The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Nursing Home Assessment of Cognitive Impairment: Development and Testing of a Brief Instrument of Mental Status
Article first published online: 3 NOV 2008
© 2008, Copyright the Authors. Journal compilation © 2008, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 56, Issue 11, pages 2069–2075, November 2008
How to Cite
Chodosh, J., Edelen, M. O., Buchanan, J. L., Yosef, J. A., Ouslander, J. G., Berlowitz, D. R., Streim, J. E. and Saliba, D. (2008), Nursing Home Assessment of Cognitive Impairment: Development and Testing of a Brief Instrument of Mental Status. Journal of the American Geriatrics Society, 56: 2069–2075. doi: 10.1111/j.1532-5415.2008.01944.x
- Issue published online: 3 NOV 2008
- Article first published online: 3 NOV 2008
- nursing home;
- mental status;
- cognitive assessment;
OBJECTIVES: To test the accuracy of a brief cognitive assessment of nursing home (NH) residents and to determine whether facility nurses can reliably perform this assessment.
DESIGN: Cross-sectional, independent cognitive screening tests with NH residents.
SETTING: Six Department of Veteran Affairs nursing facilities.
PARTICIPANTS: Three hundred seventy-four residents from six regionally distributed Veteran Affairs NHs.
MEASUREMENTS: Three cognitive assessment instruments: the Brief Interview of Mental Status (BIMS), created for this study; the Minimum Data Set (MDS) 2.0 Cognitive Performance Scale (CPS), and the Modified Mini-Mental State Examination (3MS) as the criterion standard. The 15-point BIMS tests memory and orientation and includes free and cued recall items. Research assistants administered the 3MS and BIMS to all subjects. Facility nurses administered the same BIMS to a subsample.
RESULTS: Three hundred seventy-four of 417 (89.7%) residents approached completed the 3MS and research assistant–administered BIMS (BIMS-R); 212 residents also received a facility nurse–administered BIMS (BIMS-N). The BIMS-R was more highly correlated with the 3MS than was the CPS (Pearson correlation coefficient (r)=0.79 vs 0.62; P<.01 for difference). For the subset who received facility assessments, the BIMS-N was also more highly correlated with the 3MS (Pearson r=0.74 vs 0.65; P<.01 for difference). For any impairment (3MS<78), the area under the receiver operator characteristic curve (AUC) was 0.86 for the BIMS, versus 0.77 for the CPS. For severe impairment (3MS<48) the AUC was 0.94, versus 0.85 for the CPS.
CONCLUSION: In this population, a brief cognitive test is a more accurate approach to cognitive assessment than the current observational methods employed using the MDS 2.0.