The neuropsychology of delirium: advancing the science of delirium assessment

Tieges, Z., Evans, J. J., Neufeld, K. J. and MacLullich, A. M.J. (2017) The neuropsychology of delirium: advancing the science of delirium assessment. International Journal of Geriatric Psychiatry, (doi:10.1002/gps.4711) (PMID:28393426) (Early Online Publication)

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Abstract

Objective: The diagnosis of delirium depends on eliciting its features through mental status examination and informant history. However, there is marked heterogeneity in how these features are assessed, from binary subjective clinical judgement to more comprehensive methods supported by cognitive testing. The aim of this article is to review the neuropsychological research in delirium and suggest future directions in research and clinical practice. Methods: We reviewed the neuropsychological literature on formal assessment and quantification of the different domains in delirium, focusing on the core feature of inattention. Results: Few studies have characterised and quantified the features of delirium using objective methods commonly employed in neuropsychological research. The existing evidence confirms that patients with delirium usually show impairments on objective tests of attention compared with cognitively intact controls and, in most cases, compared with patients with dementia. Further, abnormal level of arousal appears to be a specific indicator of delirium. The neuropsychological evidence base for impairments in other cognitive domains in delirium, including visual perception, language and thought processes, is small. Conclusions: Delirium diagnosis requires accurate testing for its features, but there is little neuropsychological research examining the nature of these features, or evaluating the reliability, validity and discriminatory power of existing assessment processes. More research using the neuropsychological approach has enormous potential to improve and standardise delirium assessment methods of the individual features of delirium, such as inattention, and in developing more robust reference standards to enable greater comparability between studies.

Item Type:Articles
Additional Information:Funded by the Biotechnology and Biological Sciences Research Council, the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, and the Medical Research Council.
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Evans, Professor Jonathan and Tieges, Dr Zoe
Authors: Tieges, Z., Evans, J. J., Neufeld, K. J., and MacLullich, A. M.J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Journal Name:International Journal of Geriatric Psychiatry
Publisher:Wiley
ISSN:0885-6230
ISSN (Online):1099-1166
Published Online:09 April 2017
Copyright Holders:Copyright © 2017 John Wiley & Sons
First Published:First published in International Journal of Geriatric Psychiatry, 2017

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
646501MICA: Development of a software application for detection and monitoring of attentional deficits in deliriumDavid StottMedical Research Council (MRC)MR/L023210/1RI CARDIOVASCULAR & MEDICAL SCIENCES