Informant single screening questions for delirium and dementia in acute care - A cross-sectional test accuracy pilot study

Abstract

Cognitive impairment often goes undetected in older people in hospital. Efficient screening tools are required to improve detection.
To determine diagnostic properties of two separate informant-based single screening questions for cognitive impairment (dementia and delirium) in hospitalised older people.
Patients over 65 years non-electively admitted to medical or geriatric wards within a teaching hospital. Our index tests were single screening questions (SSQ), one for dementia (“How has your relative/friend’s memory changed over the past 5 years (up to just before their current illness)?”) and one for delirium (“How has your relative/friend’s memory changed with his/her current illness?”), which were assessed with informant response given on a five point Likert scale.
Any deterioration on our index tests of SSQ-dementia and SSQ-delirium was accepted as a positive screen for cognitive impairment. Scores were compared to the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) >3.38 accepted as dementia, and Confusion Assessment Method (CAM) diagnosis of delirium. We also collected direct cognitive screening data using Mini Mental Status Examination (MMSE).
Informant responses were obtained in 70/161 (43.5%) patients, median age 80.8 (range:67–97) years; mean MMSE score 18.5 (SD: 8.1). The SSQ-dementia when compared to the IQCODE had a sensitivity of 83.3% and specificity of 93.1%. The SSQ-delirium when compared to CAM diagnosis had sensitivity of 76.9% and a specificity of 56.1%.
These findings show promise for use of an informant single screening question tool as the first step in detection of dementia in older people in acute hospital care, although this approach appears to be less accurate in screening for delirium.

Full text

R E S E A R C H A R T I C L E Open Access
Informant single screening questions for delirium
and dementia in acute care –a cross-sectional
test accuracy pilot study
Kirsty Hendry
1,3*
, Terence J Quinn
1,4
, Jonathan J Evans
2,5
and David J Stott
1,6
Abstract
Background: Cognitive impairment often goes undetected in older people in hospital. Efficient screening tools are
required to improve detection.
To determine diagnostic properties of two separate informant-based single screening questions for cognitive
impairment (dementia and delirium) in hospitalised older people.
Methods: Patients over 65 years non-electively admitted to medical or geriatric wards within a teaching hospital.
Our index tests were single screening questions (SSQ), one for dementia (“How has your relative/friend’s memory
changed over the past 5 years (up to just before their current illness)?”) and one for delirium (“How has your
relative/friend’s memory changed with his/her current illness?”), which were assessed with informant response given
on a five point Likert scale.
Any deterioration on our index tests of SSQ-dementia and SSQ-delirium was accepted as a positive screen for
cognitive impairment. Scores were compared to the Informant Questionnaire for Cognitive Decline in the Elderly
(IQCODE) >3.38 accepted as dementia, and Confusion Assessment Method (CAM) diagnosis of delirium. We also
collected direct cognitive screening data using Mini Mental Status Examination (MMSE).
Results: Informant responses were obtained in 70/161 (43.5%) patients, median age 80.8 (range:67–97) years;
mean MMSE score 18.5 (SD: 8.1). The SSQ-dementia when compared to the IQCODE had a sensitivity of 83.3% and
specificity of 93.1%. The SSQ-delirium when compared to CAM diagnosis had sensitivity of 76.9% and a specificity
of 56.1%.
Conclusions: These findings show promise for use of an informant single screening question tool as the first step
in detection of dementia in older people in acute hospital care, although this approach appears to be less accurate
in screening for delirium.
Keywords: Dementia, Delirium, Cognitive screening, Geriatrics, Psychology
Background
Cognitive impairment is a term covering a range of dis-
orders representing a clinical deficit in cognitive ability
with a significant deterioration from the person’s pre-
vious level of function [1]. It can present acutely with
rapid onset and a fluctuating short-term course such
as delirium, or as a chronic illness with a gradual, pro-
gressive course, for example mild cognitive impairment
(MCI) and dementia.
