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

Autor: Tieges Z; Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, United Kingdom.; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Scotland, Edinburgh, United Kingdom., Stott DJ; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom., Shaw R; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom., Tang E; Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, United Kingdom.; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom., Rutter LM; Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, United Kingdom., Nouzova E; Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, United Kingdom., Duncan N; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom., Clarke C; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom., Weir CJ; Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom., Assi V; Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom., Ensor H; Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom., Barnett JH; Cambridge Cognition Ltd, Cambridge, United Kingdom.; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom., Evans J; Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom., Green S; Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, United Kingdom., Hendry K; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom., Thomson M; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom., McKeever J; Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, United Kingdom., Middleton DG; Medical Devices Unit, West Glasgow Ambulatory Care Hospital, Glasgow, Scotland, United Kingdom., Parks S; Medical Devices Unit, West Glasgow Ambulatory Care Hospital, Glasgow, Scotland, United Kingdom., Walsh T; Critical Care Medicine and Anaesthesia, University of Edinburgh, Edinburgh, Scotland, United Kingdom., Weir AJ; Medical Devices Unit, West Glasgow Ambulatory Care Hospital, Glasgow, Scotland, United Kingdom., Wilson E; Critical Care Medicine and Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom., Quasim T; Anaesthesia, Critical Care and Pain Medicine, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom., MacLullich AMJ; Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, United Kingdom.; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Scotland, Edinburgh, United Kingdom.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Jan 24; Vol. 15 (1), pp. e0227471. Date of Electronic Publication: 2020 Jan 24 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0227471
Abstrakt: 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.
Competing Interests: The authors would like to declare the following granted patents for the testing of delirium associated with this research: EP 2485645 and US 9,307,940, “APPARATUS AND METHOD FOR TESTING SUSTAINED ATTENTION AND DELIRIUM”. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.
Databáze: MEDLINE
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