A comparison of four tests of cognition as predictors of inability to learn to use a metered dose inhaler in old age

This source preferred by Stephen Allen

Authors: Allen, S.C., Warwick-Sanders, M. and Baxter, M.

http://dx.doi.org/10.1111/j.1742-1241.2009.02060.x

Journal: International Journal of Clinical Practice

Volume: 63

Pages: 1150-1153

ISSN: 1368-5031

DOI: 10.1111/j.1742-1241.2009.02060.x

Background: Previous studies have shown that a Mini Mental State Examination (MMSE) score of < 24/30 and inability to copy intersecting pentagons (IP) predict inability to learn to use inhaler devices. We hypothesised that clock drawing tests (CLOX 1 and 2), being validated tests of cognitive executive function, might predict competent inhaler acquisition with a higher sensitivity and specificity than the MMSE or IP.

Methods: We studied 80 (63 women) inhaler-naïve inpatients, mean age 83 years (range 75–97 years). All performed the MMSE, IP, CLOX 1 and 2, before receiving standardised demonstration, instruction and assessment in the use of a metered dose inhaler (MDI).

Results: A total of 28/80 (35%) patients were able to acquire a satisfactory MDI technique. Using normative thresholds for impairment, the sensitivity and specificity (% with 95% confidence intervals) of the cognitive scores in predicting inability were: MMSE < 24 sensitivity 57 (42–71), specificity 76 (57–88), p = 0.04; IP sensitivity 75 (60–85), specificity 79 (59–91), p = 0.0000; CLOX1 < 10 sensitivity 83 (69–91), specificity 57 (37–75), p = 0.0004; CLOX2 < 12 sensitivity 58 (43–71), specificity 64 (44–81), p = 0.05.

Conclusion: CLOX tests did not perform better than MMSE and IP, to identify patients who are unlikely to be able to acquire MDI technique from a single episode of training. In clinical practice, most patients with an MMSE < 24 or negative IP will not be able to learn MDI technique. In this study, IP had the best overall predictive value.

This data was imported from PubMed:

Authors: Allen, S.C., Warwick-Sanders, M. and Baxter, M.

Journal: Int J Clin Pract

Volume: 63

Issue: 8

Pages: 1150-1153

eISSN: 1742-1241

DOI: 10.1111/j.1742-1241.2009.02060.x

BACKGROUND: Previous studies have shown that a Mini Mental State Examination (MMSE) score of < 24/30 and inability to copy intersecting pentagons (IP) predict inability to learn to use inhaler devices. We hypothesised that clock drawing tests (CLOX 1 and 2), being validated tests of cognitive executive function, might predict competent inhaler acquisition with a higher sensitivity and specificity than the MMSE or IP. METHODS: We studied 80 (63 women) inhaler-naïve inpatients, mean age 83 years (range 75-97 years). All performed the MMSE, IP, CLOX 1 and 2, before receiving standardised demonstration, instruction and assessment in the use of a metered dose inhaler (MDI). RESULTS: A total of 28/80 (35%) patients were able to acquire a satisfactory MDI technique. Using normative thresholds for impairment, the sensitivity and specificity (% with 95% confidence intervals) of the cognitive scores in predicting inability were: MMSE < 24 sensitivity 57 (42-71), specificity 76 (57-88), p = 0.04; IP sensitivity 75 (60-85), specificity 79 (59-91), p = 0.0000; CLOX1 < 10 sensitivity 83 (69-91), specificity 57 (37-75), p = 0.0004; CLOX2 < 12 sensitivity 58 (43-71), specificity 64 (44-81), p = 0.05. CONCLUSION: CLOX tests did not perform better than MMSE and IP, to identify patients who are unlikely to be able to acquire MDI technique from a single episode of training. In clinical practice, most patients with an MMSE < 24 or negative IP will not be able to learn MDI technique. In this study, IP had the best overall predictive value.

This data was imported from Scopus:

Authors: Allen, S.C., Warwick-Sanders, M. and Baxter, M.

