Validation of the 6-Item Cognitive Impairment Test and the 4AT test for combined delirium and dementia screening in older Emergency Department attendees

O'Sullivan, Dawn; Brady, Noeleen M.; Manning, Edmund; O'Shea, Emma; O'Grady, Síle; ‘Regan, Niamh O; Timmons, Suzanne

doi:10.1093/ageing/afx149

Cited by 108 publications

(111 citation statements)

References 29 publications

(42 reference statements)

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“…Cognition was tested at admission using the Six-Item Cognitive Impairment Test (6-CIT) [18]. The 6-CIT is a short questionnaire and consists of six questions, one memory question (remembering an address), two calculation questions (recalling numbers and months backward), and three orientation questions (naming of the time, the month, and the year).…”

Section: Cognitionmentioning

confidence: 99%

“…The 6-CIT is a short questionnaire and consists of six questions, one memory question (remembering an address), two calculation questions (recalling numbers and months backward), and three orientation questions (naming of the time, the month, and the year). The 6-CIT is a validated questionnaire in an older emergency department population [18] and is based on the 26-item Blessed Information-Memory-Concentration Scale [19]. The score on the 6-CIT ranges from 0 to 28 and has been used as a continuous and dichotomous measure with a proposed cutoff value of ≥10 points indicating low cognitive functioning [20].…”

Section: Cognitionmentioning

confidence: 99%

“…We used the 6-CIT questionnaire as a proxy for cognitive functioning. The 6-CIT was recently validated [18], and this short questionnaire was easy to apply in the clinical setting. The use of DSM-BIA to measure muscle mass was easy but may have been influenced by the patients' hydration status.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…The use of DSM-BIA to measure muscle mass was easy but may have been influenced by the patients' hydration status. Since patients with advanced dementia were excluded and the median 6-CIT score of 4 (interquartile range 0-8) in the present study population implies normal cognitive function [18], the impact of dementia on muscle measures was not examined in this study. We were not able to control for influential factors such as nutritional intake, physical activity, and treatments during hospitalization, which may have influenced our outcome measures.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Lower Cognitive Function in Older Patients with Lower Muscle Strength and Muscle Mass

Dam

Ancum

Verlaan

et al. 2018

Dement Geriatr Cogn Disord

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Background: Low muscle strength and muscle mass are associated with adverse outcomes in older hospitalized patients. The aim of this study was to assess the association between cognitive functioning and muscle strength and muscle mass in hospitalized older patients. Methods: This prospective inception cohort included 378 patients aged 70 years or older. At admission patients were assessed for cognitive functioning by use of the Six-Item Cognitive Impairment Test (6-CIT). Muscle strength and muscle mass were assessed using handheld dynamometry and segmental multifrequency bioelectrical impedance analysis, within 48 h after admission and on day 7, or earlier on the day of discharge. Results: The data of 371 patients (mean age ± standard deviation 80.1 ± 6.4 years, 49.3% female) were available for analyses. The median (interquartile range) 6-CIT score was 4 (0-8) points. At admission, lower cognitive functioning was associated with lower muscle strength, lower skeletal muscle mass (SMM), lower appendicular lean mass, and lower SMM index. Cognitive functioning was not associated with change in muscle strength and muscle mass during hospitalization. Conclusion: This study further strengthens evidence for an association between lower cognitive functioning and lower muscle strength and muscle mass, but without a further decline during hospitalization.

