A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients.
<h4>Background</h4>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 def...
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doaj-68871db2709540aba168239979e04c302021-03-04T12:43:04ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01151e022747110.1371/journal.pone.0227471A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients.Zoë TiegesDavid J StottRobert ShawElaine TangLisa-Marie RutterEva NouzovaNikki DuncanCaoimhe ClarkeChristopher J WeirValentina AssiHannah EnsorJennifer H BarnettJonathan EvansSamantha GreenKirsty HendryMeigan ThomsonJenny McKeeverDuncan G MiddletonStuart ParksTim WalshAlexander J WeirElizabeth WilsonTara QuasimAlasdair M J MacLullich<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.https://doi.org/10.1371/journal.pone.0227471 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Zoë Tieges David J Stott Robert Shaw Elaine Tang Lisa-Marie Rutter Eva Nouzova Nikki Duncan Caoimhe Clarke Christopher J Weir Valentina Assi Hannah Ensor Jennifer H Barnett Jonathan Evans Samantha Green Kirsty Hendry Meigan Thomson Jenny McKeever Duncan G Middleton Stuart Parks Tim Walsh Alexander J Weir Elizabeth Wilson Tara Quasim Alasdair M J MacLullich |
spellingShingle |
Zoë Tieges David J Stott Robert Shaw Elaine Tang Lisa-Marie Rutter Eva Nouzova Nikki Duncan Caoimhe Clarke Christopher J Weir Valentina Assi Hannah Ensor Jennifer H Barnett Jonathan Evans Samantha Green Kirsty Hendry Meigan Thomson Jenny McKeever Duncan G Middleton Stuart Parks Tim Walsh Alexander J Weir Elizabeth Wilson Tara Quasim Alasdair M J MacLullich A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients. PLoS ONE |
author_facet |
Zoë Tieges David J Stott Robert Shaw Elaine Tang Lisa-Marie Rutter Eva Nouzova Nikki Duncan Caoimhe Clarke Christopher J Weir Valentina Assi Hannah Ensor Jennifer H Barnett Jonathan Evans Samantha Green Kirsty Hendry Meigan Thomson Jenny McKeever Duncan G Middleton Stuart Parks Tim Walsh Alexander J Weir Elizabeth Wilson Tara Quasim Alasdair M J MacLullich |
author_sort |
Zoë Tieges |
title |
A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients. |
title_short |
A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients. |
title_full |
A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients. |
title_fullStr |
A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients. |
title_full_unstemmed |
A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients. |
title_sort |
smartphone-based test for the assessment of attention deficits in delirium: a case-control diagnostic test accuracy study in older hospitalised patients. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2020-01-01 |
description |
<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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. |
url |
https://doi.org/10.1371/journal.pone.0227471 |
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