Rosanne M. Leipzig, MD, PhD
What is the accuracy of various aspects of temporal orientation for detecting cognitive impairment in older patients?
Comparison of various aspects of temporal orientation with independent diagnosis of cognitive impairment by clinical interview done on the same day by 2 different physicians.
General medical wards and geriatric outpatient clinics of a university teaching hospital in Ireland.
A convenience sample of 262 inpatients and outpatients ≥ 65 years of age (median age 76 y, 58% women, 65% inpatients). Exclusion criteria were major communication difficulties (inability to speak English, severe deafness, or severe cognitive impairment precluding communication), or illness precluding participation.
Assessment of temporal orientation comprised asking patients to identify the year, month, date (day of the month), day of the week, and time of day (ensuring that they could not look at a watch or clock). Patients were encouraged to provide their best estimate if they were unsure.
Clinical interview by an experienced physician, incorporating information from caregivers, health care providers, medical records, and nursing notes. Cognitive impairment was defined as delirium (Confusion Assessment Method: acute onset and fluctuating course, difficulty focusing and maintaining attention, and either disorganized thinking or altered level of consciousness) and/or dementia (modified 5-stage Global Deterioration Scale ratings of questionable, mild, moderate, or severe).
Sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver-operating characteristic (ROC) curve.
62 patients (24%) had cognitive impairment: 15 (5.7%) had delirium, 47 (18%) had dementia, and 18 (6.9%) had questionable dementia. Test characteristics are in the Table.
In older patients, inability to correctly identify the year or month had the highest combined sensitivity and specificity for detecting cognitive impairment.
Diagnostic characteristics of temporal orientation assessment for detecting cognitive impairment in older patients*
*ROC = receiver–operating characteristic; other diagnostic terms defined in Glossary.
†Calculated from data in article.
Leipzig RM. Inability to correctly identify year or month was accurate for detecting cognitive impairment in older patients. Ann Intern Med. ;155:JC3–9. doi: 10.7326/0003-4819-155-6-201109200-02009
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Published: Ann Intern Med. 2011;155(6):JC3-9.
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