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The Executive Interview (EXIT25) as a tool for assessing executive functioning in older medical and surgical inpatients referred to a psychiatry service: feasibility of creating a brief version

Published online by Cambridge University Press:  04 March 2014

Fedza Mujic ,
Eyal Lebovich ,
Maite Von Heising ,
Damian Clifford  and
Martin J. Prince
Fedza Mujic*
Affiliation:
South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK
Eyal Lebovich
Affiliation:
South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK
Maite Von Heising
Affiliation:
South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK
Damian Clifford
Affiliation:
South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK
Martin J. Prince
Affiliation:
South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK, and Centre for Public Mental Health, Health Services and Population Research Department, P060, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
*
Correspondence should be addressed to: Dr F Mujic, South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK. Phone: 44-20-32993036; Fax: 44-20-32995855. Email: fedja3m@gmail.com.
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Abstract

Background:

Most neuropsychological tests of executive function are time-consuming and otherwise unsuitable for routine bedside assessment, particularly in older people admitted to a general hospital. After introducing the Executive Interview (EXIT25) in our routine clinical practice, we hypothesized that it would be possible to shorten it for easier administration in our group of patients while maintaining or improving properties of the scale.

Methods:

The EXIT25 was applied in 122 clinically stable medical and surgical inpatients aged 65 years and over referred to the Liaison Psychiatry Service for Older People. Individual items were initially tested for floor and ceiling effects, inter-rater and test-retest reliability, and item-total correlations. Items were then selected for retention in the brief scale on the basis of adequate item-total correlation and inter-rater and test-retest reliability. The construct validity of the original and brief versions of the EXIT25 scale was assessed.

Results:

The original EXIT25 scale was found to lack desirable scaling properties either as a classical or hierarchical scale. The study confirmed a possibility to reduce the number of items to nine out of the original 25 while improving internal consistency, test-retest and inter-rater reliability, and maintaining high correlation with the original EXIT25 score, and moderate inverse correlation with the Mini-Mental State Examination score.

Conclusions:

There is potential to abbreviate the original EXIT25, and improve internal consistency and hierarchical scaling properties. Future research is necessary to focus on piloting these brief measures of executive function in relevant clinical settings, when administered en bloc, rather than with items interspersed in the original longer version.

