A new bedside test of cognition for patients with HIV infection

• Published in: Annals of internal medicine Vol. 119; no. 10; pp. 1001 - 1004
• Main Authors: JONES, B. N, LEE TENG, E, FOLSTEIN, M. F, HARRISON, K. S
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American College of Physicians 15-11-1993
• Subjects: Acquired Immunodeficiency Syndrome - psychology; Adult; Aged; AIDS/HIV; Biological and medical sciences; Cognition Disorders - diagnosis; Cohort Studies; Female; HIV Infections - psychology; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Linear Models; Male; Medical sciences; Middle Aged; Psychological Tests; ROC Curve; Sensitivity and Specificity; Trail Making Test; Infection; Human; Mini Mental State Examination Folstein et al; Cognitive disorder; Viral disease; Cohort study; Psychometrics; AIDS; Trail Making Test; Cognitive Assessment Test; Comparative study
• ISSN: 0003-4819; 1539-3704
• DOI: 10.7326/0003-4819-119-10-199311150-00006

To compare the Mental Alternation Test, a new 60-second bedside test of cognition, with the Mini-Mental State Exam (MMSE) and the Trailmaking Test, parts A and B, in patients with human immunodeficiency virus (HIV) infection.
Cohort study.
Sixty-two inpatients with HIV infection.
The AIDS service of a referral hospital.
Scores on the MMSE; the Trailmaking Test, parts A and B; and the Mental Alternation Test were compared using correlation calculations and analyses of variance. Receiver operating curves were constructed to identify the best cutoff score on the Mental Alternation Test for detecting impaired performance on the MMSE and the Trailmaking Test.
The Mental Alternation Test score correlated significantly with MMSE (r = 0.68, P < 0.01) and Trailmaking Test, part B, scores (r = -0.54, P < 0.01). The receiver operating curves showed that a Mental Alternation Test cutoff score of 15 yielded the best results for the detection of abnormal performance on the MMSE (sensitivity, 95% [95% CI, 90% to 100%]; specificity, 79% [CI, 69% to 89%]) and the Trailmaking Test, part B (sensitivity, 78% [CI, 68% to 88%]; specificity 93% [CI, 90% to 100%]). Patients making fewer than 15 alternations in 30 seconds were significantly more likely to have abnormal MMSE (P < 0.0001) and Trailmaking Test, part B, scores (P < 0.0001). The Mental Alternation Test had good reproducibility; analyses of reliability included test-retest correlation (r = 0.80) and inter-rater reliability (r = 0.85, kappa = 0.84). Time of administration was approximately 60 seconds.
The Mental Alternation Test of cognition has good sensitivity and specificity and is easily administered. It is a valuable test to identify patients who may need further cognitive evaluation.