Cognitive impairment is a strong predictor of nega-
tive outcomes such as increased length of hospitalisa-
tion, increased 6 month mortality and increased risk of
readmission in older hospitalised individuals [2,3]. Cog-
nitive impairment is commonly seen in the acute care
setting, with between 40% and 70% elderly patients in
acute care in UK hospitals having dementia with with
less than half of these patients having a known previous
diagnosis [4,5].
* Correspondence: kirsty.hendry0@gmail.com
1
Institute of Cardiovascular and Medical Sciences, University of Glasgow,
Glasgow, UK
3
Academic Section of Geriatric Medicine, Institute of Cardiovascular and
Medical Sciences, Room 2:03, 2nd floor New Lister Building Glasgow Royal
Infirmary, Glasgow G31 2ER, UK
Full list of author information is available at the end of the article
© 2015 Hendry et al.; licensee BioMed central. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
Hendry et al. BMC Geriatrics (2015) 15:17
DOI 10.1186/s12877-015-0016-1

In-depth psychiatric assessment is not usually available
as a first means of detecting cognitive impairment due
to time and opportunity constraints. Instead, cognitive
screening tests that are quick and easy to administer are
used to identify individuals at high risk of cognitive im-
pairment, suitable for further assessment [6]. Single ques-
tion screening tests have been described for dementia [7]
and delirium [8]. There is debate surrounding which
screening test is the best to use due to the wide range
available and lack of validation in hospital settings [9].
We aimed to pilot the performance of two single screen-
ing questions (SSQ), one for delirium and one for de-
mentia, in hospitalised, elderly individuals as part of a
secondary analysis of a previously collected data set.
The SSQs were compared to a validated informant as-
sessment of dementia; the 16 item Informant Question-
naire on Cognitive Decline in the Elderly (IQCODE)
[10] and delirium diagnosis based on the Confusion As-
sessment Method (CAM) [11]. We hypothesised that
single informant-based screening questions would be
sensitive and specific in detecting dementia and delir-
ium in hospitalised older people.
Methods
Participants
We carried out a prospective, observational pilot study
of patients aged ≥65 years admitted to the acute medi-
cine unit or geriatric assessment unit of an urban teach-
ing hospital. Participants admitted to acute medicine
between October-December 2004 were randomly se-
lected, up to a maximum of 7 subjects per 24 hours
(using tables of random numbers, and linking this to al-
phabetical order of patient name). Participants from the
geriatric assessment unit were consecutive admissions
(February-March 2005). A total of 161 patients were
recruited; 80 from the acute unit and 81 from the geriatric
unit. The acute medical unit admits patients of all ages,
presenting with medical conditions requiring emer-
gency hospital admission; the geriatric assessment unit
admits older adults (age > 65) and preferentially selects
those with complex co-morbidity; frailty; physical or
cognitive decline.
Patient exclusions were Glasgow Coma Scale verbal
component rated as none or sounds only, moderate-
severe dysphasia (grossly impaired comprehension, un-
intelligible speech, or major difficulties in expression),
non-English speaking, learning disability, major deaf-
ness or blind, or readmission of patient previously in-
cluded in the study.
The patient’s capacity to provide consent was decided
by a qualified independent doctor. Those judged as
not to have the capacity to provide consent had written
informed consent provided by their next of kin. The
next of kin were provided with an information sheet to
explain study objectives as well as the nature of patient
participation.
Direct patient screening was performed within 36
hours of patient admission. Assessment included the
MMSE as a screen for cognitive impairment and also
the Confusion Assessment Method (CAM) as a meas-
ure for detecting delirium. The assessments were per-
formed by a single trained observer, a senior medical
student, who received formal one-to-one training in
bedside cognitive assessment from an experienced con-
sultant geriatrician.
Information was also obtained from patient medical
records following cognitive assessment. This included
demographic details such as age, sex and date of birth,
current living arrangements and next of kin information.
We described functional ability using an Instrumental
Activities of Daily Living scale [12].
Participants’next of kin were provided with a study
pack which contained an introductory letter, an informa-
tion sheet, two consent forms, the Informant Question-
naire on Cognitive Decline in the Elderly (IQCODE), the
two SSQ’s for dementia and delirium and an envelope to
return the completed consent form, IQCODE and SSQ’s.
