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Background <p>Cognitive impairment often goes undetected in the emergency department (ED) despite its high prevalence and role as a&#xa0;predisposing factor for delirium. Most diagnostic instruments regarding cognitive impairment currently available are too extensive for routine ED use. A&#xa0;pragmatic screening tool is therefore needed to enhance patient care.</p> Objective <p>To develop an instrument explicitly designed for the ED that can detect cognitive impairment under time- and resource-limited conditions—fast, simple, and with clear diagnostic value.</p> Methods <p>This instrument-development study created the “Kognitive Leistungseinschätzung in der Notaufnahme” (KLeiN) and validated it in the interdisciplinary ED of a&#xa0;German university hospital. The Mini-Mental State Examination (MMSE) served as the reference test for major neurocognitive disorders and the Montreal Cognitive Assessment (MoCA) for minor neurocognitive disorders.</p> Results <p>A&#xa0;multistage evaluation examined 300&#xa0;patients. The overall accuracy of KLeiN for positive screening results (pPAC) compared to reference tests was high: 74% for MMSE and 80% for MoCA. Interrater reliability was similarly robust: κ = 0.87. An abnormal KLeiN can predict an abnormal test result for cognitive impairment with 87% accuracy (MMSE) and 97% accuracy (MoCA).</p> Conclusion <p>These metrics indicate that KLeiN can serve as an effective screening instrument for cognitive impairment in the ED. Its straightforward design and brief administration time (2 min) permit low-threshold implementation. Although it does not replace comprehensive neurocognitive batteries, it provides an&#xa0;early appraisal of cognitive function that can, for example, inform initial delirium risk stratification.</p>

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Die kognitive Leistungseinschätzung in der Notaufnahme: KLeiN

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月29日

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  • Matthias Nürnberger,
  • Malte Klein,
  • Jan-Christoph Lewejohann,
  • Thomas Lehmann,
  • Stefan Brodoehl,
  • Kathrin Finke

摘要

Background

Cognitive impairment often goes undetected in the emergency department (ED) despite its high prevalence and role as a predisposing factor for delirium. Most diagnostic instruments regarding cognitive impairment currently available are too extensive for routine ED use. A pragmatic screening tool is therefore needed to enhance patient care.

Objective

To develop an instrument explicitly designed for the ED that can detect cognitive impairment under time- and resource-limited conditions—fast, simple, and with clear diagnostic value.

Methods

This instrument-development study created the “Kognitive Leistungseinschätzung in der Notaufnahme” (KLeiN) and validated it in the interdisciplinary ED of a German university hospital. The Mini-Mental State Examination (MMSE) served as the reference test for major neurocognitive disorders and the Montreal Cognitive Assessment (MoCA) for minor neurocognitive disorders.

Results

A multistage evaluation examined 300 patients. The overall accuracy of KLeiN for positive screening results (pPAC) compared to reference tests was high: 74% for MMSE and 80% for MoCA. Interrater reliability was similarly robust: κ = 0.87. An abnormal KLeiN can predict an abnormal test result for cognitive impairment with 87% accuracy (MMSE) and 97% accuracy (MoCA).

Conclusion

These metrics indicate that KLeiN can serve as an effective screening instrument for cognitive impairment in the ED. Its straightforward design and brief administration time (2 min) permit low-threshold implementation. Although it does not replace comprehensive neurocognitive batteries, it provides an early appraisal of cognitive function that can, for example, inform initial delirium risk stratification.