Diagnostic test accuracy of a novel smartphone application for the assessment of attention deficits in delirium in older hospitalised patients: a prospective cohort study protocol

Rutter, L.-M. et al. (2018) Diagnostic test accuracy of a novel smartphone application for the assessment of attention deficits in delirium in older hospitalised patients: a prospective cohort study protocol. BMC Geriatrics, 18, 217. (doi: 10.1186/s12877-018-0901-5) (PMID:30223771) (PMCID:PMC6142423)

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Background: Delirium is a common and serious clinical syndrome which is often missed in routine clinical care. The core cognitive feature is inattention. We developed a novel bedside neuropsychological test for assessing inattention in delirium implemented on a smartphone platform (DelApp). We aim to evaluate the diagnostic performance of the DelApp in a representative cohort of older hospitalised patients. Methods: This is a prospective study of older non-scheduled hospitalised patients (target n = 500, age ≥ 65), recruited from elderly care and acute orthopaedic wards. Exclusion criteria are: non-English speakers; severe vision or hearing impairment; photosensitive epilepsy. A structured reference standard delirium assessment based on DSM-5 criteria will be used, which includes a cognitive test battery administered by a trained assessor (Orientation-Memory-Concentration Test, Abbreviated Mental Test-10, Delirium Rating Severity Scale-Revised-98, digit span, months and days backwards, Vigilance A’ test) and assessment of arousal (Observational Scale of Level of Arousal, Richmond Agitation Sedation Scale). Prior change in cognition will be documented using the Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be categorized as delirium (with/without dementia), possible delirium, dementia, no cognitive impairment, or undetermined. A separate assessor (blinded to diagnosis and assessments) will administer the DelApp index test within 3 h of the reference standard assessment. The DelApp comprises assessment of arousal (score 0-4) and sustained attention (score 0-6), yielding a total score between 0 and 10 (higher score = better performance). Outcomes (length of stay, mortality and discharge location) will be collected at 12 weeks. We will evaluate a priori cutpoints derived from a previous case-control study. Measures of the accuracy of DelApp will include sensitivity, specificity, positive and negative predictive values, and area under the ROC curve. We plan repeat assessments on up to 4 occasions in a purposive subsample of 30 patients (15 delirium, 15 no delirium) to examine changes over time. Discussion: This study evaluates the diagnostic test accuracy of a novel smartphone test for delirium in a representative cohort of older hospitalised patients, including those with dementia. DelApp has the potential to be a convenient, objective method of improving delirium assessment for older people in acute care. Trial registration: Clinical trials.gov, NCT02590796. Registered on 29 Oct 2015. Protocol version 5, dated 25 July 2016.

Item Type:Articles
Additional Information:This work was funded by the Medical Research Council (MRC) through a Developmental Pathway Funding Scheme, reference MR/L023210/1 (PI: AMJM). AMJM and ZT are members of the University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology which was funded by the Biotechnology and Biological Sciences Research Council and MRC as part of the Lifelong Health & Wellbeing cross-Council initiative (MR/K026992/1).
Keywords:Attention, cognition, consecutive series, delirium, dementia, diagnostic accuracy study, neuropsychological test, prospective study, smartphone test.
Glasgow Author(s) Enlighten ID:Quasim, Professor Tara and Thomson, Meigan and Hendry, Miss Kirsty and Evans, Professor Jonathan and Clarke, Miss Caoimhe and Stott J, Professor David and Shaw, Mr Robert
Authors: Rutter, L.-M., Nouzova, E., Stott, D. J., Weir, C. J., Assi, V., Barnett, J. H., Clarke, C., Duncan, N., Evans, J., Green, S., Hendry, K., McGinlay, M., McKeever, J., Middleton, D. G., Parks, S., Shaw, R., Tang, E., Walsh, T., Weir, A. J., Wilson, E., Quasim, T., MacLullich, A. M.J., and Tieges, Z.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:BMC Geriatrics
Publisher:BioMed Central
ISSN (Online):1471-2318
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in BMC Geriatrics 18: 217
Publisher Policy:Reproduced under a Creative Commons License

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