TY - JOUR
T1 - Attention, vigilance and visuospatial function in hospitalized elderly medical patients
T2 - Relationship to neurocognitive diagnosis
AU - Leonard, Maeve
AU - O'Connell, Henry
AU - Williams, Olugbenga
AU - Awan, Fahad
AU - Exton, Chris
AU - O'Connor, Margaret
AU - Adamis, Dimitrios
AU - Dunne, Colum
AU - Cullen, Walter
AU - Meagher, David J.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - OBJECTIVE: Efficient detection of neurocognitive disorders is a key diagnostic challenge. We explored how simple bedside tests of attention, vigilance and visuospatial function might assist in identifying delirium in hospitalized patients.METHODS: Performance on a battery of bedside cognitive tests was compared in elderly medical inpatients with DSM-IV delirium, dementia, comorbid delirium-dementia, and no neurocognitive disorder.RESULTS: 193 patients [mean age 79.9±7.3; 97 male] were assessed with delirium (n=45), dementia (n=33), comorbid delirium-dementia (n=65) and no neurocognitive disorder (NNCD) (n=50). The ability to meaningfully engage with the tests varied from 84% (Spatial Span Forwards) to 57% (Vigilance B test), and was especially problematic among the comorbid delirium-dementia group. The NNCD was distinguished from the delirium groups for most tests, and from the dementia group for the Vigilance B test and the Clock Drawing Test. The dementia group differed from delirium groups in respect of the Months Backward Test, Vigilance A and B tests, Global assessment of visuospatial ability and the Interlocking Pentagons Test. Overall, patients with delirium were best identified by three tests - the Months Backward Test, Vigilance A test and the Global Assessment of visuospatial function with failure to correctly complete any two of these predicting delirium status in 80% of cases.CONCLUSION: Simple bedside tests of attention, vigilance and visuospatial ability can help to distinguish neurocognitive disorders, including delirium, from other presentations. There is a need to develop more accurate methods specifically designed to assess patients with neurocognitive disorder who are unable to engage with conventional tests.
AB - OBJECTIVE: Efficient detection of neurocognitive disorders is a key diagnostic challenge. We explored how simple bedside tests of attention, vigilance and visuospatial function might assist in identifying delirium in hospitalized patients.METHODS: Performance on a battery of bedside cognitive tests was compared in elderly medical inpatients with DSM-IV delirium, dementia, comorbid delirium-dementia, and no neurocognitive disorder.RESULTS: 193 patients [mean age 79.9±7.3; 97 male] were assessed with delirium (n=45), dementia (n=33), comorbid delirium-dementia (n=65) and no neurocognitive disorder (NNCD) (n=50). The ability to meaningfully engage with the tests varied from 84% (Spatial Span Forwards) to 57% (Vigilance B test), and was especially problematic among the comorbid delirium-dementia group. The NNCD was distinguished from the delirium groups for most tests, and from the dementia group for the Vigilance B test and the Clock Drawing Test. The dementia group differed from delirium groups in respect of the Months Backward Test, Vigilance A and B tests, Global assessment of visuospatial ability and the Interlocking Pentagons Test. Overall, patients with delirium were best identified by three tests - the Months Backward Test, Vigilance A test and the Global Assessment of visuospatial function with failure to correctly complete any two of these predicting delirium status in 80% of cases.CONCLUSION: Simple bedside tests of attention, vigilance and visuospatial ability can help to distinguish neurocognitive disorders, including delirium, from other presentations. There is a need to develop more accurate methods specifically designed to assess patients with neurocognitive disorder who are unable to engage with conventional tests.
KW - Aged
KW - Aged, 80 and over
KW - Arousal/physiology
KW - Attention/physiology
KW - Cognition Disorders/diagnosis
KW - Comorbidity
KW - Delirium/diagnosis
KW - Dementia/diagnosis
KW - Diagnostic and Statistical Manual of Mental Disorders
KW - Female
KW - Hospitalization
KW - Humans
KW - Male
KW - Neuropsychological Tests/standards
KW - Psychomotor Performance/physiology
KW - Spatial Behavior/physiology
KW - Wakefulness
UR - http://www.scopus.com/inward/record.url?scp=84992175088&partnerID=8YFLogxK
U2 - 10.1016/j.jpsychores.2016.09.011
DO - 10.1016/j.jpsychores.2016.09.011
M3 - Article
C2 - 27772564
AN - SCOPUS:84992175088
SN - 0022-3999
VL - 90
SP - 84
EP - 90
JO - Journal of Psychosomatic Research
JF - Journal of Psychosomatic Research
ER -