Bedside assessment of executive cognitive impairment: The executive interview

D. R. Royall, R. K. Mahurin, K. F. Gray

Research output: Contribution to journalArticle

472 Citations (Scopus)

Abstract

Objective: This study is a pilot validation of the Executive Interview (EXIT), a novel instrument designed to assess executive cognitive function (ECF) at the bedside. Design: Inter-rater reliability testing and validation using inter-group comparisons across levels of care and measures of cognition and behavior. Participants: Forty elderly subjects randomly selected across four levels of care. Setting: Settings ranged from independent living apartments to designated Alzheimer's Special Care units in a single 537-bed retirement community. Measurements: The EXIT: a 10-minute, 25-item interview scored from 0-50 (higher scores = greater executive dyscontrol) was administered by a physician. Subjects were also administered the Mini-Mental State Exam (MMSE) and traditional tests of 'frontal' executive function by a neuropsychologist, and the Nursing Home Behavior Problem Scale (NHBPS) by Licensed Vocational Nurses. Results: Interrater reliability was high (r = .90). EXIT scores correlated well with other measures of ECF. The interview discriminated among residents at each level of care. In contrast, the MMSE did not discriminate apartment-dwelling from residential care residents, or residential care from nursing home residents. The EXIT was highly correlated with disruptive behaviors as measured by the NHBPS (r = .79). Conclusions: These preliminary findings suggest that the EXIT is a valid and reliable instrument for the assessment of executive impairment at the bedside. It correlates well with level of care and problem behavior. It discriminates residents at earlier stages of cognitive impairment than the MMSE.

Original languageEnglish (US)
Pages (from-to)1221-1226
Number of pages6
JournalJournal of the American Geriatrics Society
Volume40
Issue number12
StatePublished - 1992

Fingerprint

Interviews
Executive Function
Nursing Homes
Cognition
Independent Living
Retirement
Cognitive Dysfunction
Reproducibility of Results
Physicians
Problem Behavior

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Bedside assessment of executive cognitive impairment : The executive interview. / Royall, D. R.; Mahurin, R. K.; Gray, K. F.

In: Journal of the American Geriatrics Society, Vol. 40, No. 12, 1992, p. 1221-1226.

Research output: Contribution to journalArticle

@article{ad8b89ef21454f0a9fdae499a7b35d5b,
title = "Bedside assessment of executive cognitive impairment: The executive interview",
abstract = "Objective: This study is a pilot validation of the Executive Interview (EXIT), a novel instrument designed to assess executive cognitive function (ECF) at the bedside. Design: Inter-rater reliability testing and validation using inter-group comparisons across levels of care and measures of cognition and behavior. Participants: Forty elderly subjects randomly selected across four levels of care. Setting: Settings ranged from independent living apartments to designated Alzheimer's Special Care units in a single 537-bed retirement community. Measurements: The EXIT: a 10-minute, 25-item interview scored from 0-50 (higher scores = greater executive dyscontrol) was administered by a physician. Subjects were also administered the Mini-Mental State Exam (MMSE) and traditional tests of 'frontal' executive function by a neuropsychologist, and the Nursing Home Behavior Problem Scale (NHBPS) by Licensed Vocational Nurses. Results: Interrater reliability was high (r = .90). EXIT scores correlated well with other measures of ECF. The interview discriminated among residents at each level of care. In contrast, the MMSE did not discriminate apartment-dwelling from residential care residents, or residential care from nursing home residents. The EXIT was highly correlated with disruptive behaviors as measured by the NHBPS (r = .79). Conclusions: These preliminary findings suggest that the EXIT is a valid and reliable instrument for the assessment of executive impairment at the bedside. It correlates well with level of care and problem behavior. It discriminates residents at earlier stages of cognitive impairment than the MMSE.",
author = "Royall, {D. R.} and Mahurin, {R. K.} and Gray, {K. F.}",
year = "1992",
language = "English (US)",
volume = "40",
pages = "1221--1226",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - Bedside assessment of executive cognitive impairment

T2 - The executive interview

AU - Royall, D. R.

AU - Mahurin, R. K.

AU - Gray, K. F.

PY - 1992

Y1 - 1992

N2 - Objective: This study is a pilot validation of the Executive Interview (EXIT), a novel instrument designed to assess executive cognitive function (ECF) at the bedside. Design: Inter-rater reliability testing and validation using inter-group comparisons across levels of care and measures of cognition and behavior. Participants: Forty elderly subjects randomly selected across four levels of care. Setting: Settings ranged from independent living apartments to designated Alzheimer's Special Care units in a single 537-bed retirement community. Measurements: The EXIT: a 10-minute, 25-item interview scored from 0-50 (higher scores = greater executive dyscontrol) was administered by a physician. Subjects were also administered the Mini-Mental State Exam (MMSE) and traditional tests of 'frontal' executive function by a neuropsychologist, and the Nursing Home Behavior Problem Scale (NHBPS) by Licensed Vocational Nurses. Results: Interrater reliability was high (r = .90). EXIT scores correlated well with other measures of ECF. The interview discriminated among residents at each level of care. In contrast, the MMSE did not discriminate apartment-dwelling from residential care residents, or residential care from nursing home residents. The EXIT was highly correlated with disruptive behaviors as measured by the NHBPS (r = .79). Conclusions: These preliminary findings suggest that the EXIT is a valid and reliable instrument for the assessment of executive impairment at the bedside. It correlates well with level of care and problem behavior. It discriminates residents at earlier stages of cognitive impairment than the MMSE.

AB - Objective: This study is a pilot validation of the Executive Interview (EXIT), a novel instrument designed to assess executive cognitive function (ECF) at the bedside. Design: Inter-rater reliability testing and validation using inter-group comparisons across levels of care and measures of cognition and behavior. Participants: Forty elderly subjects randomly selected across four levels of care. Setting: Settings ranged from independent living apartments to designated Alzheimer's Special Care units in a single 537-bed retirement community. Measurements: The EXIT: a 10-minute, 25-item interview scored from 0-50 (higher scores = greater executive dyscontrol) was administered by a physician. Subjects were also administered the Mini-Mental State Exam (MMSE) and traditional tests of 'frontal' executive function by a neuropsychologist, and the Nursing Home Behavior Problem Scale (NHBPS) by Licensed Vocational Nurses. Results: Interrater reliability was high (r = .90). EXIT scores correlated well with other measures of ECF. The interview discriminated among residents at each level of care. In contrast, the MMSE did not discriminate apartment-dwelling from residential care residents, or residential care from nursing home residents. The EXIT was highly correlated with disruptive behaviors as measured by the NHBPS (r = .79). Conclusions: These preliminary findings suggest that the EXIT is a valid and reliable instrument for the assessment of executive impairment at the bedside. It correlates well with level of care and problem behavior. It discriminates residents at earlier stages of cognitive impairment than the MMSE.

UR - http://www.scopus.com/inward/record.url?scp=0026447823&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026447823&partnerID=8YFLogxK

M3 - Article

C2 - 1447438

AN - SCOPUS:0026447823

VL - 40

SP - 1221

EP - 1226

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 12

ER -