Evaluating attention in delirium: A comparison of bedside tests of attention

Abstract

Aim: Impaired attention is a core diagnostic feature for delirium. The present study examined the discriminating properties for patients with delirium versus those with dementia and/or no neurocognitive disorder of four objective tests of attention: digit span, vigilance "A" test, serial 7s subtraction and months of the year backwards together with global clinical subjective rating of attention.Methods: This as a prospective study of older patients admitted consecutively in a general hospital. Participants were assessed using the Confusion Assessment Method, Delirium Rating Scale-98 Revised and Montreal Cognitive Assessment scales, and months of the year backwards. Pre-existing dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria. Results:The sample consisted of 200 participants (mean age 81.1 ± 6.5 years; 50% women; pre-existing cognitive impairment in 126 [63%]). A total of 34 (17%) were identified with delirium (Confusion Assessment Method +). The five approaches to assessing attention had statistically significant correlations (P < 0.05). Discriminant analysis showed that clinical subjective rating of attention in conjunction with the months of the year backwards had the best discriminatory ability to identify Confusion Assessment Method-defined delirium, and to discriminate patients with delirium from those with dementia and/or normal cognition. Both of these approaches had high sensitivity, but modest specificity. Conclusion:Objective tests are useful for prediction of non-delirium, but lack specificity for a delirium diagnosis. Global attentional deficits were more indicative of delirium than deficits of specific domains of attention. Geriatr

The neuropsychology of delirium: advancing the science of delirium assessment

“…Studies have used a range of tests for measuring attention in delirium including vigilance tests, the months of the year backward (MOTYB) test and counting up tasks (e.g. Adamis et al, 2016;Brown et al, 2011;Meagher et al, 2010;O'Keeffe and Gosney, 1997;O'Regan et al, 2014). Most of these tests involve different types of attention and differ in terms of the demands placed on other cognitive, overlapping processes including (working) memory and executive function (Corbetta and Shulman, 2002).…”

Delirium pathway: a North Hampshire experience

“…Such simple assessment has been found to be superior to structured tests of attention. 8,9 A Montreal Cognitive Assessment (MoCA) test was done at the beginning and end of the pathway. This test was employed after initial use of the Mini Mental State Examination (MMSE) because of its higher sensitivity in identifying mild cognitive impairment (MCI).…”

Benzodiazepines and/or neuroleptics for the treatment of delirium in palliative care?—a critical appraisal of recent randomized controlled trials

“…The DSM-5 definition now relies on disturbance of cognition such as memory deficit, disorientation, language, visuospatial ability, or perception (1). In addition, disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment) are mandatory features (3)(4)(5). However, while the DSM-5 definition is used widely in clinical and research settings, it does not represent a consensus definition in all fields of medicine.…”