Date of Award

9-1996

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Abstract

The Composite Exam of Mental Status (CEMS) is an instrument designed to screen patients for dementia and other cognitive impairments. This test is comprised of 12 subsections each requiring different cognitive abilities to complete. Areas assessed are Attention/Concentration, Orientation, Immediate Recall, Spontaneous Recall, Cued Recall, Naming, Verbal Fluency, Writing, Planning, Mental Flexibility, Construction and Abstract Reasoning.

The purpose of this study was to conduct concurrent validity analyses and initial norm development of the CEMS. The archival data for this study had been collected at 2 nursing homes in the upper midwest over a one year period. There were 168 (males = 43, females = 125) primarily geriatric participants with a mean age of 80.4 years. The overwhelming majority (93%) were Caucasians. For the purposes of this study the participants were assigned to four groups based on diagnosis: No Impairment, Dementia, Depression, and Cerebral Vascular Accident (CVA). The subjects were placed in one of these groups based on diagnosis assigned by their physicians and included in their medical chart.

Analyses included one-way Analysis of Variance (ANOVA) comparisons of subscale means across diagnostic groups, and Receiver Operator Characteristic (ROC) curve analysis of cutoff points on CEMS Total Score.

Results of the ANOVAs showed that GEMS was able to. differentiate the Dementia group from No Impairment, Depression and CVA groups. The results did not clearly differentiate the Depression group or the CVA group. This result is attributed to a lack of specific diagnoses in this sample.

AOC analysis showed the GEMS to have a high Sensitivity (96%), or true positive rate but a low Specificity (32%), or false positive rate, when used at the most accurate cutoff point of 31. This test may be better used by evaluating the pattern of subscale scores. It is believed that GEMS might differentiate diffuse from focal brain lesi9ns and cortical from subcortical impairments, however this was not confirmed in the present study due to limitations with the research sample. More study is needed to confirm the value of the GEMS as a mental status screening instrument.

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