrier reliable identification acutely chronically impaired cognitive function lack acceptable screening tool multiple brief screening instruments derived ed validation trials previously demonstrated tools appropriately sensitive clinical usethe primary objective evaluate compare ottawa 3dy o3dy brief alzheimers screen bas short blessed test sbt caregivercompleted ad8 cad8 diagnostic test performance cognitive dysfunction geriatric ed patients using mini mental status exam mmse criterion standard secondary objective assess diagnostic accuracy cad8 informantbased instrument used combination performancebased screening toolsin observational crosssectional cohort study one urban academic universityaffiliated medical center trained research assistants ras collected patients responses confusion assessment method intensive care unit bas sbt available reliable caregivers completed cad8 mmse obtained o3dy reconstructed elements mmse bas consenting subjects noncritically ill englishspeaking adults age 65 years received potentially sedating medications prior cognitive testing using mmse score 23 criterion standard cognitive dysfunction sensitivity specificity likelihood ratios receiver operating characteristic roc area curve auc computed venn diagrams constructed quantitatively compare degree overlap among positive test results performancebased instrumentsthe prevalence cognitive dysfunction 163 patients enrolled complete data collection 37 including 55 delirium dementia selfreported 3 caregivers available complete cad8 56 patients sbt bas o3dy demonstrated 95 sensitivity compared 83 sensitivity cad8 sbt superior specificity 65 combination instruments cad8 significantly improved diagnostic accuracy sbt provided optimal overlap mmsethe sbt bas o3dy three brief performancebased screening instruments identify geriatric patients cognitive dysfunction rapidly mmse among three instruments sbt provides best diagnostic test characteristics overlap mmse results addition cad8 instruments enhance diagnostic accuracy