Journal: International Journal of Clinical Practice

Volume: 63

Issue: 8

Pages: 1150-1153

eISSN: 1742-1241

ISSN: 1368-5031

DOI: 10.1111/j.1742-1241.2009.02060.x

Background: Previous studies have shown that a Mini Mental State Examination (MMSE) score of < 24/30 and inability to copy intersecting pentagons (IP) predict inability to learn to use inhaler devices. We hypothesised that clock drawing tests (CLOX 1 and 2), being validated tests of cognitive executive function, might predict competent inhaler acquisition with a higher sensitivity and specificity than the MMSE or IP. Methods: We studied 80 (63 women) inhaler-naïve inpatients, mean age 83 years (range 75-97 years). All performed the MMSE, IP, CLOX 1 and 2, before receiving standardised demonstration, instruction and assessment in the use of a metered dose inhaler (MDI). Results: A total of 28/80 (35%) patients were able to acquire a satisfactory MDI technique. Using normative thresholds for impairment, the sensitivity and specificity (% with 95% confidence intervals) of the cognitive scores in predicting inability were: MMSE < 24 sensitivity 57 (42-71), specificity 76 (57-88), p = 0.04; IP sensitivity 75 (60-85), specificity 79 (59-91), p = 0.0000; CLOX1 < 10 sensitivity 83 (69-91), specificity 57 (37-75), p = 0.0004; CLOX2 < 12 sensitivity 58 (43-71), specificity 64 (44-81), p = 0.05. Conclusion: CLOX tests did not perform better than MMSE and IP, to identify patients who are unlikely to be able to acquire MDI technique from a single episode of training. In clinical practice, most patients with an MMSE < 24 or negative IP will not be able to learn MDI technique. In this study, IP had the best overall predictive value. © 2009 Blackwell Publishing Ltd.

This data was imported from Web of Science (Lite):

Authors: Allen, S.C., Warwick-Sanders, M. and Baxter, M.

Journal: INTERNATIONAL JOURNAL OF CLINICAL PRACTICE

Volume: 63

Issue: 8

Pages: 1150-1153

eISSN: 1742-1241

ISSN: 1368-5031

DOI: 10.1111/j.1742-1241.2009.02060.x

This data was imported from Europe PubMed Central:

Authors: Allen, S.C., Warwick-Sanders, M. and Baxter, M.

Journal: International journal of clinical practice

Volume: 63

Issue: 8

Pages: 1150-1153

eISSN: 1742-1241

ISSN: 1368-5031

BACKGROUND: Previous studies have shown that a Mini Mental State Examination (MMSE) score of < 24/30 and inability to copy intersecting pentagons (IP) predict inability to learn to use inhaler devices. We hypothesised that clock drawing tests (CLOX 1 and 2), being validated tests of cognitive executive function, might predict competent inhaler acquisition with a higher sensitivity and specificity than the MMSE or IP. METHODS: We studied 80 (63 women) inhaler-naïve inpatients, mean age 83 years (range 75-97 years). All performed the MMSE, IP, CLOX 1 and 2, before receiving standardised demonstration, instruction and assessment in the use of a metered dose inhaler (MDI). RESULTS: A total of 28/80 (35%) patients were able to acquire a satisfactory MDI technique. Using normative thresholds for impairment, the sensitivity and specificity (% with 95% confidence intervals) of the cognitive scores in predicting inability were: MMSE < 24 sensitivity 57 (42-71), specificity 76 (57-88), p = 0.04; IP sensitivity 75 (60-85), specificity 79 (59-91), p = 0.0000; CLOX1 < 10 sensitivity 83 (69-91), specificity 57 (37-75), p = 0.0004; CLOX2 < 12 sensitivity 58 (43-71), specificity 64 (44-81), p = 0.05. CONCLUSION: CLOX tests did not perform better than MMSE and IP, to identify patients who are unlikely to be able to acquire MDI technique from a single episode of training. In clinical practice, most patients with an MMSE < 24 or negative IP will not be able to learn MDI technique. In this study, IP had the best overall predictive value.

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