Sparing time for screening delirium in cancer patients on opioids with theBlessed Orientation-Memory-Concentration Test (BOMC) compared with the Mini Mental State Examination (MMSE): a validation study

OBJECTIVE: The Mini Mental State Examination (MMSE) is the gold standard co gnitive lest for screening delirium in cancer patients on opioids. But the MMSE is long and requires writing, reading and drawing from patients with V arious degrees of physical inability. Age and educational level affect the MMSE score. The Blessed Orientation-Memory-Concentration (BOMC) test is str ictly oral and brief. This six item test is not affected by age or educatio nal level. PATIENTS AND METHODS: We conducted a validation study of BOMC for screening delirium in cancer patients laking opioids. One physician examined 25 adva nced cancer patients 34 times with MMSE and BOMC. Diagnosis of delirium was made by the same examiner according to the DSM IV criteria. The MMSE score was used for diagnosis of cognitive failure. RESULTS: Seveny-six percent of the patients completed the MMSE and 100% the BOMC. Scores of the two tests were correlated (0.71). An average 4 min 12 sec was gained with BOMC compared with MMSE. For a 10/11 cutoff, the BOMC h ad 83% sensitivity and 95% specificity for delirium diagnosis. Positive and negative predictive Values were 91%. The time for the BOMC was correlated with BOMC score (0.6). A BOMC lime of 3 min 20 sec had 91% sensitivity and specificity for delirium diagnosis. CONCLUSION: BOMC is more applicable than MMSE for screening delirium in can cer patient. The relationship between BOMC time and delirium deserves furth er investigations.