Comparison of standardized mini mental test and brife mental state examination in evaluation of mental status in elderely patients referred to emergency department

Elderly patients constitute a discrete population in the emergency department (ED). Assessment of mental status is of utmost importance in these patients. Standardized tests applied briefly and easily are beneficial in order to identify and treat cognitive disorders of elderly. This study aims to devise a test with these features. This prospective study enrolled 300 consecutive ED patients over 65 years of age between August 1st and November 30th, 2000. All patients were given a rough assessment of mental status and underwent BMSE and SMMT. Test scores were compared with the pre-test clinical judgement of the physician and correlations were calculated. After two months tests were repeated for 1 10 of the patients and the relation of the difference values with prognosis were evaluated. BMSE (p<0.001)and SMMT (p<0.001) scores were found significantly related to age. Test scores declined as age rose. Men's scores were higher than women's (SMMT p<0.001, BMSE p=0.003) and married patients scored higher than widows (SMMT p=0.001, BMSE p=0.001). Retired patients obtained higher scores than the others (SMMT p<0.001, BMSE p=0.003). Level of education was found relevant as primary school graduates had the lowest scores (SMMT p<0.001, BMSE p=0.001). Patients with normal neurologic examination had higher scores than those with abnormal findings (SMMT p<0.001, BMSE p<0.001). In this study the physicians' clinical judgement of mental status of elderly patients had a low correlation with test scores. Absence of a standard examination method and possible optimistic behaviour of the physician in determining the judgement may have caused the low correlation values. SMMT scores were moderately correlated with BMSE scores which showed the tests could be used for mental status examination in the ED (kappa 0.40, p<0.001). BMSE was found %79 sensitive and %60 specific taking SMMT as the standard method. BMSE and SMMT scores were found to have a low correlation with the judgements made by emergency physicians and were not proved to be useful in predicting short term prognosis. The tests were shown to be applied rapidly and easily in the ED population. These tests can be used as standard methods in mental status examination of elderly patients.