A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients


Autoři: Zoë Tieges aff001;  David J. Stott aff003;  Robert Shaw aff003;  Elaine Tang aff001;  Lisa-Marie Rutter aff001;  Eva Nouzova aff001;  Nikki Duncan aff003;  Caoimhe Clarke aff003;  Christopher J. Weir aff004;  Valentina Assi aff004;  Hannah Ensor aff004;  Jennifer H. Barnett aff005;  Jonathan Evans aff007;  Samantha Green aff001;  Kirsty Hendry aff003;  Meigan Thomson aff003;  Jenny McKeever aff001;  Duncan G. Middleton aff008;  Stuart Parks aff008;  Tim Walsh aff009;  Alexander J. Weir aff008;  Elizabeth Wilson aff010;  Tara Quasim aff011;  Alasdair M. J. MacLullich aff001
Působiště autorů: Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, United Kingdom aff001;  Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Scotland, Edinburgh, United Kingdom aff002;  Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom aff003;  Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom aff004;  Cambridge Cognition Ltd, Cambridge, United Kingdom aff005;  Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom aff006;  Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom aff007;  Medical Devices Unit, West Glasgow Ambulatory Care Hospital, Glasgow, Scotland, United Kingdom aff008;  Critical Care Medicine and Anaesthesia, University of Edinburgh, Edinburgh, Scotland, United Kingdom aff009;  Critical Care Medicine and Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom aff010;  Anaesthesia, Critical Care and Pain Medicine, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom aff011
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227471

Souhrn

Background

Delirium is a common and serious acute neuropsychiatric syndrome which is often missed in routine clinical care. Inattention is the core cognitive feature. Diagnostic test accuracy (including cut-points) of a smartphone Delirium App (DelApp) for assessing attention deficits was assessed in older hospital inpatients.

Methods

This was a case-control study of hospitalised patients aged ≥65 years with delirium (with or without pre-existing cognitive impairment), who were compared to patients with dementia without delirium, and patients without cognitive impairment. Reference standard delirium assessment, which included a neuropsychological test battery, was based on Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A separate blinded assessor administered the DelApp arousal assessment (score 0–4) and attention task (0–6) yielding an overall score of 0 to 10 (lower scores indicate poorer performance). Analyses included receiver operating characteristic curves and sensitivity and specificity. Optimal cut-points for delirium detection were determined using Youden’s index.

Results

A total of 187 patients were recruited, mean age 83.8 (range 67–98) years, 152 (81%) women; n = 61 with delirium; n = 61 with dementia without delirium; and n = 65 without cognitive impairment. Patients with delirium performed poorly on the DelApp (median score = 4/10; inter-quartile range 3.0, 5.5) compared to patients with dementia (9.0; 5.5, 10.0) and those without cognitive impairment (10.0; 10.0, 10.0). Area under the curve for detecting delirium was 0.89 (95% Confidence Interval 0.84, 0.94). At an optimal cut-point of ≤8, sensitivity was 91.7% (84.7%, 98.7%) and specificity 74.2% (66.5%, 81.9%) for discriminating delirium from the other groups. Specificity was 68.3% (56.6%, 80.1%) for discriminating delirium from dementia (cut-point ≤6).

Conclusion

Patients with delirium (with or without pre-existing cognitive impairment) perform poorly on the DelApp compared to patients with dementia and those without cognitive impairment. A cut-point of ≤8/10 is suggested as having optimal sensitivity and specificity. The DelApp is a promising tool for assessment of attention deficits associated with delirium in older hospitalised adults, many of whom have prior cognitive impairment, and should be further validated in representative patient cohorts.

Klíčová slova:

Attention – Case-control studies – Cell phones – Cognitive impairment – Dementia – Diagnostic medicine – Geriatrics – Neuropsychological testing


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