Journal Article

Comparing performance on the Months of the Year Backwards test in hospitalised patients with delirium, dementia, and no cognitive impairment: an exploratory study

Weir, Christopher J., Wilson, Elizabeth, Süßenbach, Lisa-Marie, Duncan, Nikki, Quasim, Tara, Weir, Alexander J., Clarke, Caoimhe, Keerie, Catriona, Tieges, Zoë, Assi, Valentina, Evans, Jonathan, Walsh, Tim, Middleton, Duncan, Barnett, Jennifer H., Stott, David J., Hasemann, Wolfgang, Nouzova, Eva, MacLullich, Alasdair M. J.

2021

Overview

Key summary points Aim To investigate performance of the Months of the Year Backwards (MOTYB) test in older hospitalised patients with delirium, dementia, and no cognitive impairment. Findings Half of the patients with delirium (46%) could not engage with MOTYB compared to only 11% of patients with dementia without delirium. In patients able to give responses, those with delirium or dementia performed significantly worse than those without cognitive impairment. Message Our findings show the potential value of analysing response patterns, especially initial engagement, self-correction, and ability to continue to do the task in addition to considering exclusively the capacity to correctly recite the months until July, June or January. Purpose To investigate performance of the Months of the Year Backwards (MOTYB) test in older hospitalised patients with delirium, dementia, and no cognitive impairment. Methods Secondary analysis of data from a case–control study of 149 hospitalised patients aged ≥ 65 years with delirium [with or without dementia ( N  = 50)], dementia [without delirium ( N  = 46)], and no cognitive impairment ( N  = 53). Verbatim transcripts of MOTYB audio recordings were analysed to determine group differences in response patterns. Results In the total sample [median age 85y (IQR 80–88), 82% female], patients with delirium were more often unable to recite months backward to November (36/50 = 72%) than patients with dementia (21/46 = 46%; p  < 0.01) and both differed significantly from patients without cognitive impairment (2/53 = 4%; p ’s < 0.001). 121/149 (81%) of patients were able to engage with the test. Patients with delirium were more often unable to engage with MOTYB (23/50 = 46%; e.g., due to reduced arousal) than patients with dementia (5/46 = 11%; p  < 0.001); both groups differed significantly ( p ’s < 0.001) from patients without cognitive impairment (0/53 = 0%). There was no statistically significant difference between patients with delirium (2/27 = 7%) and patients with dementia (8/41 = 20%) in completing MOTYB to January, but performance in both groups differed ( p  < 0.001 and p  < 0.02, respectively) from patients without cognitive impairment (35/53 = 66%). Conclusion Delirium was associated with inability to engage with MOTYB and low rates of completion. In patients able to engage with the test, error-free completion rates were low in delirium and dementia. Recording of engagement and patterns of errors may add useful information to MOTYB scoring.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Aged / Aged, 80 and over / Arousal / Case-Control Studies / Clinical medicine / Cognitive ability / Cognitive Dysfunction - diagnosis / Cognitive Dysfunction - epidemiology / Cognitive impairment / Delirium / Delirium - diagnosis / Delirium - epidemiology / Dementia / Dementia - diagnosis / Dementia - epidemiology / Dementia - psychology / Female / Geriatrics/Gerontology / Humans / Internal Medicine / Male / Medicine / Medicine & Public Health / Memory / Patients / Research Paper