Study packs were either handed to the next of kin in
person, with verbal instructions also being given by the
researcher or, if this was not possible, posted to the
home address. In cases where the next of kin was not
available to complete the study, any relative or carer
who had known the patient for a minimum of 5 years
could complete the study.
The study was approved by the Scotland A Multi-
centre Research Ethics Committee.
Reference standards
The CAM [11] is a commonly used measure of delirium
in hospitalised patients. The CAM consists of 9 opera-
tionalised criteria based on the DSM-IIIR. Observations
made during direct cognitive testing as well as informa-
tion obtained from nurse interview regarding fluctuating
course and sleep-wake cycle are used to evaluate four
components of patient cognition; acute onset and 1)
fluctuating course, 2) inattention, 3) disorganised think-
ing and 4) altered level of consciousness. For delirium to
be diagnosed by the CAM, criteria 1) and 2) must be
present as well as either 3) or 4).
The 16 item IQCODE [10] is an informant-based
questionnaire which asks relatives to consider changes
in the patient’s abilities at certain activities within the
last 10 years. Such items include “remembering where
things are usually kept”and “learning new things”. Rela-
tive responses are given on a 5-point Likert scale ranging
from “Much improved”to “Much worse. Average rating
across all items is then calculated with a cut off of >3.38
accepted as indicative of possible dementia in this study.
Hendry et al. BMC Geriatrics (2015) 15:17 Page 2 of 6

The MMSE [13] is a multiple component screening
tool which aims to measure 6 cognitive domains; orienta-
tion, registration, attention & calculation, recall, language
and copying ability. The test is administered directly to
the patient, usually by a member of the medical team.
The test is scored out of a total of 30 with a score of <24
generally accepted as indication of possible cognitive
impairment.
Index tests
Two SSQs were developed as screens for dementia and
delirium. Relative responses were measured on a 5-
point Likert scale. The 5 response options to each ques-
tion were;
–Much Improved/A Bit Improved/Hasn’t Changed
Much/A Bit Worse/Much Worse
–The SSQ-delirium was;
–“How has your relative/friend’s memory changed
with his/her current illness?”
–The SSQ-dementia was;
–“How has your relative/friend’s memory changed
over the past 5 years (up to just before their current
illness)?”
Statistical methods
Data were analysed using SPSS version 19. Clinical and
demographic information was examined using descrip-
tive statistics. We compared subjects with and without
an informant response.
For analysis of SSQ data, we used three categories:
“much worse”;“bit worse”and “no decline”(which was
a combination of “much better”,“bit better”and no
change scores). To allow test accuracy analysis, SSQ re-
sponses were further dichotomised as suspected cognitive
impairment (“bit worse”and “much worse”responses)
and no cognitive impairment (“much better”,“bit better”
and “no change”responses).
We used ROC analyses to compare index test of SSQ-
delirium against the reference standard CAM and also
the MMSE. We compared SSQ –dementia against the
reference standard of IQCODE. We used usual diag-
nostic thresholds for IQCODE (mean score <3.38) and
for MMSE (total score <24).
We described diagnostic metrics of sensitivity; specifi-
city; positive and negative predictive value and corres-
ponding 95% confidence intervals (95%CI).
We described differences in scores on ordinal reference
standard tests (IQCODE and MMSE) for the three SSQ
categories across both SSQ’s. Patient’s scores on the MMSE
and IQCODE were analysed for statistical significance
between the three SSQ outcomes using Kruskal-Wallis
H Test analyses. Between group analyses were then car-
ried out to determine where the statistical difference lay
using Mann Whitney U post hoc analysis with Bonferroni
correction.
Results
The characteristics of the 161 participants recruited for
this study are shown in Table 1, as well as separate ana-
lyses for patients with complete and incomplete single
screening question data. SSQ’s were completed for 70
patients. There was found to be no significant differ-
ence between characteristics of respondents and non-
respondents except in terms of age (p = 0.049).
