Clinical observations have shown that some older patients are unable to learn to use a
metered dose inhaler (MDI) despite having a normal abbreviated mental test (AMT) score, possibly because of
dyspraxia or unrecognised
cognitive impairment. Thirty
inhaler-naive inpatients (age 76-94) with an AMT score of 8-10 (normal) were studied. Standard MDI training was given and the level of competence reached was scored (inhalation score). A separate observer performed the minimental test (
MMT), Barthel index, geriatric depression score (GDS), ideational
dyspraxia test (IDT), and
ideomotor dyspraxia test (IMD). No correlative or threshold relationship was found between inhalation score and Barthel index, GDS, or IDT. However, a significant correlation was found between inhalation score and IMD (r = 0.45, p = 0.039) and
MMT (r = 0.48, p = 0.032) and threshold effects emerged in that no subject with a
MMT score of less than 23/30 had an inhalation score of 5/10 or more (adequate technique requires 6/10 or more), and all 17/18 with an inhalation score of 6/10 or more had an IMD of 14/20 or more. The three patients with a
MMT >22 and inhalation score <6 had abnormal IMD scores. Inability to learn an adequate
inhaler technique in subjects with a normal AMT score appears to be due to unrecognised
cognitive impairment or
dyspraxia. The
MMT is probably a more useful screening test than the AMT score in this context.