Bedside cognitive examination

Delirium and dementia are often overlooked among the elderly ill. Their recognition depends in part on the bedside cognitive or “sensorial” examination. Individual components of the examination, such as orientation testing, serial sevens, and three-object recall, are not sufficiently sensitive or specific to serve as adequate screening tests. However, a number of brief instruments, described here, which standardize the administration of several traditional bedside tests, show promise when used in combination form. This article also describes a procedure for analyzing selected responses to provide a combination instrument with still better diagnostic accuracy.