Of the 70 patients who had data for both the dementia
and delirium SSQ, 26 (37.1%) had a positive screen on
both single questions, 25 (35.7%) had a negative screen
on both single questions, 9 (12.9%) had a positive screen
only for delirium and 10 (14.3%) had a positive screen
only for dementia.
Kruskal-Wallis H Test analysis revealed a statistically
significant difference in MMSE scores between the dif-
ferent SSQ-delirium outcomes (H(2) = 21.4 , p < 0.001)
(see Table 2).
A statistically significant difference in MMSE scores
was also found between the different SSQ-dementia out-
comes (H(2) = 16.8, p < 0.001), with a median of 3.06 for
patients identified as “no change or better”, 3.94 for pa-
tients identified as “a bit worse”and 4.88 for patients
identified as “much worse”.
Kruskal-Wallis H Test analysis also revealed a statisti-
cally significant difference in IQCODE scores between
the different SSQ-delirium outcomes (H(2) = 27.3, p <
0.001), with a median of 3.07 for those identified as “no
change or better”, 3.75 for those identified as “a bit
worse”and 4.85 for patients identified as “much worse”.
A statistically significant difference in IQCODE scores
was also found between the different SSQ-dementia
(H(2) = 41.2, p < 0.001), with a median of 3.06 for those
identified as “no change or better”,3.94forpatients
identified as “a bit worse”and 4.88 for patients identi-
fied as “much worse”.
ROC analyses were carried out to calculate the sensi-
tivity and specificity values of the SSQ-dementia and
the SSQ -delirium, when comparing screening accuracy
to a directly comparable routinely used screening in-
strument (IQCODE with a cut score of <3.38 and CAM
positive diagnosis, respectively). Analysis revealed the
SSQ-dementia (AUC = 0.882) had good diagnostic ac-
curacy and SSQ-delirium (AUC = 0.665) had fair diagnos-
tic accuracy. Sensitivity and specificity data are reported
in Table 3.
Discussion
The most prominent finding from this pilot study was
the high sensitivity and specificity of the single screening
question for dementia. This one-item screen performed
Hendry et al. BMC Geriatrics (2015) 15:17 Page 3 of 6

at a similar level to the routinely used 16-item IQCODE.
However, while the single screening question for delir-
ium showed a similar sensitivity, it had low specificity.
Almost half of individuals with normal cognitive function-
ing, as classified by CAM diagnosis, were identified by the
single screening question having suspected delirium.
While the SSQ-delirium appeared not to perform well
as a first step in delirium detection, this may be better
explained by methodological issues with difficulties in
screening for delirium, in general. A defining feature of
delirium is fluctuation in presence of symptoms, and as
such it is very difficult to have exact concurrence between
a screening tool for delirium and the reference standard;
in this study the SSQ-delirium and CAM, respectively.
Thus, it is possible that delirium can be present at one
testing point but not the other. Interpretation of the per-
formance of the SSQ-delirium in this study is limited as
data on the time lag between the SSQ-delirium and CAM
were not collected. It would also be of interest for fu-
ture studies to test the SSQ-delirium blinded from CAM
diagnosis.
Undiagnosed dementia may be able to account for the
high number of false positive results identified by the
single screening question for delirium. The majority of
patients identified as positive by the single screening
question for delirium also had a positive results on the
single screening question for dementia. It is possible that
an informant based question is not suitable to accurately
differentiate those at high risk of having delirium from
those at high risk of having dementia.
Direct cognitive testing of patients is the most commonly
used screening method for cognitive impairment [14].
However, informant testing shows promise in improving
detection of at-risk individuals. It has been demonstrated
Table 2 IQCODE and MMSE scores (means and S.D.) across SSQ acute and chronic responses
SSQ response No change or better Bit worse Much worse
IQCODE Acute SSQ 3.4 3.9** 4.6**
(SD = 0.6, N = 35) (SD = 0.6, N = 25) (SD = 0.5, N = 10)
Chronic SSQ 3.2 3.9** 4.7**
(SD = 0.4 N = 34) (SD = 0.6 N = 27) (SD = 0.4, N = 10)
MMSE Acute SSQ 22.9 15.0** 12.0**
(SD = 5.6, N = 35) (SD = 8.6, N = 25) (SD = 5.8, N = 10)
Chronic SSQ 22.0 17.1* 10.1**
(SD = 6.3, N = 34) (SD = 7.9, N = 27) (SD = 6.6, N = 10)
Notes: Mann Whitney U post hoc analysis with Bonferroni correction.
