INVESTIGATING COGNITIVE IMPAIRMENT IN THE EMERGENCY DEPARTMENT: THE ROLE OF THE INFORMANT HISTORY

Abstract Ref: 
0012

Adam Dyer, Shamis Nabeel, Robert Briggs, Desmond O’Neill, Sean Kennelly
Centre for Ageing, Neuroscience and the Humanities, Tallaght Hospital, Dublin, Ireland

Background: The informant history is a crucial investigation in clarifying the nature,
extent and appropriate follow-up of cognitive impairment in older adults presenting to
the Emergency Department (ED). However, very little research has been published on its
use to date (1).
Methods: A convenience sample of older adults (aged >70 years) underwent detailed
cognitive assessment in the ED of a tertiary referral hospital. Cognitive assessment consisted
of tools for delirium (CAM-ICU) and a general cognitive screener (sMMSE). In
individuals where either of these were positive, an informant history was sought and the
AD8 informant interview for dementia administered.
Results: Two hundred and twenty patients were included (mean age: 78.8 ± 6.16). Of those
screened positive on the CAM-ICU (11.8%, 26/220) or sMMSE (41.8%; 81/194), informant
histories were available in just under two-thirds (61.1%). In 39% (26/66), informant histories
were consistent with previously undiagnosed dementia. The majority of informants
were immediate relatives (62/66; 94%) with a mean interview duration of 6.1 minutes. The
vast majority were rated very high in “informant confidence” (96.9%, 64/66) and “contribution
to patients’ care” (93/9%, 62/66). Following a review of the attending physicians’ notes,
a reference to an informant history was only documented in 5.6% of cases.
Conclusions: The informant history is a crucial investigation in the complete cognitive
assessment of older adults. The informant history provides a ready source of reliable
information to the assessing physician warranting further emphasis on both undergraduate
and postgraduate medical curricula.
Reference:
1. Briggs R, O’Neill D. The informant history: a neglected aspect of clinical education
and practice. QJM; pii: hcv145 [Epub ahead of print].