Meagher DJ, O’Connell H, Leonard M, Williams O, Awan F, Exton C, Tenorio M, O’Connor M, Dunne CP, Cullen W, McFarland J, Adamis D. Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients. World J Psychiatr 2020; 10(4): 46-58 [PMID: 32399398 DOI: 10.5498/wjp.v10.i4.46]
Corresponding Author of This Article
David J Meagher, MD, PhD, Chairman, Professor, Head, Department of Psychiatry, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland. david.meagher@ul.ie
Research Domain of This Article
Psychiatry
Article-Type of This Article
Basic Study
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Meagher DJ, O’Connell H, Leonard M, Williams O, Awan F, Exton C, Tenorio M, O’Connor M, Dunne CP, Cullen W, McFarland J, Adamis D. Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients. World J Psychiatr 2020; 10(4): 46-58 [PMID: 32399398 DOI: 10.5498/wjp.v10.i4.46]
World J Psychiatr. Apr 19, 2020; 10(4): 46-58 Published online Apr 19, 2020. doi: 10.5498/wjp.v10.i4.46
Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients
Dimitrios Adamis, John McFarland, Walter Cullen, Colum P Dunne, Margaret O’Connor, Michael Tenorio, Chris Exton, Fahad Awan, Olugbenga Williams, Maeve Leonard, Henry O’Connell, David J Meagher
David J Meagher, Henry O’Connell, Maeve Leonard, Olugbenga Williams, Fahad Awan, Margaret O’Connor, Colum P Dunne, Walter Cullen, John McFarland, Dimitrios Adamis, Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland
Chris Exton, Michael Tenorio, Department of Computer Sciences, University of Limerick, Limerick V94 YVHO, Ireland
Walter Cullen, School of Medicine, University College Dublin, Dublin 4 D04 V1W8, Ireland
Author contributions: Meagher DJ, O’Connell H, Leonard M, Williams O, Awan F, Exton C, Tenorio M, O’Connor M, Dunne CP, Cullen W, McFarland J and Adamis D contributed to the writing and revising of the manuscript; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by University Hospital Limerick Regional Ethics Committee approved (REC 100/12).
Conflict-of-interest statement: The authors have no conflicts of interest to declare other than that they are members of the Cognitive Impairment Research Group (CIRG) that developed the Lighthouse and LSD tests described in this study.
Data sharing statement: No additional data are available.
Corresponding author: David J Meagher, MD, PhD, Chairman, Professor, Head, Department of Psychiatry, Graduate Entry Medical School, University of Limerick, Limerick V94 YVHO, Ireland. david.meagher@ul.ie
Received: October 2, 2019 Peer-review started: October 2, 2019 First decision: November 6, 2019 Revised: January 17, 2020 Accepted: March 4, 2020 Article in press: March 4, 2020 Published online: April 19, 2020 Processing time: 197 Days and 21.9 Hours
ARTICLE HIGHLIGHTS
Research background
Efficient detection of delirium and comorbid delirium-dementia is a key diagnostic challenge. It’s a key challenge of developing of new, efficient delirium-focused methods of cognitive assessment for improved detection of neurocognitive disorders in everyday clinical practice.
Research motivation
This study the accuracy of a series of commonly used conventional tests as well as these novel tests in the detection of delirium in a real world sample of older hospital medical patients.
Research objectives
The authors aimed to compare the accuracy of two novel bedside tests of attention, vigilance and visuospatial function with conventional bedside cognitive tests in identifying delirium in older hospitalized patients.
Research methods
This cognitive performance study was conducted in referrals to a consultation-liaison psychiatry service of patients with delirium, dementia, comorbid delirium-dementia, as well as comparison subjects with no neurocognitive diagnosis. Altered mental state consecutive cases were identified on daily rounds.
Research results
All conventional tests had sensitivity of > 70% for delirium, with best overall accuracy for the Vigilance-B, Vigilance-A and Months Backward tests. The sustained attention component of the Lighthouse Test was the most distinguishing of delirium.
Research conclusions
Vigilance and visuospatial ability can help to distinguish neurocognitive disorders, including delirium, from other presentations. The Lighthouse test, Letter and Shape Drawing test are novel tests with high accuracy for detecting delirium.
Research perspectives
Lighthouse test, Letter and Shape Drawing tests’ impact upon delirium detection in everyday practice warrants further study.
