Allen, S. C., Warwick-Sanders, M. and Baxter, M., 2009. A comparison of four tests of cognition as predictors of inability to learn to use a metered dose inhaler in old age. International Journal of Clinical Practice, 63 (8), pp. 1150-1153.
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Official URL: http://dx.doi.org/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.
|Subjects:||Technology > Medicine and Health > Medicine and Surgery|
|Group:||School of Health and Social Care > Centre for Postgraduate Medical Research and Education|
|Deposited By:||Prof Stephen Allen|
|Deposited On:||28 Feb 2010 18:05|
|Last Modified:||07 Mar 2013 15:21|
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