Evaluation of a decision tree for screening major neurocognitive disorders and delirium in older adults

PURPOSE This study validates a decision tree for screening MND, delirium, and their co-occurrence. METHODS The tool combined four validated tests: CODEX as initial screen, CAM to confirm delirium if CODEX was abnormal, MoCA for MND screening when delirium was absent, and IQCODE-R to assess MND in cases of delirium. The decision tree is compared with the DSM-V gold standard. RESULTS A total of 130 patients (mean age 82.7) were enrolled. The mean time for the full assessment was 12.6 minutes. CODEX was abnormal in 88 patients (68%), CAM confirmed 38 delirium patients (43%). MoCA identified MND in 42 non-delirious patients (84%), and IQCODE-R in 27 patients with delirium (71%). Agreement with DSM-V clinical diagnosis was excellent (Cohen’s kappa = 0.89). CONCLUSION This approach offers clinicians a simple, reliable, effective screening strategy for MND, delirium and the association of these two conditions in older adults.