* = p < 0.01, ** = p < 0.001, compared to ‘nochange or better’.
Abbreviations: MMSE Mini-mental state examination, IQCODE Informant questionnaire on cognitive decline in the elderly, IADL Instrumental activities of daily living.
Table 1 Summary of characteristics of all patients with specification of respondents and non-respondents to the single
screening questions
All patients Patients with informant Patients with no informant
(n = 161) (n = 70) (n = 91)
Mean age (years) 79.6 80.9 * 78.6 *
(range = 65–97) (range = 67–97) (range = 65–94)
Male n (%) 62 (38.5%) 27 (38.5%) 35 (38.5%)
Living arrangements n (%):
Alone 80 (49.7) 32 (45.7) 48 (52.7)
With spouse/other family 66 (41.0) 31 (41.2) 35 (38.5)
Sheltered accommodation 8 (5) 4 (4) 4 (4)
Nursing/residential care 4 (2.5) 1 (1.4) 3 (3.3)
Cognitive and functional assessments
MMSE mean (SD) 18.9 (7.7) 18.5 (8.1) 19.2 (7.5)
MMSE <24 n (%) 107 (66.4%) 45 (64.3%) 62 (68.1%)
CAM positive n (%) 27 (16.8%) 13 (18.6%) 14 (15.4%)
IADL mean score (SD) 8.7 (4.3) 9.1 (4.2) 8.4 (4.4)
*p = 0.049.
Abbreviations: CAM Confusion assessment method, MMSE Mini-mental state examination, IADL Instrumental activities of daily living.
Hendry et al. BMC Geriatrics (2015) 15:17 Page 4 of 6

that an informant questionnaire shows the same perform-
ance as direct cognitive testing, despite the fact that these
different screening tools measure different patient attri-
bute [15]. A major advantage of informant based assess-
ments is that they do not suffer the same problems as
cognitive testing of being independent of patient’seduca-
tion level and less susceptible to ceiling effects [16]. Single
question screening for cognitive impairment is a hot topic
at the moment and there is a paid incentive being rolled
out across hospitals in England in an attempt to improve
diagnosis of patients with cognitive impairment known as
the Commission for Quality and Innovation (CQUIN)
framework. Of particular interest to this study is the
first stage, ‘Find’whereby the patient or informant is
asked the question, ‘Has the patient been more forgetful
in the last 12 months to the extent that it has signifi-
cantly affected their daily life?’This suggests that single
question methods of screening for cognitive impair-
ment are beginning to be used on a large scale despite
not being fully validated.
The advantage of using an informant-based screening
tool for delirium is less clear than for dementia. Due to
the fluctuating nature of delirium, it can easily be missed
and the need for a relative to be present to provide in-
formation introduces further timing challenges as access
to informants is only possible at discrete selected times.
However, evidence suggests that delirium is most pre-
valent in older patients when they are at their most sick,
usually soon after admission or in those patients who have
prolonged hospitalisation. Thus, those may be particularly
important times to use the SSQ-delirium. It is clear from
the literature that some form of delirium screening is
needed rather than subjective clinical judgement which
has been shown to perform poorly at detecting prevalent
delirium [17]. This supports the need for a more struc-
tured approach to be implemented as a brief first step to
identify those with suspected delirium who would then be
assessed using diagnostic tools such as the CAM.
