(P31) Comparing SPMSQ and BIMS as Cognitive Screeners in Nursing Homes

Introduction/Objective: Cognitive impairment (CI) is wide-spread in the geriatric population. Traditionally, the Brief Interview for Mental Status (BIMS) has been used as part of the Minimum Data Set 3.0 to screen nursing home residents for CI. The Center for Medicare and Medicaid Services (CMS) mandated the BIMS to be used across all post-acute care settings starting in October 2010. The BIMS has been shown to be less sensitive at detecting mild and moderate cognitive impairment compared to other cognitive assessment tools including the Montreal Cognitive Assessment (MoCA) and the Saint Louis University Mental Status Examination (SLUMS). The Short Portable Mental Status Questionnaire (SPMSQ) is an alternative screening tool that is brief in administration. The purpose of this study was to compare accuracy and appropriateness of BIMS with SPMSQ as cognitive screening tools in nursing home residents, using the MoCA and SLUMS as the gold standard.

Design/Methodology : We compiled cognitive assessment results from BIMS, SPMSQ, SLUMS, and MoCA from EMRs across two nursing home settings and performed several cognitive assessments in person during routine patient visits. Inclusion criteria for the sample was being a nursing home resident under current or prior care of the attending psychiatrist and having documentation of both SPMSQ and BIMS scores as well as either MoCA or SLUMS scores. The MoCA and SLUMS were the gold standard for this comparison. Data analysis included comparing BIMS and SPMSQ scores with either MoCA or SLUMS scores for each patient, whichever test was documented in the chart. Given that each cognitive assessment tool has their own individual categories and score ranges, and BIMS does not have a “mild cognitive impairment” category, we chose to compare accuracy for detecting any level of cognitive impairment as well as for classifying severe cognitive impairment.

Results: We screened 105 patients who had been under the care of the attending psychiatrist at two nursing homes. Of the 105, a total of 74 patients met criteria of having documented scores for both SPMSQ and BIMS and either MoCA or SLUMS. Our data analysis demonstrated that BIMS was inaccurate in assessing CI vs normal 47.3% of the time when using MoCA or SLUMS as the gold standard, whereas SPMSQ was inaccurate 44.6% of the time. We also found that when comparing to MoCA/SLUMS as the gold standard, BIMS was inaccurate in assessing mild CI100% of the time while SPMSQ was inaccurate 53.6% of the time.

Conclusion/Discussion : There were no significant differences in BIMS as a tool for assessing CI in comparison to SPMSQ. However, when comparing severity of CI, BIMS was less sensitive in detecting patients with mild CI. Given the results of this study, we suggest CMS consider reconfiguring BIMS to include a mild CI category or that SPMSQ be considered as a replacement to BIMS due to its utility in classifying patients with mild CI. This study is generalizable to nursing home residents being screened for CI.