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Cognitive impairment in medical inpatients. II: Do physicians miss cognitive impairment?
D M Harwood1, T Hope, R Jacoby
1Section of Old Age Psychiatry, University of Oxford Department of Psychiatry, Warneford Hospital, UK.
Aim:
to study the recognition of cognitive impairment in elderly medical inpatients by medical staff.
Methods:
201 patients over 65 were assessed by administration of standard cognitive screening tests and an interview with relatives. We made Diagnostic and Statistical Manual (DSM) IIIR diagnoses of various causes of cognitive impairment and clinical diagnoses for those patients not fulfilling DSM IIIR criteria. Medical notes were scrutinized for any mention of cognitive impairment.
Results:
46% of the patients found to be cognitively impaired by the researcher had no record of cognitive impairment in the medical notes. However, 14 out of 15 of the patients with DSM IIIR delirium, and 22 out of the 26 patients with DSM IIIR dementia, were identified as cognitively impaired by the physicians. This suggests that the physicians were detecting the vast majority of patients with clinically significant cognitive impairment.