Caution must be taken when interpreting these results
as the reference standards were screening tests rather
than a formal clinical diagnosis. lack of comprehensive
clinical evaluation for dementia was a further major
limitation . The recruitment and consent strategy could
have lead to biases within this study; those at higher
risk of cognitive impairment may have had more visits
from family and hence more likely to return the informant
questionnaire, especially in cases where the patient was
unable to provide consent and hence a relative or carer
had to provide consent. As this study obtained single
question informant report in less than half of patients this
raises issues of feasibility as there is strong potential for
many individuals with suspected cognitive impairment
not being assessed. From this data set, it is unclear whe-
ther such low response rates were due to patients not hav-
ing a suitable relative or carer available to answer the
single screening questions or whether it was due to a lack
of appropriate measures taken by the researcher to insure
return of informant responses.
Presenting informants with the IQCODE prior to an-
swering the single screening questions may also have in-
fluenced the results, possibly enhancing how well the
single screening questions appeared to perform.
However, within these limitations we believe our results
still provide useful information on how simple responses
from informants may perform. This pilot study was
strengthened by broad inclusion criteria thus providing
a sample relatively representative of older adult acute
care admissions. We based our SSQ’sontheformatof
a validated informant questionnaire, the IQCODE.
These preliminary findings show promise for use of a
single question screening tool as the first step in the detec-
tion of cognitive impairment and prompt more thorough
investigation. As yet there is no one cognitive screening
tool that has achieved widespread consensus, thus the
comparisons made to the IQCODE and MMSE only pro-
vide evidence for the value of carrying out a more in-
depth study. Future research should compare the single
question screen to a gold standard clinical evaluation of
dementia and delirium to determine more reliable diag-
nostic accuracy figures. The use of an informant-based
single screening question may be particularly useful in
combination with a direct cognitive testing method in
helping to distinguish patients who fall within the mid-
dle, grey area of scores on cognitive test based screen-
ing tools. Furthermore, it is apparent that there is need
for investigation to determine how to get higher uptake
of relatives/carers to provide informant report.
Table 3 Analysis of diagnostic accuracy
Single question
for acute
confusion
Single question
for chronic
deterioration in
memory
CAM + ve IQCODE <3.38
Area Under Curve (95% CI) 0.67 (50.8-82.3) 0.88 (79.6-96.8)
Sensitivity of Single Question 10/13 35/42
(%, 95% CI) (76.9) (83.3)
Specificity of Single Question 32/57 27/29
(%) (56.1) (93.1)
Positive Predictive Value of
Single Question
10/32 35/37
(%) (28.6) (94.6)
Negative Predictive Value of
Single Question
32/35 27/24
(%) (91.4) (79.4)
Abbreviations: CAM Confusion assessment method, MMSE Mini-mental state
examination, IQCODE Informant questionnaire on cognitive decline in
the elderly.
Hendry et al. BMC Geriatrics (2015) 15:17 Page 5 of 6

Conclusions
Routine screening for cognitive impairment is necessary
in older hospitalised patients and effective screening is
beneficial to clinical staff as well as the outcomes of the
patients. This task is made more difficult by the lack of
uniformity regarding the various screening tools avail-
able [18]. This pilot study has provided evidence that a
single-item informant based screen may perform in a
comparable way to much longer screens for dementia by
effectively differentiating those with suspected cognitive
impairment from normally functioning patients. Further
validation is warranted. However, if a screening tool as
straightforward as asking a single question, which has
low time cost and requires little to no training to admin-
ister, can perform as well as more complex screens such
as the IQCODE, then it would seem intuitive that this is
a preferable option. However, results showed that a single
question screening tool may not have the same potential
when identifying individuals with suspected delirium.
Competing interests
The authors declare that they have no competing interests.
Authors’contributions
DJS made substantial contributions to the conception, design and
acquistition of data. All authors were involved in the analysis and
interpretation of the data, with KH taking the primary role in statistical
analysis. KH drafted the manuscript. TJQ, JE and DJS revised the manuscript
extensively for important intellectual content. All authors have given final
approval of the version to be published.
Author details
1
Institute of Cardiovascular and Medical Sciences, University of Glasgow,
Glasgow, UK.
2
Institute of Health and Wellbeing, University of Glasgow,
Glasgow, UK.
3
Academic Section of Geriatric Medicine, Institute of
Cardiovascular and Medical Sciences, Room 2:03, 2nd floor New Lister
Building Glasgow Royal Infirmary, Glasgow G31 2ER, UK.
