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Bedside assessment of executive cognitive impairment: the executive interview
D R Royall1, R K Mahurin, K F Gray
1Department of Psychiatry, University of Texas Health Science Center, San Antonio 78284-7792.
Objective:
This study is a pilot validation of the Executive Interview (EXIT), a novel instrument designed to assess executive cognitive function (ECF) at the bedside.
Design:
Inter-rater reliability testing and validation using inter-group comparisons across levels of care and measures of cognition and behavior.
Participants:
Forty elderly subjects randomly selected across four levels of care.
Setting:
Settings ranged from independent living apartments to designated Alzheimer's Special Care units in a single 537-bed retirement community.
Measurements:
The EXIT: a 10-minute, 25-item interview scored from 0-50 (higher scores = greater executive dyscontrol) was administered by a physician. Subjects were also administered the Mini-Mental State Exam (MMSE) and traditional tests of "frontal" executive function by a neuropsychologist, and the Nursing Home Behavior Problem Scale (NHBPS) by Licensed Vocational Nurses.
Results:
Interrater reliability was high (r = .90). EXIT scores correlated well with other measures of ECF. The interview discriminated among residents at each level of care. In contrast, the MMSE did not discriminate apartment-dwelling from residential care residents, or residential care from nursing home residents. The EXIT was highly correlated with disruptive behaviors as measured by the NHBPS (r = .79).
Conclusions:
These preliminary findings suggest that the EXIT is a valid and reliable instrument for the assessment of executive impairment at the bedside. It correlates well with level of care and problem behavior. It discriminates residents at earlier stages of cognitive impairment than the MMSE.