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Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients
BACKGROUND: Efficient detection of delirium and comorbid delirium-dementia is a key diagnostic challenge. Development of new, efficient delirium-focused methods of cognitive assessment is a key challenge for improved detection of neurocognitive disorders in everyday clinical practice. AIM: To compar...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203081/ https://www.ncbi.nlm.nih.gov/pubmed/32399398 http://dx.doi.org/10.5498/wjp.v10.i4.46 |
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author | Meagher, David J O’Connell, Henry Leonard, Maeve Williams, Olugbenga Awan, Fahad Exton, Chris Tenorio, Michael O’Connor, Margaret Dunne, Colum P Cullen, Walter McFarland, John Adamis, Dimitrios |
author_facet | Meagher, David J O’Connell, Henry Leonard, Maeve Williams, Olugbenga Awan, Fahad Exton, Chris Tenorio, Michael O’Connor, Margaret Dunne, Colum P Cullen, Walter McFarland, John Adamis, Dimitrios |
author_sort | Meagher, David J |
collection | PubMed |
description | BACKGROUND: Efficient detection of delirium and comorbid delirium-dementia is a key diagnostic challenge. Development of new, efficient delirium-focused methods of cognitive assessment is a key challenge for improved detection of neurocognitive disorders in everyday clinical practice. AIM: To compare the accuracy of two novel bedside tests of attention, vigilance and visuospatial function with conventional bedside cognitive tests in identifying delirium in older hospitalized patients. METHODS: 180 consecutive elderly medical inpatients (mean age 79.6 ± 7.2; 51% female) referred to a psychiatry for later life consultation-liaison service with delirium, dementia, comorbid delirium–dementia and cognitively intact controls. Participants were assessed cross-sectionally with conventional bedside cognitive tests [WORLD, Months Backward test (MBT), Spatial span, Vigilance A and B, Clock Drawing test and Interlocking Pentagons test] and two novel cognitive tests [Lighthouse test, Letter and Shape Drawing test (LSD)-4]. RESULTS: Neurocognitive diagnoses were delirium (n = 44), dementia (n = 30), comorbid delirium-dementia (n = 60) and no neurocognitive disorder (n = 46). All conventional tests had sensitivity of > 70% for delirium, with best overall accuracy for the Vigilance-B (78.3%), Vigilance-A (77.8%) and MBT (76.7%) tests. The sustained attention component of the Lighthouse test was the most distinguishing of delirium (sensitivity 84.6%; overall accuracy 75.6%). The LSD-4 had sensitivity of 74.0% and overall accuracy 74.4% for delirium identification. Combining tests allowed for enhanced sensitivity (> 90%) and overall accuracy (≥ 75%) with the highest overall accuracy for the combination of MBT-Vigilance A and the combined Vigilance A and B tests (both 78.3%). When analyses were repeated for those with dementia, there were similar findings with the MBT-Vigilance A the most accurate overall combination (80.0%). Combining the Lighthouse-SA with the LSD-4, a fail in either test had sensitivity for delirium of 91.4 with overall accuracy of 74.4%. CONCLUSION: Bedside tests of attention, vigilance and visuospatial ability can help to distinguish neurocognitive disorders, including delirium, from other presentations. The Lighthouse test and the LSD-4 are novel tests with high accuracy for detecting delirium. |
format | Online Article Text |
id | pubmed-7203081 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-72030812020-05-12 Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients Meagher, David J O’Connell, Henry Leonard, Maeve Williams, Olugbenga Awan, Fahad Exton, Chris Tenorio, Michael O’Connor, Margaret Dunne, Colum P Cullen, Walter McFarland, John Adamis, Dimitrios World J Psychiatry Basic Study BACKGROUND: Efficient detection of delirium and comorbid delirium-dementia is a key diagnostic challenge. Development of new, efficient delirium-focused methods of cognitive assessment is a key challenge for improved detection of neurocognitive disorders in everyday clinical practice. AIM: To compare the accuracy of two novel bedside tests of attention, vigilance and visuospatial function with conventional bedside cognitive tests in identifying delirium in older hospitalized patients. METHODS: 180 consecutive elderly medical inpatients (mean age 79.6 ± 7.2; 51% female) referred to a psychiatry for later life consultation-liaison service with delirium, dementia, comorbid delirium–dementia and cognitively intact controls. Participants were assessed cross-sectionally with conventional bedside cognitive tests [WORLD, Months Backward test (MBT), Spatial span, Vigilance A and B, Clock Drawing test and Interlocking Pentagons test] and two novel cognitive tests [Lighthouse test, Letter and Shape Drawing test (LSD)-4]. RESULTS: Neurocognitive diagnoses were delirium (n = 44), dementia (n = 30), comorbid delirium-dementia (n = 60) and no neurocognitive disorder (n = 46). All conventional tests had sensitivity of > 70% for delirium, with best overall accuracy for the Vigilance-B (78.3%), Vigilance-A (77.8%) and MBT (76.7%) tests. The sustained attention component of the Lighthouse test was the most distinguishing of delirium (sensitivity 84.6%; overall accuracy 75.6%). The LSD-4 had sensitivity of 74.0% and overall accuracy 74.4% for delirium identification. Combining tests allowed for enhanced sensitivity (> 90%) and overall accuracy (≥ 75%) with the highest overall accuracy for the combination of MBT-Vigilance A and the combined Vigilance A and B tests (both 78.3%). When analyses were repeated for those with dementia, there were similar findings with the MBT-Vigilance A the most accurate overall combination (80.0%). Combining the Lighthouse-SA with the LSD-4, a fail in either test had sensitivity for delirium of 91.4 with overall accuracy of 74.4%. CONCLUSION: Bedside tests of attention, vigilance and visuospatial ability can help to distinguish neurocognitive disorders, including delirium, from other presentations. The Lighthouse test and the LSD-4 are novel tests with high accuracy for detecting delirium. Baishideng Publishing Group Inc 2020-04-19 /pmc/articles/PMC7203081/ /pubmed/32399398 http://dx.doi.org/10.5498/wjp.v10.i4.46 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Basic Study Meagher, David J O’Connell, Henry Leonard, Maeve Williams, Olugbenga Awan, Fahad Exton, Chris Tenorio, Michael O’Connor, Margaret Dunne, Colum P Cullen, Walter McFarland, John Adamis, Dimitrios Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients |
title | Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients |
title_full | Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients |
title_fullStr | Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients |
title_full_unstemmed | Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients |
title_short | Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients |
title_sort | comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients |
topic | Basic Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203081/ https://www.ncbi.nlm.nih.gov/pubmed/32399398 http://dx.doi.org/10.5498/wjp.v10.i4.46 |
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