Journal CME, September 2023: Comparison of the Brief Interview for Mental Status (BIMS) and Montreal Cognitive Assessment (MoCA) for identifying cognitive impairments and predicting rehabilitation outcomes in an inpatient rehabilitation facility-Journal CME, September 2023: Comparison of the Brief Interview for Mental Status (BIMS) and Montreal Cognitive Assessment (MoCA) for identifying cognitive impairments and predicting rehabilitation outcomes in an inpatient rehabilitation facility

Journal CME, September 2023: Comparison of the Brief Interview for Mental Status (BIMS) and Montreal Cognitive Assessment (MoCA) for identifying cognitive impairments and predicting rehabilitation outcomes in an inpatient rehabilitation facility

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The study by Erin Y. Harmon and Robert W. Gillen compares the Brief Interview for Mental Status (BIMS) and the Montreal Cognitive Assessment (MoCA) in identifying cognitive impairments and predicting rehabilitation outcomes within an inpatient rehabilitation facility. The primary aim was to evaluate the sensitivity and specificity of BIMS relative to MoCA and explore their relationships with various rehabilitation outcomes, such as functional independence at discharge, rehabilitation efficiency, length of stay (LOS), and discharge destination.<br /><br />The retrospective cohort study analyzed data from 2252 patients admitted for orthopedic or general rehabilitation. The study found that the BIMS demonstrated low sensitivity in detecting mild (0.257) and moderate (0.384) cognitive impairments when compared to the MoCA. Conversely, the MoCA identified mild or moderate cognitive impairments in a more significant portion of patients.<br /><br />Key findings include:<br />- The BIMS missed cognitive impairments in 74.3% and 61.1% of patients with mild and moderate cognitive impairments respectively, as identified by the MoCA.<br />- Patients classified with moderate cognitive impairment by the MoCA had notably lower GG scores at discharge and lower rehabilitation efficiency than those flagged by the BIMS.<br />- The MoCA was better at predicting longer LOS and discharge destinations than the BIMS.<br /><br />The study concludes that while the BIMS is quick and has high specifics for severe cognitive impairments, it lacks the sensitivity needed for detecting mild and moderate impairments, which are common in the rehab setting. The MoCA, being more comprehensive and considering multiple cognitive domains, served as a better predictor of rehabilitation outcomes and could thus benefit treatment planning and post-discharge strategies. <br /><br />The limitations noted include the retrospective nature of the study, which may contain measurement biases, and the exclusion of patients with certain neurological impairments, which can limit the generalizability of the findings. The use of the MoCA as the criterion standard, despite being a screening tool itself, and potential variations in MoCA cutoff scores were also mentioned as constraints of the study.

Keywords

BIMS

MoCA

cognitive impairments

rehabilitation outcomes

sensitivity

specificity

functional independence

length of stay

discharge destination

retrospective cohort study