4
Academic Section
of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, Room
2.44, 2nd floor New Lister Building Glasgow Royal Infirmary, Glasgow G31
2ER, UK.
5
Mental Health and Wellbeing, University of Glasgow, The Academic
Centre, Gartnavel Royal Hospital, R212 Level 2, 1055 Great Western Road,
Glasgow G12 0XH, UK.
6
Academic Section of Geriatric Medicine, Institute of
Cardiovascular and Medical Sciences, Room 9, 2nd floor New Lister building
Glasgow Royal Infirmary, Glasgow G31 2ER, UK.
Received: 17 October 2014 Accepted: 16 February 2015
References
1. American Psychiatric Association. Diagnostic and statistical manual of
mental disorders, (4
th
ed., text revision). Washington DC: American
Psychiatric Association; 2000.
2. Maxwell CA. Screening hospitalised injured older adults for cognitive
impairment and pre-injury functional impairment. Appl Nurs Res. In press.
3. Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM. Inpatient
rehabilitation specifically designed for geriatric patients: Systematic review
and meta-analysis of randomised controlled trials. Br Med J. 2010;340:c1718.
4. Sampson E, Blanchard M, Jones L, Tookman A, King M. Dementia in the
acute hospital: prospective cohort study. Br J Psychiatry. 2009;195:61–6.
5. Gordon A, Hu H, Byrne A, Stott DJ. Dementia screening in acute medical
and geriatric hospital admissions. Psychiatr Bull. 2009;33:52–4.
6. Galvin JE, Roe CM, Morris JC. Evaluation of cognitive impairment in older
adults. Arch Neurol. 2007;64:718–24.
7. Ayalon L. The IQCODE versus a single-item informant measure to discriminate
between cognitively intact individuals and individuals with dementia or
cognitive impairment. J Geriatr Psychiatry Neurol. 2011;24:168–73.
8. Sands MB, Dantoc BP, Hartshorn A, Ryan CJ, Lujic S. Single question in
delirium (SQiD): testing its efficacy against psychiatric interview, the
confusion assessment method and the memorial delirium assessment scale.
Palliat Med. 2010;24:561–5.
9. Cullen B, O’Neill B, Evans J, Coen RF, Lawlor BA. A review of screening tests
for cognitive impairment. J Neurol Neurosurg Psychiatry. 2007;78:790–9.
10. Jorm AF, Korten AE. Assessment of cognitive decline in the elderly by
informant interview. Br J Psychiatry. 1988;152:209–13.
11. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying
confusion: the confusion assessment method. A new method for detection
of delirium. Ann Intern Med. 1990;113:941–8.
12. Lawton MP, Brody EM. Assessment of older people: Self-maintaining and
instrumental activities of daily living. Gerontologist. 1969;9:179–86.
13. Folstein M, Folstein SE, McHugh PR. “Mini-Mental State”a practical method
for grading the cognitive state of patients for the clinician. J Psychiatr Res.
1975;12:189–98.
14. MacKinnon A, Mulligan R. Combining cognitive testing and informant
report to increase accuracy in screening for dementia. Am J Psychiatry.
1998;155:1529–35.
15. Jorm AF. Assessment of cognitive impairment and dementia using
informant report. Clin Psychol Rev. 1996;45:627–37.
16. Douglas VC, Neuhaus J, Johnson JK, Racine CA, Miller BL, Josephson SA.
Dementia = (MC)
2
: a 4-item screening test for mild cognitive impairment
and dementia. Alzheimer Dis Assoc Disord. 2011;25:220–4.
17. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people.
Lancet. 2014;383:911–22.
18. Lees R, Fearon P, Harrison JK, Broomfield NM, Quinn TJ. Cognitive and
mood assessment in stroke research: focused review of contemporary
studies. Stroke. 2012;43:1678–80.
Submit your next manuscript to BioMed Central
and take full advantage of:
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at
www.biomedcentral.com/submit
Hendry et al. BMC Geriatrics (2015) 15:17 Page 6 of 6