Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients
David J Meagher, Henry O’Connell, Maeve Leonard, Olugbenga Williams, Fahad Awan, Chris Exton, Michael Tenorio, Margaret O’Connor, Colum P Dunne, Walter Cullen, John McFarland, Dimitrios Adamis
David J Meagher, Henry O’Connell, Maeve Leonard, Olugbenga Williams, Fahad Awan, Margaret O’Connor, Colum P Dunne, Walter Cullen, John McFarland, Dimitrios Adamis, Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
Chris Exton, Michael Tenorio, Department of Computer Sciences, University of Limerick, Limerick V94 YVHO, Ireland
Walter Cullen, School of Medicine, University College Dublin, Dublin 4 D04 V1W8, Ireland
Dimitrios Adamis, Sligo Mental Health Services, Ballytivan, Sligo F91 CD34, Ireland
Author contributions: Meagher DJ, O’Connell H, Leonard M, Williams O, Awan F, Exton C, Tenorio M, O’Connor M, Dunne CP, Cullen W, McFarland J and Adamis D contributed to the writing and revising of the manuscript; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by University Hospital Limerick Regional Ethics Committee approved (REC 100/12).
Conflict-of-interest statement: The authors have no conflicts of interest to declare other than that they are members of the Cognitive Impairment Research Group (CIRG) that developed the Lighthouse and LSD tests described in this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: David J Meagher, MD, PhD, Chairman, Professor, Head, Department of Psychiatry, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland. david.meagher@ul.ie
Received: October 2, 2019
Peer-review started: October 2, 2019
First decision: November 6, 2019
Revised: January 17, 2020
Accepted: March 4, 2020
Article in press: March 4, 2020
Published online: April 19, 2020
ARTICLE HIGHLIGHTS
Research background
Efficient detection of delirium and comorbid delirium-dementia is a key diagnostic challenge. It’s a key challenge of developing of new, efficient delirium-focused methods of cognitive assessment for improved detection of neurocognitive disorders in everyday clinical practice.
Research motivation
This study the accuracy of a series of commonly used conventional tests as well as these novel tests in the detection of delirium in a real world sample of older hospital medical patients.
Research objectives
The authors aimed 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.
Research methods
This cognitive performance study was conducted in referrals to a consultation-liaison psychiatry service of patients with delirium, dementia, comorbid delirium-dementia, as well as comparison subjects with no neurocognitive diagnosis. Altered mental state consecutive cases were identified on daily rounds.
Research results
All conventional tests had sensitivity of > 70% for delirium, with best overall accuracy for the Vigilance-B, Vigilance-A and Months Backward tests. The sustained attention component of the Lighthouse Test was the most distinguishing of delirium.
Research conclusions
Vigilance and visuospatial ability can help to distinguish neurocognitive disorders, including delirium, from other presentations. The Lighthouse test, Letter and Shape Drawing test are novel tests with high accuracy for detecting delirium.
Research perspectives
Lighthouse test, Letter and Shape Drawing tests’ impact upon delirium detection in everyday practice warrants further study.
