Abstract
Introduction: The Mini-Mental State Examination (MMSE) is a common cognitive screening test, but its utility in identifying impairments in survivors of acute respiratory failure is unclear. The purpose of this study was to evaluate MMSE performance versus a concurrently administered detailed neuropsychological test battery in survivors of acute respiratory failure. Methods: This cross-sectional analysis used data from the ARDSNet Long Term Outcomes Study (ALTOS) and Awakening and Breathing Controlled Trial (ABC). Participants were 242 survivors of acute respiratory failure. The MMSE and detailed neuropsychological tests were administered at 6 and 12months post-hospital discharge for the ALTOS study, and at hospital discharge, 3 and 12months for the ABC study. Overall cognitive impairment identified by the MMSE (score <24) was compared to impairments identified by the neuropsychological tests. We also matched orientation, registration, attention, memory and language domains on the MMSE to the corresponding neuropsychological test. Pairwise correlations, sensitivity, specificity, positive and negative predictive values, and agreement were assessed. Results: Agreement between MMSE and neuropsychological tests for overall cognitive impairment was fair (42 to 80%). Specificity was excellent (≥93%), but sensitivity was poor (19 to 37%). Correlations between MMSE domains and corresponding neuropsychological tests were weak to moderate (6months: r = 0.11 to 0.28; 12months: r = 0.09 to 0.34). The highest correlation between the MMSE and neuropsychological domains was for attention at 6months (r = 0.28) and language at 12months (r = 0.34). Conclusions: In acute respiratory failure survivors, the MMSE has poor sensitivity in detecting cognitive impairment compared with concurrently administered detailed neuropsychological tests. MMSE results in this population should be interpreted with caution.
| Original language | English |
|---|---|
| Article number | 220 |
| Journal | Critical Care |
| Volume | 19 |
| Issue number | 1 |
| DOIs | |
| State | Published - May 5 2015 |
Bibliographical note
Publisher Copyright:© 2015 Pfoh et al.
Funding
ERP takes responsibility for the content of the manuscript including the data and analysis. This research was supported by the NIH (grant numbers: R24HL111895, R01HL091760, R01HL091760-02S1, R01HL096504 and K23AG034257), the Johns Hopkins Institute for Clinical and Translational Research (ICTR) (grant number: UL1 TR 000424–06) and the ALTA and EDEN/OMEGA trials (contracts for sites participating in this study: HSN268200536170C, HHSN268200536171C, HHSN268200536173C, HHSN268200536174C, HSN268200536175C and HHSN268200536179C). The sponsors had no role in the data acquisition, analysis or preparation of the manuscript. We thank all patients and their proxies who participated in the study. We acknowledge our dedicated research staff, including the following who assisted with data collection, training and quality assurance and/or data management: Lindsay Anderson, Ellen Caldwell, Nancy Ciesla, William Flickinger, Jacqueline Flynn, Jonathan Gellar, Stephanie Gundel, John Keenan, Christopher Mayhew, Melissa McCullough, Jessica McCurley, Mardee Merrill, Laura Methvin, Kristin Sepulveda, Kelly Swanson, Elizabeth Vayda and Cassie Wicken. Investigators and research staff from the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network sites that participated in this follow-up study: University of Washington, Harborview (*L Hudson, S Gundel, *C Hough, M Neff, K Sims, A Ungar, T Watkins); Johns Hopkins University (*R Brower, H Fessler, D Hager, P Mendez-Tellez, D Needham, K Oakjones); Johns Hopkins Bayview Medical Center (J Sevransky, A Workneh); University of Maryland (C Shanholtz, D Herr, H Howes, G Netzer, P Rock, A Sampaio, J Titus); Union Memorial Hospital (P Sloane, T Beck, D Highfield, S King); Washington Hospital Center (B Lee, N Bolouri); Vanderbilt University (*AP Wheeler, GR Bernard, M Hays, S Mogan, TW Rice); Wake Forest University (*RD Hite, A Harvey, PE Morris, M Ragusky); Intermountain Medical Center (*A Morris, *C Grissom, A Austin, S Barney, S Brown, J Ferguson, H Gallo, T Graydon, E Hirshberg, A Jephson, N Kumar, M Lanspa, R Miller, D Murphy, J Orme, A Stowe, L Struck, F Thomas, D Ward,); LDS Hospital (P Bailey, W Beninati, L Bezdjian, T Clemmer, S Rimkus, R Tanaka, L Weaver); McKay Dee Hospital (C Lawton, D Hanselman); Utah Valley Regional Medical Center (K Sundar, W Alward, C Bishop, D Eckley, D Harris, T Hill, B Jensen, K Ludwig, D Nielsen, M Pearce). Clinical Coordinating Center: Massachusetts General Hospital and Harvard Medical School (*D Schoenfeld, N Dong, M Guha, E Hammond, P Lazar, R Morse, C Oldmixon, N Ringwood, E Smoot, BT Thompson, R Wilson). National Heart, Lung and Blood Institute: A Harabin, S Bredow, M Waclawiw, G Weinmann. Data and Safety Monitoring Board: RG Spragg (chair), A Slutsky, M Levy, B Markovitz, E Petkova, C Weijer. Protocol Review Committee: J Sznajder (chair), M Begg, L Gilbert-McClain, E Israel, J Lewis, S McClave, P Parsons. *Principal investigator.
| Funders | Funder number |
|---|---|
| Johns Hopkins Institute for Clinical and Translational Research | |
| National Institutes of Health (NIH) | R01HL096504, K23AG034257, R24HL111895 |
| National Heart, Lung, and Blood Institute (NHLBI) | R01HL091760 |
| Institute for Clinical and Translational Research, University of Wisconsin, Madison | HSN268200536175C, UL1 TR 000424–06, HHSN268200536173C, HHSN268200536174C, HHSN268200536171C, HSN268200536170C, HHSN268200536179C |
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine