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Unrecognised cognitive impairment in hospice patients: a pilot study

The Institute for Palliative Medicine at San Diego Hospice, San Diego, California

CH Zurhellen

Department of Psychiatry, University of California, San Diego, La Jolla, California

LC Diamond

Department of Psychiatry, University of California, San Diego, La Jolla, California

LB Dunn

Department of Psychiatry and Helen Diller Family Comprehensive Cancer Center. University of California, San Francisco, California

BW Palmer

Department of Psychiatry, University of California, San Diego, La Jolla, California

DV Jeste

Department of Psychiatry, University of California, San Diego, La Jolla, California; Psychiatry Service, VA San Diego Healthcare System, San Diego, California

EW Twamley

Department of Psychiatry, University of California, San Diego, La Jolla, California; Psychology Service, VA San Diego Healthcare System, San Diego, California etwamley{at}ucsd.edu

The presence of cognitive impairment in patients who are receiving hospice care can affect numerous practical, ethical and legal aspects of their healthcare. A number of factors can contribute to cognitive impairment in these patients. Prevalence rates of cognitive impairment vary widely, but it remains under-recognised and under-treated. The aims of this pilot study were to evaluate the presence and nature of cognitive deficits in patients receiving inpatient hospice care who did not have a known current or past diagnosis of a cognitive disorder or any obvious cognitive impairments. A convenience sample of 30 patients receiving inpatient hospice care underwent bedside cognitive testing. A comprehensive battery of tests was used, including the Mini-Mental State Examination (MMSE) and standardised neuropsychological tests of pre-morbid intellectual functioning, immediate and delayed recall, digit span forward and backward, verbal reasoning and letter and category fluency. On average, subjects were impaired on the MMSE and on tests of learning, verbal reasoning and letter and category fluency. Furthermore, 12 of the 30 subjects met DSM-IV cognitive impairment criteria for dementia based on impaired performance in memory and at least one other cognitive domain on testing. The results of this pilot study suggest that a sizable proportion of patients receiving inpatient hospice care have undetected but clinically significant cognitive impairments. Assessing for and helping patients, families and caregivers deal with cognitive impairment might benefit patients' quality of life, relationships and overall care at the end of life. Future research in this population is needed to evaluate the causes and time course of cognitive impairment over time, as well as any relationship between cognitive impairment and decision-making capacity.

Key Words: cognitive impairment • delirium • dementia • hospice • neuropsychology • palliative care

This version was published on October 1, 2008

Palliative Medicine, Vol. 22, No. 7, 842-847 (2008)
DOI: 10.1177/0269216308096907


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