Kokmen E, Naessens JM, Offord KP. A short test of mental status (encompassing about 5 minutes) was administered to 93 consecutive neurologic outpatients. The Short Test of Mental Status (STMS) was specifically developed for use in 4 behavioral neurologists (Emre Kokmen, MD [deceased], B.F.B., D.S.K., and. The Short Test of Mental Status can be administered to patients in inpatient and outpatient settings in approximately 5 Kokmen E, Naessens JM, Offord KP.
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Copyright American Medical Association. The Short Test of Mental Status STMS was specifically developed for use in dementia assessment and was intended to be more sensitive to problems of learning and mental agility that may be seen in mild cognitive impairment MCI.
It covers a broad range of cognitive functions and uses a 4-word learning list with a delayed recall of approximately 3 minutes. The patients were derived from 2 sources: Volunteers with and without cognitive complaints or disorders were recruited.
Each patient was evaluated by either a behavioral neurologist or a behavioral neurology fellow, who obtained a medical history from the patient and corroborating sources and performed a complete neurological examination including the STMS.
If cognitively impaired, the patient had a laboratory assessment and structural neuroimaging of the brain using either computed tomography or magnetic resonance imaging. Each patient underwent a 4-hour neuropsychological test, which included the MMSE iokmen and a battery of standard neuropsychological tests. A consensus meeting was held weekly to review each patient’s examination results. The team consisted of nurses, a menttal E. Subjects were given a consensus evaluation based on all of the current information listed earlier and were evaluated as having normal cognition, MCI, or dementia according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition.
The diagnosis of MCI was made if the patient met the following criteria: Because the comparison of the MMSE and STMS was not prospectively conceived, the original study design did not maintain strict independence between test scores and clinical diagnoses.
The neurologists’ diagnoses used the STMS and the patient’s medical history and functional assessment, and the neuropsychologists used the MMSE scores and the full psychometric battery.
We grouped subjects according to their status at follow-up. Subjects were considered to have stable normal cognition if they remained cognitively healthy during the course of follow-up and for a minimum of 2 subsequent annual evaluations. By this strategy, the diagnostic groupings were based on future status; although we used the same instruments and procedures as at baseline, subjects were grouped according to clinical course.
As an additional approach to avoid circularity, we performed analyses in which we grouped subjects according to their CDR score. Because the CDR included information obtained from the patient’s medical history, the global CDR score assigned to each patient contained additional information not derived from the mental status assessments.
We used t tests for bivariate comparisons. Areas tesst the receiver operating characteristic curves were compared using a modified Mann-Whitney U test statistic. The demographic features of the subjects grouped by categories are presented in Table 2.
There were more women than men in all groups. Subjects with stable normal cognition were slightly younger than the other subjects. The area under the receiver operating characteristic curve was modestly but significantly better for the STMS compared with the MMSE for discriminating between diagnostic groups stable normal cognition vs tets MCI. For discriminating between prevalent MCI and AD, there was no difference in the performance of the 2 tests.
The STMS exhibited a similar pattern of trade-offs between sensitivity and specificity across a larger range of scores. The differences between the 2 tests were modest, and the most conservative comparison of the STMS and menatl MMSE would be to say that they were very similar overall in their diagnostic accuracy. The additional cognitive test items offered by the STMS revealed impairments in subjects with MCI compared with those who had normal cognition and also showed lower performance in subjects with normal cognition who subsequently developed MCI or AD.
A potential ehort of the analyses was the bias introduced by the availability of the STMS to the neurologists and the MMSE to the neuropsychologists at the time that the baseline diagnoses were formulated. We attempted to minimize these potential biases by using 2 different analytic strategies, both of which showed that the STMS was modestly superior to the MMSE.
Another limitation in this data set was that our subjects were relatively well educated. Our results may not generalize to elderly individuals with low educational attainment. The introduction of calculations, verbal similarities, and fund of information in the STMS was intentional, because it was developed for use with a population with a high school education.
The MMSE has been the mainstay of bedside cognitive testing.
A short test of mental status: description and preliminary results.
Bedside mental status assessment is only 1 aspect in the evaluation of cognitive impairment. Clinical judgment and neuropsychological testing are integral in diagnosing MCI. Corresponding author and reprints: We acknowledge the contributions of Kris Johnson, RN, and the nurses, neuropsychometrists, and allied health staff at the Mayo Alzheimer’s Disease Research Center and Healthy Aging Project, Rochester, for input and efforts obtaining information used in this article.
Carpenter, BS, for assistance with this project.
A short test of mental status: Description and preliminary results — Mayo Clinic
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