Screening Cognitive Performance with the Resident Assessment Instrument for Mental Health Cognitive Performance Scale

Article excerpt

Objective: The validity of the Cognitive Performance Scale (CPS) embedded in the Resident Assessment Instrument-Mental Health (RAI-MH) was evaluated among adult psychiatric inpatients.

Methods: The CPS is a brief measure of cognitive performance, with scores ranging from 0 (intact) to 6 (very severe impairment). The CPS scores were compared with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scores for 215 adult psychiatric inpatients.

Results: The CPS scores were significantly correlated with MMSE scores (r = -0.69, P < 0.001) and MoCA scores (r = -0.69, P < 0.001). Higher scores on the CPS were associated with greater functional impairment, older age, and a greater prevalence of dementia diagnoses than lower CPS scores.

Conclusions: Pilot data show the CPS is a valid screening measure of cognitive performance among adult psychiatric inpatients. Additional research is needed to replicate our study using a larger sample with more diverse mental health conditions.

Can J Psychiatry. 2010;55(11):736-740.

Clinical Implications

* The CPS is a brief measure for screening for impaired cognitive performance among adult mental health inpatients.

* The CPS can be combined with other RAI-MH information, including symptoms, functioning, behaviours, substance use, and resource use.

* The CPS is available for every adult mental health inpatient in Ontario and wherever the RAI-MH is used.

Limitations

* Our study used a retrospective convenience sample where MMSE and MoCA assessments were not available for all patients.

* The sample lacked patients with schizophrenia or other psychosis diagnoses.

* Sensitivity to change analyses could not be assessed.

Key Words. interresident assessment instrument-mental health, cognition, validation

Abbreviations used in this article

ADL-H activities of daily living hierarchy

CPS Cognitive Performance Scale

MMSE Mini-Mental State Examination

MoCA Montreal Cognitive Assessment

RAI-MH Resident Assessment Instrument-Mental Health

Cognitive impairment is a common condition associated with various mental illnesses that can challenge treatment efficacy.' Brief screening measures are needed for mental health care to identify people with cognitive deficits in need of more in-depth assessment and intervention.2

The RAI-MH includes a brief measure of cognitive performance, the CPS. The RAI-MH is part of a suite of assessment systems for use in various health sectors,3 is mandated for use in inpatient psychiatric beds in Ontario, and is used internationally. The RAI-MH includes care planning, outcome measurement, quality measurement, and resource allocation applications.

The CPS has never been evaluated among psychiatric inpatients and, given the widespread use of the RAI-MH, may be a valuable screening tool for cognitive performance. The CPS, originally developed based on the nursing home equivalent of the RAI-MH, has been found to significantly correlate with the MMSE and to strongly predict cognitive impairment among nursing home residents.4"6 Our study examines the validity of the CPS by comparing it with 2 commonly used cognitive assessments, the MMSE and the MoCA.

Methods

Sample

Data were collected from a retrospective review of 1476 charts of patients discharged between June 1, 2006, and May 3 1 , 2009, from an adult inpatient mental health and addictions hospital in Guelph, Ontario. All patients consented to the use of their health information collected over the coui'se of treatment for evaluation and research purposes. Patient data were included if a RAI-MH and MMSE and (or) MoCA were completed within 7 days of admission. Among the 1476 eligible charts reviewed, 157 patients with MMSEs and 77 with MoCAs were linked to the RAI-MH (n = 227).

About one-half of the patients were female (50. …

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