A Novel Computerized Test for Detecting and Monitoring Visual Attentional Deficits and Delirium in the ICU

Green, Cameron; Hendry, Kirsty; Wilson, Elizabeth; Walsh, Timothy; Allerhand, Mike; MacLullich, Alasdair M.J.; Tieges, Zoë

doi:10.1097/ccm.0000000000002477

Cited by 7 publications

(12 citation statements)

References 25 publications

(29 reference statements)

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“…This preliminary study demonstrated initial feasibility and validity of a smartphone test for detecting and monitoring attention and arousal impairments in delirium in the ICU. In the present exploratory work, the DelApp-ICU had excellent diagnostic performance in a selected sample of ICU patients, consistent with previous findings using a hardware version of the test [18]. DelApp-ICU scores were responsive to a within-person change in delirium diagnosis according to the CAM-ICU.…”

Section: Discussionsupporting

confidence: 90%

“…Exclusion criteria were age under 18 years, known pre-existing cognitive impairment, brain injury, visual or hearing impairments severe enough to preclude cognitive testing, and photosensitive epilepsy. Patients with a Richmond Agitation and Sedation Scale Score (RASS) of ≤ -3 (any movement (but no eye contact) to voice) [20] were excluded so as to align with the criteria of a previous study [18], and because this was an exploratory study, we wanted to include as many ICU patients in our sample able to undergo the sustained counting task (Figure 1). The sample size was determined based on a previous pilot study using the EDTB-ICU, where large effect sizes were found [18].…”

Section: Main Studymentioning

confidence: 99%

“…A pilot study using a modified paradigm (EDTB-ICU) suggested that this test also performs well in detecting delirium in ICU patients with RASS> -3. The EDTB-ICU also showed promising utility for longitudinally tracking attentional deficits [18].…”

Section: Introductionmentioning

confidence: 99%

“…More recently we have developed a modified DelApp for use in ICU settings. The DelApp-ICU is based on the EDTB-ICU [18]; it includes a brief behavioural assessment and is suitable for use in non-verbal patients.…”

Section: Introductionmentioning

confidence: 99%

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Development and feasibility of a smartphone-based test for the objective detection and monitoring of attention impairments in delirium in the ICU

Tang

Laverty

Weir³

et al. 2018

Journal of Critical Care

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Section: Discussionsupporting

confidence: 90%

Section: Main Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Development and feasibility of a smartphone-based test for the objective detection and monitoring of attention impairments in delirium in the ICU

Tang

Laverty

Weir³

et al. 2018

Journal of Critical Care

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“…To help address the need for objective bedside tests of attention suitable for use in older hospitalised patients with delirium and/or dementia, we previously developed a neuropsychological test of sustained and focused attention implemented on a purpose-built computerised device called the Edinburgh Delirium Test Box (EDTB; [ 13 , 20 , 21 ]). We subsequently developed a prototype software application for smartphones (‘DelApp’) which is based on the EDTB tasks [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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BackgroundDelirium 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.MethodsThis 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.DiscussionThis 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 registrationClinical trials.gov, NCT02590796. Registered on 29 Oct 2015. Protocol version 5, dated 25 July 2016.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0901-5) contains supplementary material, which is available to authorized users.

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A systematic review of studies reporting on neuropsychological and functional domains used for assessment of recovery from delirium in acute hospital patients

McCartney

Noble

MacLullich

et al. 2023

Int J Geriat Psychiatry

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Objectives Assessing for recovery in delirium is essential in guiding ongoing investigation and treatment. Yet, there is little scrutiny and no research or clinical consensus on how recovery should be measured. We reviewed studies which used tests of neuropsychological domains and functional ability to track recovery of delirium longitudinally in acute hospital settings. Methods/Design We systematically searched databases (MEDLINE, PsycInfo, CINAHL, Embase, http://ClinicalTrials.gov, Cochrane Central Register of Controlled Trials), from inception to October 14th, 2022. Inclusion criteria were: adult acute hospital patients (≥18 years) diagnosed with delirium by a validated tool; 1+ repeat assessment using an assessment tool measuring domains of delirium/functional recovery ≤7 days from baseline. Two reviewers independently screened articles, performed data extraction, and assessed risk of bias. A narrative data synthesis was completed. Results From 6533 screened citations, we included 39 papers (reporting 32 studies), with 2370 participants with delirium. Studies reported 21 tools with an average of four repeat assessments including baseline (range 2–10 assessments within ≤7 days), measuring 15 specific domains. General cognition, functional ability, arousal, attention and psychotic features were most commonly assessed for longitudinal change. Risk of bias was moderate to high for most studies. Conclusions There was no standard approach for tracking change in specific domains of delirium. The methodological heterogeneity of studies was too high to draw firm conclusions on the effectiveness of assessment tools to measure delirium recovery. This highlights the need for standardised methods for assessing recovery from delirium.

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A Novel Computerized Test for Detecting and Monitoring Visual Attentional Deficits and Delirium in the ICU

Cited by 7 publications

References 25 publications

Development and feasibility of a smartphone-based test for the objective detection and monitoring of attention impairments in delirium in the ICU

Development and feasibility of a smartphone-based test for the objective detection and monitoring of attention impairments in delirium in the ICU

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

A systematic review of studies reporting on neuropsychological and functional domains used for assessment of recovery from delirium in acute hospital patients

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