 |
 |
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
19 June 2001 | Volume 134 Issue 12 | Pages 1120-1123
Background: Earlier anecdotal observations suggested to us that certain aspects of judgment in sick adults approximate the thinking of children.
Objective: To describe changes in judgment associated with serious illness in otherwise competent adults.
Design: Cohort study.
Setting: Urban acute-care hospital and senior citizen center.
Participants: Sicker (Karnofsky score
Measurements: Seven Piagetian tasks of judgment designed to study childhood cognitive development. Degree of sickness was determined by using the Karnofsky scale of physical function.
Results: Patients with Karnofsky scores of 50 or less responded correctly to fewer Piagetian tasks than controls (mean [±SD], 1.8 ± 2.6 vs. 5.9 ± 1.6; P < 0.001). Furthermore, a smaller proportion of sicker patients responded correctly to each of the seven tasks. Patients with Karnofsky scores greater than 50 did not perform differently than controls.
Conclusion: In sicker hospitalized patients, performance on seven Piagetian tasks of judgment was similar to that among children younger than 10 years of age. This evidence of cognitive impairment warrants further investigation.
Author and Article Information
From the Joan and Sanford I. Weill College of Medicine of Cornell University, New York, New York; and Lynbrook Public School System, Lynbrook, New York.
Grant Support: By a grant from the New York Bar Foundation.
Acknowledgments: The authors thank Drs. Joseph A. Glick and Martha J. Hadley for sharing their knowledge of the measurement of judgment and the meaning of Piaget's tests.
Requests for Single Reprints: Eric J. Cassell, MD, 28 Old Fulton Street, Brooklyn, NY 11201; e-mail, ecassell{at}email.msn.com.
Current Author Addresses: Dr. Cassell: 28 Old Fulton Street, Brooklyn, NY 11201.
Dr. Leon: Department of Psychiatry, Joan and Sanford I. Weill College of Medicine of Cornell University, 1300 York Avenue, New York, NY 10021.
Dr. Kaufman: Lynbrook Public School System, 111 Atlantic Avenue, Lynbrook, NY 11563.
Author Contributions: Conception and design: E.J. Cassell, A.C. Leon, S.G. Kaufman.
Analysis and interpretation of the data: E.J. Cassell, A.C. Leon.
Drafting of the article: E.J. Cassell, A.C. Leon, S.G. Kaufman.
Critical revision of the article for important intellectual content: E.J. Cassell, A.C. Leon.
Final approval of the article: E.J. Cassell, A.C. Leon.
Provision of study materials or patients: S.G. Kaufman.
Statistical expertise: A.C. Leon.
Obtaining of funding: E.J. Cassell.
Administrative, technical, or logistic support: E.J. Cassell, S.G. Kaufman.
Collection and assembly of data: E.J. Cassell, S.G. Kaufman. BRIEF COMMUNICATION
Preliminary Evidence of Impaired Thinking in Sick Patients
50; n = 24) and less sick (Karnofsky score > 50; n = 39) hospitalized patients were compared with controls (n = 28). Normal performance on the Mini-Mental State Examination (score 
24) was required for study entrance.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  P. B. Rahmner, L. L Gustafsson, J. Larsson, U. Rosenqvist, G. Tomson, and I. Holmstrom Variations in understanding the drug-prescribing process: a qualitative study among Swedish GPs Fam. Pract., December 22, 2008; (2008) cmn103v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. L. Field A Patient With Acute Traumatic Quadriplegia Who Requested a DNR Order Psychosomatics, May 1, 2008; 49(3): 252 - 254. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Workman A communication model for encouraging optimal care at the end of life for hospitalized patients QJM, December 1, 2007; 100(12): 791 - 797. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Workman Researching a good death BMJ, March 10, 2007; 334(7592): 485 - 486. [Full Text] [PDF]
|
|
|
|
|
|
S. Workman Cardiopulmonary resuscitation: charting a course for the future QJM, October 1, 2006; 99(10): 711 - 715. [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Bernat and L. M. Peterson Patient-Centered Informed Consent in Surgical Practice Arch Surg, January 1, 2006; 141(1): 86 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Tonelli Waking the Dying: Must We Always Attempt To Involve Critically Ill Patients in End-of-Life Decisions? Chest, February 1, 2005; 127(2): 637 - 642. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Cassell Consent or Obedience? Power and Authority in Medicine N. Engl. J. Med., January 27, 2005; 352(4): 328 - 330. [Full Text] [PDF]
|
|
|
|
 |
|
 M L Gross Treating competent patients by force: the limits and lessons of Israel's Patient's Rights Act J. Med. Ethics, January 1, 2005; 31(1): 29 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Bedell, T. B. Graboys, E. Bedell, and B. Lown Words That Harm, Words That Heal Arch Intern Med, July 12, 2004; 164(13): 1365 - 1368. [Full Text] [PDF]
|
|
|
|
 |
|
 M. B. Happ, P. Tuite, K. Dobbin, D. DiVirgilio-Thomas, and J. Kitutu COMMUNICATION ABILITY, METHOD, AND CONTENT AMONG NONSPEAKING NONSURVIVING PATIENTS TREATED WITH MECHANICAL VENTILATION IN THE INTENSIVE CARE UNIT Am. J. Crit. Care., May 1, 2004; 13(3): 210 - 218. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Meier and R. S. Morrison Autonomy Reconsidered N. Engl. J. Med., April 4, 2002; 346(14): 1087 - 1089. [Full Text] [PDF]
|
|
Article
