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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Impaired Thinking in Sick Patients
19 June 2001 | Volume 134 Issue 12 | Page S16
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Preliminary Evidence of Impaired Thinking in Sick Patients." It is in the 19 June 2001 issue of Annals of Internal Medicine (volume 134, pages 1120-1123). The authors are EJ Cassell, AC Leon, and SG Kaufman.
What is the problem and what is known about it so far?
Sick people may have difficulty thinking clearly, which is worrisome because they often need to make complicated medical decisions. Surprisingly, the ability of sick people to think has not been carefully studied. Doctors sometimes use a test called the Mini-Mental Status Examination (MMSE) to judge patients' thinking. The MMSE involves simple tests of orientation (for example, name the year), memory (for example, remember three objects), attention (for example, spell "world" backwards), and language (for example, name familiar objects or read and write a sentence). Jean Piaget, a psychologist, developed a set of tasks that test the thinking of young children. An example of Piaget's tasks is the "conservation of volume" task. In this task, the tester shows the person being tested two identical, short wide glasses containing equal amounts of water. The tester then pours water from one of these glasses into a tall, narrow glass, and asks the person whether the short, wide glass that still has water in it and the tall narrow glass contain the same amount of water. Young children often say that the tall narrow glass contains more water even though it does not. It is unknown whether sick people with normal MMSE scores might display the types of thinking problems that Piaget's tasks evaluate.
Why did the researchers do this particular study?
To learn more about thinking problems in sick people.
Who was studied?
63 hospitalized sick patients and 28 nonsick people in a senior citizen center. All participants had normal MMSE scores.
How was the study done?
The researchers judged hospitalized patients' level of sickness according to the Karnofsky scale, which rates how well people care for personal activities, such as eating, bathing, and using the toilet. "Sicker patients" required considerable assistance with these activities, while "less sick patients" required little assistance. The researchers then asked the hospitalized patients and the nonsick people from the senior citizen center to perform seven of the thinking tasks developed by Piaget.
What did the researchers find?
Sicker patients correctly answered an average of about two of the seven tasks, while the nonsick people correctly answered an average of about six. Less sick patients performed about as well as nonsick people.
What were the limitations of the study?
It is unknown whether the results will hold up in studies that include a larger number of diverse people. The relationship between being able to perform Piaget tasks correctly and the ability to make well-reasoned medical decisions is not known.
What are the implications of the study?
Sicker, hospitalized patients appear to perform seven tasks of thinking incorrectly more often than less sick hospitalized patients or nonsick people. The MMSE may not detect all important thinking problems. The ability of sick people to think deserves further study.
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