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 Gerontol Int 2016; 16: 1028-1035.

Keywords: attention; attention tests; delirium; older people; psychometrics.