CLINICAL PRACTICE AND HEALTH
Reliability of three questions for the screening of advanced
cognitive impairment in polypathological patients
Internal Medicine Department, Hospital Royo Villanova, Zaragoza,
Research Group on Comorbidity and Polypathology in Aragón,
Aragón Health Sciences Institute,
Department of Medicine, Dermatology and Psychiatry, University of Zaragoza School of Medicine,
Internal Medicine Department, Hospital Miguel Servet, Zaragoza,
Internal Medicine Department, Hospital Obispo Polanco, Teruel,
Internal Medicine Department, Hospital de Alcañiz, Alcañiz,
Internal Medicine Department and
Geriatrics Department, Hospital de
Barbastro, Huesca, Spain
Aim: To determine whether answering three questions erroneously (“what is the date today?,”“when were you
born?” and “how old are you?”) allows for the detection of advanced cognitive impairment in polypathological patients.
Methods: A cross-sectional study of patients admitted to the internal medicine and geriatrics departments was
carried out. Advanced cognitive impairment was diagnosed when patients made 7–10 errors in the Short Portable
Mental Status Questionnaire.
Results: We included 441 polypathological patients, 330 of them from the internal medicine departments and
111 from the geriatrics department. Their mean age was 80.8 years (8.9 years). Of them, 141 (32.0%) answered one
question incorrectly, 58 (13.1%) answered two and 89 (20.2%) answered all three questions incorrectly. The preva-
lence of advanced cognitive impairment was 27.7%. The sensitivity, speciﬁcity, and positive and negative predictive
values of the test were 0.705, 0.991, 0.966 and 0.898, respectively. The accuracy of the test was 0.912. The area
under the receiver operating characteristic curve was 0.947, 95% CI 0.923–0.970.
Conclusions: The three questions test has very good speciﬁcity and positive predictive value, and it can be used for
the screening of advanced cognitive impairment in polypathological patients. Geriatr Gerontol Int 2018; 18:
Keywords: dementia, polypathological patient, screening, sensitivity, speciﬁcity.
With an aging population and advances in healthcare, it
is becoming more and more frequent for one patient to
have more than one chronic disease. Multimorbidity is
the coexistence of several acute or chronic diseases in
the same person.
Polypathology has been deﬁned as the
coexistence of two or more chronic and symptomatic
diseases, often related, with frequent re-exacerbations
that have a negative effect on the functional situation
of the patient and generate special requirements at the
various levels of healthcare. In 2007, the Andalusian
Government established a set of criteria to deﬁne a
patient as polypathological.
The estimations are that
30–38% of the patients admitted in internal medicine
departments are polypathological,
and that the preva-
lence in primary healthcare centers is 1.38%.
Polypathological patients (PP) are usually very old.
Their average age in different studies ranges between
77 and 81 years.
Cognitive impairment is highly prevalent in PP. Up
to 39–50% of them present with cognitive impairment,
and 26–36% have been diagnosed with dementia.
Furthermore, these patients frequently present dyspnea,
and fatigability both physical and mental, and are
unable to stay focused during interviews, so that the
usual instruments of dementia detection cannot be
used. During hospital admission, several factors, among
them the presence of other incapacitating diseases,
often hinder suitable assessment of their cognitive state.
Accepted for publication 15 September 2017.
Correspondence: Professor Jesús Díez-Manglano PhD, Duquesa
Villahermosa 163, 8
D, 50009 Zaragoza, Spain.
doi: 10.1111/ggi.13204 |© 2017 Japan Geriatrics Society
Geriatr Gerontol Int 2018; 18: 441–447