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) (PMCID:PMC6980392)
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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 |
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| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Clarke, Miss Caoimhe and Weir, Mr Alexander and Hendry, Miss Kirsty and Evans, Professor Jonathan and Shaw, Mr Robert and Tieges, Dr Zoe and Parks, Dr Stuart and Nouzova, Eva and Quasim, Professor Tara and Stott J, Professor David and McKeever, Jenny and Thomson, Dr Meigan |
| 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 > 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 College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU |
| 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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