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Section: Cognitionmentioning

confidence: 99%

Section: Cognitionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Lower Cognitive Function in Older Patients with Lower Muscle Strength and Muscle Mass

Dam

Ancum

Verlaan

et al. 2018

Dement Geriatr Cogn Disord

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“…The 4 A's test (4AT) is a short, four‐item test of delirium that takes under 2 min to complete and can be performed by healthcare professionals without special training . The 4AT has been validated in multiple studies in various populations and is used widely internationally as a clinical tool. The 4AT is available in several languages (https://www.the4at.com; see also Supporting Information Appendix S1).…”

Section: Introductionmentioning

confidence: 99%

Screening for delirium after surgery: validation of the 4 A's test (4AT) in the post‐anaesthesia care unit

et al. 2019

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Summary Postoperative delirium is common and has multiple adverse consequences. Guidelines recommend routine screening for postoperative delirium beginning in the post‐anaesthesia care unit. The 4 A's test (4AT) is a widely used assessment tool for delirium but there are no studies evaluating its use in the post‐anaesthesia care unit. We evaluated the performance of the 4AT in the post‐anaesthesia care unit in a tertiary German medical centre. Adults who were able to provide informed consent, were not scheduled for postoperative intensive care, and who did not have dementia or severe neuropsychiatric disorders underwent screening by trained research staff with the Nurse Delirium Screening Scale and a new German translation of the 4AT in a random order at the point of discharge from the post‐anaesthesia care unit. Reference standard assessment of delirium was psychiatric evaluation by experienced clinicians. Five hundred and forty‐three patients (mean age (SD) 52 (18) years) were analysed; 22 (4.1%) patients developed delirium. The sensitivity and specificity of the 4AT were 95.5% (95%CI 77.2–99.9) and 99.2% (95%CI 98.1–99.8), respectively. The area under the receiver operator characteristic curve was 0.998 (95%CI 0.995–1.000). The Nursing Delirium Screening Scale had a sensitivity of 27.3% (95%CI 10.7–50.2) and specificity of 99.4% (95%CI 98.3–99.9), with an area under the curve of 0.761 (95%CI 0.629–0.894). These findings suggest that the 4AT is an effective and robust instrument for delirium detection in the post‐anaesthesia care unit.

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Neuroimaging for differential diagnosis of transient neurological attacks

Wang

Zha

2022

Brain and Behavior

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Background: Rapid yet comprehensive neuroimaging protocols are required for patients with suspected acute stroke. However, stroke mimics can account for approximately one in five clinically diagnosed acute ischemic strokes and the rate of thrombolyzed mimics can be as high as 17%. Therefore, to accurately determine the diagnosis and differentiate mimics from true transient ischemic attacks, acute ischemic stroke is a challenge to every clinician. Discussion: Medical history and neurological examination, noncontract head computed tomography, and routine magnetic resonance imaging play important roles in the assessment and management of patients with transient neurological attacks in the emergency department. This review attempts to summarize how neuroimaging can be utilized to help differentiate the most common mimics from transient ischemic attack and acute ischemic stroke. Conclusion: Although imaging can help direct critical triage decisions for intravenous thrombolysis or endovascular therapy, more detailed medical history and neurological examination are crucial for making a prompt and accurate diagnosis for transient neurological attack patients. K E Y W O R D S acute ischemic stroke, computed tomography, magnetic resonance image, transient and neurological attack, transient ischemic attack 1 INTRODUCTION Transient neurological attacks (TNAs) are common causes of emergency department (ED) visits. The final diagnosis of patients with TNAs can be divided into three categories: transient ischemic attack (TIA), acute ischemic stroke (AIS), and mimics (Mimics) after obtaining medical history, neurological examination, laboratory tests, and neuroimaging. As the risk of stroke recurrence or progression is highest in the 90 days following the first episode of either TIA or AIS, these two causes are of greatest concern. However, focal ischemia is not the cause of most TNAs. According to the literature, Mimics account for This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Validation of the 6-Item Cognitive Impairment Test and the 4AT test for combined delirium and dementia screening in older Emergency Department attendees

Cited by 108 publications

References 29 publications

Lower Cognitive Function in Older Patients with Lower Muscle Strength and Muscle Mass

Lower Cognitive Function in Older Patients with Lower Muscle Strength and Muscle Mass

Screening for delirium after surgery: validation of the 4 A's test (4AT) in the post‐anaesthesia care unit

Neuroimaging for differential diagnosis of transient neurological attacks

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