Still delirious after all these years

"Alert and Oriented × 3?" Correlates of Mini-Cog Performance in a Post/Nondelirious Intensive Care Unit Sample

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.

Recognition and management of delirium among doctors, nurses, physiotherapists, and psychologists: an Italian survey

BACKGROUND

There are no studies that have identified the ability to recognize and manage delirium among Italian health providers caring for patients at risk. Therefore, the Italian Association of Psychogeriatrics (AIP) conducted a multicenter survey among doctors, nurses, psychologists and physiotherapists to assess their competence regarding the theme of delirium and its management in the everyday clinical practice.

METHODS

The survey period was 1st June 2013 to 30th November 2013. The invitation to participate was sent via email, with publication on the AIP website. The survey included 14 questions and two case vignettes.

RESULTS

A total of 648/1,500 responses were collected. Most responders were doctors (n = 322/800), followed by nurses (n = 225/500), psychologists (n = 51/100), and physiotherapists (n = 30/100). Generally, doctors and psychologists correctly defined delirium, while nurses and physiotherapists did not. The most frequently used diagnostic tools were the Confusion Assessment Method (CAM) and the Diagnostic and Statistical Manual of Mental Disorders-IV. Delirium intensity was rarely assessed. Hypoactive delirium was generally managed with non-pharmacological approaches, while hyperactive delirium with a combination of non-pharmacological and pharmacological approaches. However, possible causes of delirium were under-assessed by half of doctors and by the majority of other professionals. Nurses, psychologists and physiotherapists did not answer the case vignettes, while doctors identified the correct answer in most cases.

CONCLUSIONS

This is the first Italian survey among health providers caring for patients at risk of delirium. This is also the first survey including doctors, nurses, psychologists and physiotherapists. The results emphasize the importance of training to improve knowledge of this relevant unmet medical need.