Selecting a Bedside Cognitive Vital Sign to Monitor Cognition in Hospital: Feasibility, Reliability, and Responsiveness of Logical Memory

Nicholas, Padraic; O’Caoimh, Rónán; Gao, Yang; Habib, Afsana; Mross, Thomas Karol; Clarnette, Roger; Molloy, D. William

doi:10.3390/ijerph16193545

Open AccessArticle

Selecting a Bedside Cognitive Vital Sign to Monitor Cognition in Hospital: Feasibility, Reliability, and Responsiveness of Logical Memory

by

Padraic Nicholas

^1,†,

Rónán O’Caoimh

^1,2,3,*,†

,

Yang Gao

¹,

Afsana Habib

³,

Thomas Karol Mross

⁴,

Roger Clarnette

⁵ and

D. William Molloy

^1,3

¹

Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Douglas Road, T12 XH60 Cork, Ireland

²

Clinical Sciences Institute, National University of Ireland Galway, Costello Road, H91 TK33 Galway, Ireland

³

Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland

⁴

Geriatrisches Zentrum Bethanien, Agaplesion Bethanien Krankenhaus, Rohrbacher Str. 149, 69126 Heidelberg, Germany

⁵

School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to the work.

Int. J. Environ. Res. Public Health 2019, 16(19), 3545; https://doi.org/10.3390/ijerph16193545

Submission received: 31 July 2019 / Revised: 15 September 2019 / Accepted: 19 September 2019 / Published: 22 September 2019

(This article belongs to the Special Issue Efficient Use of Acute Hospital Services for Older People)

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Abstract

Although there is a high prevalence of delirium and cognitive impairment among hospitalised older adults, short, reliable cognitive measures are rarely used to monitor cognition and potentially alert healthcare professionals to early changes that might signal delirium. We evaluated the reliability, responsiveness, and feasibility of logical memory (LM), immediate verbal recall of a short story, compared to brief tests of attention as a bedside “cognitive vital sign” (CVS). Trained nursing staff performed twice-daily cognitive assessments on 84 clinically stable inpatients in two geriatric units over 3–5 consecutive days using LM and short tests of attention and orientation including months of the year backwards. Scores were compared to those of an expert rater. Inter-rater reliability was excellent with correlation coefficients for LM increasing from r = 0.87 on day 1 to r = 0.97 by day 4 (p < 0.0001). A diurnal fluctuation of two points from a total of 30 was deemed acceptable in clinically stable patients. LM scores were statistically similar (p = 0.98) with repeated testing (suggesting no learning effect). All nurses reported that LM was feasible to score routinely. LM is a reliable measure of cognition showing diurnal variation but minimal learning effects. Further study is required to define the properties of an ideal CVS test, though LM may satisfy these.

Keywords: attention; cognitive screening; cognitive vital sign; logical memory; older adults; delirium; dementia; hospital

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MDPI and ACS Style

Nicholas, P.; O’Caoimh, R.; Gao, Y.; Habib, A.; Mross, T.K.; Clarnette, R.; Molloy, D.W. Selecting a Bedside Cognitive Vital Sign to Monitor Cognition in Hospital: Feasibility, Reliability, and Responsiveness of Logical Memory. Int. J. Environ. Res. Public Health 2019, 16, 3545. https://doi.org/10.3390/ijerph16193545

AMA Style

Nicholas P, O’Caoimh R, Gao Y, Habib A, Mross TK, Clarnette R, Molloy DW. Selecting a Bedside Cognitive Vital Sign to Monitor Cognition in Hospital: Feasibility, Reliability, and Responsiveness of Logical Memory. International Journal of Environmental Research and Public Health. 2019; 16(19):3545. https://doi.org/10.3390/ijerph16193545

Chicago/Turabian Style

Nicholas, Padraic, Rónán O’Caoimh, Yang Gao, Afsana Habib, Thomas Karol Mross, Roger Clarnette, and D. William Molloy. 2019. "Selecting a Bedside Cognitive Vital Sign to Monitor Cognition in Hospital: Feasibility, Reliability, and Responsiveness of Logical Memory" International Journal of Environmental Research and Public Health 16, no. 19: 3545. https://doi.org/10.3390/ijerph16193545

APA Style

Nicholas, P., O’Caoimh, R., Gao, Y., Habib, A., Mross, T. K., Clarnette, R., & Molloy, D. W. (2019). Selecting a Bedside Cognitive Vital Sign to Monitor Cognition in Hospital: Feasibility, Reliability, and Responsiveness of Logical Memory. International Journal of Environmental Research and Public Health, 16(19), 3545. https://doi.org/10.3390/ijerph16193545

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Selecting a Bedside Cognitive Vital Sign to Monitor Cognition in Hospital: Feasibility, Reliability, and Responsiveness of Logical Memory

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