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

Tieges, Z. et al. (2020) 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, 15(1), e0227471. (doi: 10.1371/journal.pone.0227471) (PMID:31978127)

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Abstract

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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Quasim, Dr Tara and Thomson, Meigan and Hendry, Miss Kirsty and Clarke, Caoimhe and Evans, Professor Jonathan and Parks, Dr Stuart and Nouzova, Eva and Weir, Mr Alexander and Tieges, Dr Zoe and Stott J, Professor David and Shaw, Mr Robert and McKeever, Jenny
Creator Roles:
Tieges, Z.Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Writing – original draft, Writing – review and editing
Stott, D. J.Conceptualization, Funding acquisition, Investigation, Methodology, Supervision, Writing – original draft, Writing – review and editing
Shaw, R.Investigation, Writing – original draft, Writing – review and editing
Nouzova, E.Investigation, Writing – original draft, Writing – review and editing
Clarke, C.Investigation, Writing – review and editing
Evans, J.Conceptualization, Funding acquisition, Methodology, Supervision, Writing – review and editing
Hendry, K.Investigation, Writing – review and editing
Thomson, M.Investigation, Writing – review and editing
McKeever, J.Investigation, Writing – review and editing
Parks, S.Conceptualization, Funding acquisition, Software
Weir, A. J.Conceptualization, Funding acquisition, Software, Supervision, Writing – review and editing
Quasim, T.Conceptualization, Funding acquisition, Supervision, Writing – review and editing
Authors: Tieges, Z., Stott, D. J., Shaw, R., Tang, E., Rutter, L.-M., Nouzova, E., Duncan, N., Clarke, C., Weir, C. J., Assi, V., Ensor, H., Barnett, J. H., Evans, J., Green, S., Hendry, K., Thomson, M., McKeever, J., Middleton, D. G., Parks, S., Walsh, T., Weir, A. J., Wilson, E., Quasim, T., 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
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:PLoS ONE
Publisher:Public Library of Science
ISSN:1932-6203
ISSN (Online):1932-6203
Copyright Holders:Copyright © 2020 Tieges et al.
First Published:First published in PLoS ONE 15(1): e0227471
Publisher Policy:Reproduced under a Creative Commons License
Data DOI:10.7488/ds/2752

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
190857MICA: Development of a software application for detection and monitoring of attentional deficits in deliriumDavid Stott JMedical Research Council (MRC)MR/L023210/1 RA2870Institute of Cardiovascular & Medical Sciences