Keywords

The Executive InterviewEXIT25scale testingexecutive functionolder people
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 6 , June 2014 , pp. 935 - 941
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Almkvist, O. (1994). Neuropsychological deficits in vascular dementia in relation to Alzheimer's disease: reviewing evidence for functional similarity or divergence. Dementia, 5, 203–209.Google ScholarPubMed
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders DSM-IV. Washington, DC: American Psychiatric Association.Google Scholar
Brookes, R. L., Hannesdottir, K., Lawrence, R., Morris, R. G. and Markus, H. S. (2012). Brief Memory and Executive Test: evaluation of a new screening test for cognitive impairment due to small vessel disease. Age and Ageing, 41, 212–218.Google Scholar
Chen, P., Ratcliff, G., Belle, S. H., Cauley, J. A., DeKosky, S. T. and Ganguli, M. (2000). Cognitive tests that best discriminate between presymptomatic AD and those who remain nondemented. Neurology, 55, 1847–1853.Google Scholar
Dubois, B., Slachevsky, A., Litvan, I. and Pillon, B. (2000). The FAB: a Frontal Assessment Battery at bedside. Neurology, 50, 1621–1626.Google Scholar
Faustman, W. O., Moses, J. A. and Csernansky, J. G. (1990). Limitations of the Mini-Mental State Examination in predicting neuropsychological functioning in a psychiatric sample. Acta Psychiatrica Scandinavica, 81, 126–131.Google Scholar
Folstein, M. F., Folstein, S. F. and McHugh, P. R. (1975). “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinicians. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Holzer, J. C., Gansler, D. A., Moczynski, N. P. and Folstein, M. (1997). Cognitive functions in the informed consent evaluation process. Journal of Academic Psychiatry Law, 25, 531–540.Google Scholar
Johnson, J. K., Lui, L.-Y. and Yaffe, K. (2007). Executive function, more than global cognition, predicts functional decline and mortality in elderly women. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62, 1134–1141.Google Scholar
Kiosses, D. N., Klimstra, S., Murphy, C. and Alexopoulos, G. S. (2001). Executive dysfunction and disability in elderly patients with major depression. American Journal of Geriatric Psychiatry, 9, 269–274.CrossRefGoogle ScholarPubMed
Larson, E. B. and Heinemann, A. W. (2010). Rasch analysis of the Executive Interview (The EXIT-25) and introduction of an abridged version (The Quick EXIT). Archives of Physical Medicine and Rehabilitation, 91, 389–394.Google Scholar
Mann, L. S., Westlake, T., Wise, T. N., Beckman, A., Beckman, P. and Portez, D. (1999), Executive functioning and compliance in HIV patients. Psychological Reports, 84, 319–322.CrossRefGoogle ScholarPubMed
Martinez-Aran, A. et al. (2002). Executive function in patients with remitted bipolar disorder and schizophrenia and its relationship with functional outcome. Psychotherapy and Psychosomatics, 71, 39–46.Google Scholar
Mathuranath, P. S., Nestor, P. J., Berrios, G. E., Rakowicz, W. and Hodges, J. R. (2000). A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia. Neurology, 55, 1613–1620.CrossRefGoogle ScholarPubMed
McGurk, S. R. and Meltzer, H. Y. (2000). The role of cognition in vocational functioning in schizophrenia. Schizophrenia Research, 45, 175–184.Google Scholar
Mokken, R. J. (1971). A Theory and Procedure of Scale Analysis. Berlin, Germany: De Gruyter.Google Scholar
Molenaar, I. W. and Sijtsma, K. (2000). MSP5 for Windows. A Program for Mokken Scale Analysis for Polytomous Items. Groningen, Netherlands: IEC ProGamma.Google Scholar
Naugle, R. I. and Kawczak, K. (1989). Limitations of the Mini-Mental State Examination. Cleveland Clinic Journal of Medicine, 56, 277–281.Google Scholar
Román, G. C. et al. (2004). Vascular cognitive disorder: a new diagnostic category updating vascular cognitive impairment and vascular dementia. Journal of the Neurological Sciences, 226, 81–87.CrossRefGoogle ScholarPubMed
Royall, D., Mahurin, R. K. and Gray, K. (1992). Bedside assessment of executive cognitive impairment: the Executive Interview (EXIT). Journal of American Geriatric Society, 40, 1221–1226.Google Scholar
Royall, D. et al. (1993). Executive impairment among functionally dependent: comparisons between schizophrenic and elderly subjects. American Journal of Psychiatry, 150, 1813–1819.Google Scholar
Royall, D. R., Cabello, M. and Polk, M. J. (1998). Executive dyscontrol: an important factor affecting the level of care received by older retirees. Journal of American Geriatric Society, 46, 1519–1524.Google Scholar
Royall, D. R., Rauch, R., Roman, G. C., Cordes, J. and Polk, M. (2001). MRI findings associated with impairment on the Executive Interview. Experimental Ageing Research, 27, 293–308.Google Scholar
Royall, D. R. et al. (2002). Executive control function: a review of its promise and challenges for clinical research: a report from the Committee on Research of the American Neuropsychiatric Association. Journal of Neuropsychiatry and Clinical Neuroscience, 14, 377–405.Google Scholar
Schillerstrom, J. E., Deuter, M. S., Wyatt, R., Stern, S. L. and Royall, D. R. (2003). Prevalence of executive impairment in patients seen by a psychiatry consultation service. Psychosomatics, 44, 290–297.Google Scholar
Schillerstrom, J. E. et al. (2005). Prevalence, course and risk factors for executive impairment in patients hospitalized on general medicine service. Psychosomatics, 46, 411–417.Google Scholar
Schwamm, L. H., Van Dyke, C., Kiernan, R. J., Merrin, E. L. and Mueller, J. (1987). The Neurobehavioral Cognitive Status Examination: comparison with the Cognitive Capacity Screening Examination and the Mini-Mental State Examination in a neurosurgical population. Annals of Internal Medicine, 107, 486–491.Google Scholar
Stewart, J. T., Gonzales-Perez, E., Zhu, Y. and Robinson, B. E. (1999). Cognitive predictors of resistiveness in dementia patients. American Journal of Geriatric Psychiatry, 7, 259–263.Google Scholar