Reliability of three questions for the screening of advanced cognitive impairment in polypathological patients.

AIM: To determine whether answering three questions erroneously ("what is the date today?," "when were you born?" and "how old are you?") allows for the detection of advanced cognitive impairment in polypathological patients. METHODS: A cross-sectional study of patients admitted to the internal medicine and geriatrics departments was carried out. Advanced cognitive impairment was diagnosed when patients made 7-10 errors in the Short Portable Mental Status Questionnaire. RESULTS: We included 441 polypathological patients, 330 of them from the internal medicine departments and 111 from the geriatrics department. Their mean age was 80.8 years (8.9 years). Of them, 141 (32.0%) answered one question incorrectly, 58 (13.1%) answered two and 89 (20.2%) answered all three questions incorrectly. The prevalence of advanced cognitive impairment was 27.7%. The sensitivity, specificity, and positive and negative predictive values of the test were 0.705, 0.991, 0.966 and 0.898, respectively. The accuracy of the test was 0.912. The area under the receiver operating characteristic curve was 0.947, 95% CI 0.923-0.970. CONCLUSIONS: The three questions test has very good specificity and positive predictive value, and it can be used for the screening of advanced cognitive impairment in polypathological patients. Geriatr Gerontol Int 2018; 18: 441-447.

Acute renal failure due to interstitial nephritis after intravesical instillation of BCG.

Intravesical chemotherapy with bacilli Calmette-Guerin (BCG) has been an established therapy for preventing recurrence of, and for treatment of, superficial transitional cell carcinoma of the bladder, but it is not without side effects. A variety of renal complications have been reported and attributed to mycobacterial infection. Although renal complications are uncommon, several cases of interstitial nephritis (with or without granulomas) and mesangial glomerulonephritis have been reported. We report a 76-year-old male patient who developed acute renal failure due to interstitial nephritis after intravesical instillation of BCG. Corticosteroids may serve the recovery of renal function without concomitant use of anti-tubercular therapy, provided systemic signs and mycobacterial infection are absent. Serum creatinine should be checked in at-risk patients in order to detect this complication early.