Use of the cognitive performance scale to identify under- and over-treatment of cognitive deficits in nursing home residents with dementia

OBJECTIVE: To determine the practicality of using the Minimum Data Set (MDS) Cognitive Performance Scale (CPS) to evaluate the appropriateness of acetylcholinesterase inhibitor (AChEI) use in the treatment of Alzheimer's disease and related disorders. DESIGN: A cross-sectional study of nursing facility residents using the medical record and MDS data. SETTING: Three skilled nursing facilities. PATIENTS/PARTICIPANTS: 275 residents with MDS assessments completed from March 1 through September 30, 2000. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): CPS scores and documented diagnoses for those residents who received and did not receive AChEI therapy. RESULTS: The median CPS score for all subjects was 3 (range, 0-6), with significant differences (P = .000; chi square) among the facilities. Overall, 13.8% of subjects received an AChEI, most commonly donepezil. As only 12.9% of residents with mild to moderate impairment were receiving an AChEI, they may have been under-treated. However, over-treatment may have been an issue among the 16.2% of subjects with severe impairment who were treated. Differences among facilities could have reflected differences in patient populations or procedures used to complete the MDS. CONCLUSION: The CPS is a practical tool for nursing facilities to use to standardize the assessment of cognitive function. The CPS could be used by pharmacists and others as an adjunct to the assessment of the effectiveness of interventions, such as AChEI therapy, to improve or maintain the functional status of nursing facility residents. Further studies are necessary before the CPS could be used, by itself, to direct pharmacotherapy of cognitive impairment.

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