MMSE items that predict incident delirium and hypoactive subtype in older medical inpatients

Area of Science:

• Geriatrics
• Neurology
• Psychiatry

Background:

• Hypoactive delirium is frequently under-recognized in older adults.
• Early identification of delirium risk factors is crucial for timely intervention.

Purpose of the Study:

• To identify Mini-Mental State Examination (MMSE) items predicting incident delirium.
• To determine which MMSE items predict hypoactive delirium presentation.

Main Methods:

• Older medical inpatients (n=291) were screened for prevalent delirium using the Confusion Assessment Method-Spanish (CAM-S).
• Nondelirious patients underwent daily CAM-S ratings and initial MMSE evaluations.
• Delirious patients were assessed using the Delirium Rating Scale-Revised-98 for severity and motor subtype.

Main Results:

• Disorientation to time (OR 4.4) and place (OR 3.8) at admission predicted incident delirium, classifying 88.3% of subjects.
• Disorientation and visuoconstructional impairment were associated with hypoactive or mixed delirium subtypes.
• Bedside cognitive deficits identified patients at risk for developing incident delirium, especially hypoactive or mixed types.

Conclusions:

• MMSE deficits, particularly orientation, are significant predictors of incident delirium in older inpatients.
• Close monitoring of patients with orientation deficits is recommended to detect emergent delirium.
• Consideration for dementia or other cognitive impairment evaluation at admission is advised for at-risk patients.