0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

A New Bedside Test of Cognition for Patients with HIV Infection

Beverly N. Jones, MD; Evelyn Lee Teng, PhD; Marshal F. Folstein, MD; and Katharine S. Harrison, MD
[+] Article and Author Information

From Johns Hopkins Hospital, Baltimore, Maryland. Requests for Reprints: Katharine S. Harrison, MD, Division of Infectious Diseases, Johns Hopkins Hospital, Ross Building 1159, 720 Rutland Avenue, Baltimore, MD 21205. Acknowledgments: The authors thank Dr. Charles Rohde for helping with the statistical analyses. Grant Support: Training grant AGO-149 from the National Institute of Aging.


Copyright 2004 by the American College of Physicians


Ann Intern Med. 1993;119(10):1001-1004. doi:10.7326/0003-4819-119-10-199311150-00006
Text Size: A A A

Objective: To compare the Mental Alternation Test, a new 60-second bedside test of cognition, with the Mini-Mental State Exam (MMSE) and the Trailmaking Test, parts A and B, in patients with human immunodeficiency virus (HIV) infection.

Design: Cohort study.

Participants: Sixty-two inpatients with HIV infection.

Setting: The AIDS service of a referral hospital.

Measurements: Scores on the MMSE; the Trailmaking Test, parts A and B; and the Mental Alternation Test were compared using correlation calculations and analyses of variance. Receiver operating curves were constructed to identify the best cutoff score on the Mental Alternation Test for detecting impaired performance on the MMSE and the Trailmaking Test.

Main Results: The Mental Alternation Test score correlated significantly with MMSE (r = 0.68, P < 0.01) and Trailmaking Test, part B, scores (r = 0.54,P < 0.01). The receiver operating curves showed that a Mental Alternation Test cutoff score of 15 yielded the best results for the detection of abnormal performance on the MMSE (sensitivity, 95% [95% CI, 90% to 100%]; specificity, 79% [CI, 69% to 89%]) and the Trailmaking Test, part B (sensitivity, 78% [CI, 68% to 88%]; specificity 93% [CI, 90% to 100%]). Patients making fewer than 15 alternations in 30 seconds were significantly more likely to have abnormal MMSE (P < 0.0001) and Trailmaking Test, part B, scores (P < 0.0001). The Mental Alternation Test had good reproducibility; analyses of reliability included test-retest correlation (r = 0.80) and inter-rater reliability (r = 0.85, = 0.84). Time of administration was approximately 60 seconds.

Conclusions: The Mental Alternation Test of cognition has good sensitivity and specificity and is easily administered. It is a valuable test to identify patients who may need further cognitive evaluation.

Figures

Grahic Jump Location
Figure 1.
Scatterplot of Mini-Mental State Exam (MMSE) scores versus Mental Alternation Test scores.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Receiver operating curve.

The usefulness of different cut-off values for defining abnormal performance on the Mental Alternation Test was determined by calculating the sensitivity and specificity of each cut-off score for abnormal Mini-Mental State Exam (MMSE) performance (MMSE score < 24).

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)