Unrecognised cognitive impairment in hospice patients: a pilot study

Area of Science:

• Gerontology
• Neuropsychology
• Palliative Care

Background:

• Cognitive impairment significantly affects healthcare for hospice patients, presenting practical, ethical, and legal challenges.
• Prevalence rates of cognitive impairment in this population are variable, yet it is often under-recognized and undertreated.
• Existing cognitive disorders or obvious impairments were excluded to focus on previously undiagnosed deficits.

Purpose of the Study:

• To evaluate the presence and nature of cognitive deficits in patients receiving inpatient hospice care.
• To identify undiagnosed cognitive impairments in patients without a known history of cognitive disorders.
• To assess the clinical significance of these undetected cognitive impairments.

Main Methods:

• A pilot study involving a convenience sample of 30 inpatient hospice care patients.
• Bedside cognitive testing using a comprehensive battery of standardized neuropsychological tests.
• Inclusion of the Mini-Mental State Examination (MMSE) and tests assessing memory, reasoning, and fluency.

Main Results:

• Patients demonstrated average impairments on the MMSE and tests of learning, verbal reasoning, and fluency.
• Twelve out of 30 patients met DSM-IV criteria for dementia based on memory and other cognitive domain deficits.
• A significant proportion of hospice patients exhibited undetected, clinically significant cognitive impairments.

Conclusions:

• Undetected cognitive impairments are prevalent in inpatient hospice care patients.
• Addressing cognitive impairment can enhance patient quality of life, relationships, and end-of-life care.
• Further research is required to understand the causes, progression, and impact on decision-making capacity of cognitive impairment in this population.