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©The Author(s) 2020.
World J Psychiatr. Apr 19, 2020; 10(4): 46-58
Published online Apr 19, 2020. doi: 10.5498/wjp.v10.i4.46
Published online Apr 19, 2020. doi: 10.5498/wjp.v10.i4.46
Table 1 Demographic and clinical data for the total group and four neurocognitive groups (mean + SD)
| Total group (n = 180) | Delirium (n = 44) | Comorbid delirium-dementia (n = 60) | Dementia (n = 30) | No neurocognitive disorder (n = 46) | |
| Female (%) | 51% | 53% | 56% | 37% | 48% |
| Age | 79.6 ± 7.2 | 77.7 ± 8.4 | 80.1 ± 7.0 | 81.8 ± 4.6 | 79.3 ± 7.5 |
| Total number of medications | 10.1 ± 4.7 | 10.0 ± 4.2 | 10.3 ± 5.0 | 9.7 ± 4.4 | 10.3 ± 5.1 |
| Number of psychotropics2 | 1.7 ± 1.6 | 1.9 ± 1.6 | 2.2 ± 1.7 | 1.7 ± 1.6 | 0.8 ± 1.1 |
| DRS-R98 total12 | 17.0 ± 9.2 | 22.9 ± 5.7 | 24.0 ± 6.0 | 10.9 ± 4.4 | 6.5 ± 3.3 |
| Short IQCODE3 | 3.7 ± 0.7 | 3.1 ± 0.1 | 4.4 ± 0.5 | 4.0 ± 0.5 | 3.1 ± 0.1 |
Table 2 Performance on the Conventional bedside cognitive tests for the overall population and for each of the neurocognitive diagnostic groups (number completing correctly and %)
| Overall group (n = 180) | Delirium (n = 44) | Comorbid delirium-dementia (n = 60) | Dementia (n = 30) | NNCD (n = 46) | |
| World backwards test | 42 (23) | 6 (14) | 5 (8) | 6 (20) | 25 (54) |
| Months backwards test | 74 (41) | 12 (28) | 8 (13) | 20 (66) | 34 (74) |
| Spatial span forwards | 68 (38) | 14 (32) | 12 (20) | 13 (43) | 29 (63) |
| Spatial span backwards | 67 (37) | 15 (34) | 8 (13) | 15 (50) | 29 (63) |
| Vigilance A test | 88 (49) | 16 (36) | 10 (17) | 23 (77) | 39 (85) |
| Vigilance B test | 49 (27) | 3 (7) | 3 (5) | 13 (43) | 30 (65) |
| Global visuospatial test | 72 (40) | 9 (20) | 15 (25) | 12 (40) | 37 (80) |
| Clock drawing test | 78 (43) | 16 (36) | 13 (22) | 14 (47) | 35 (76) |
| Interlocking pentagons test | 87 (48) | 17 (39) | 14 (23) | 18 (60) | 38 (83) |
Table 3 Accuracy of conventional bedside tests of cognition for delirium diagnosis in the overall population (n = 180) and for those with dementia (n = 90)
| Sensitivity (95%CI) | Specificity (95%CI) | Positive predictive value (95%CI) | Negative predictive value (95%CI) | Overall accuracy (95%CI) | |
| Overall population (n = 180) | |||||
| WORLD | 89.4% (81.9–94.6) | 40.8% (29.7–52.7) | 67.4% (62.9-71.6) | 73.8% (60.2-84.0) | 68.9% (61.6-75.6) |
| MBT | 80.8% (71.9-87.4) | 71.1% (59.5-80.9) | 79.3% (72.6-84.6) | 73.0% (64.0-80.4) | 76.7% (69.8-82.6) |
| SSF | 75.0% (65.6-83.0) | 55.3% (43.4-67.0) | 69.6% (64.0-75.1) | 61.8% (52.3-70.5) | 66.7% (59.3-73.5) |
| SSB | 77.9% (68.7-85.4) | 57.9% (46.0-69.1) | 71.7% (65.6-77.1) | 65.7% (56.0-74.2) | 69.4% (62.2-76.1) |
| Vigilance A | 75.0% (65.6-83.0) | 81.6% (71.0-89.6) | 84.8% (77.4-90.1) | 70.5% (62.7-77.2) | 77.8% (71.0-83.6) |
| Vigilance B | 94.2% (87.9-97.9) | 56.6% (44.7-67.9) | 74.8% (69.6-79.4) | 87.8% (76.3-94.1) | 78.3% (71.6-84.1) |
| GVS | 76.9% (67.6-84.6) | 63.2% (51.3-73.9) | 74.1% (67.6-79.6) | 66.7% (57.5-74.7) | 71.1% (63.9-77.6) |
| CDT | 72.1% (62.5-80.5) | 64.5% (52.7-75.1) | 73.5% (66.7-79.4) | 62.8% (54.3-70.6) | 68.9% (61.6-75.6) |
| IPT | 70.2% (60.4-78.8) | 73.7% (62.3-83.1) | 78.5% (71.1-84.4) | 64.4% (56.6-71.4) | 71.7% (64.5-78.1) |
| Dementia population (n = 90) | |||||
| WORLD | 91.7% (81.6-97.2) | 20.0% (7.7-38.6) | 69.6% (65.4-73.6) | 54.6% (28.5-78.3) | 67.8% (57.1-77.3) |
| MBT | 86.7% (75.4-94.1) | 66.7% (47.2-82.7) | 83.9% (75.6-89.7) | 71.4% (55.6-83.3) | 80.0% (70.3-87.7) |
| SSF | 80.0% (67.7-89.2) | 43.3% (25.5-62.6) | 73.9% (66.8-79.8) | 52.0% (36.1-67.5) | 67.8% (57.1-77.3) |
| SSB | 86.7% (75.4-94.1) | 50.0% (31.3-68.7) | 77.6% (70.5-83.4) | 65.2% (47.3-79.7) | 74.4% (64.2-83.1) |
| Vigilance A | 83.3% (71.5-91.7) | 76.7% (57.7-90.1) | 87.7% (78.1-93.2) | 69.7% (55.8-80.7) | 81.1% (71.5-88.6) |
| Vigilance B | 95.0% (86.1-99.0) | 43.3% (25.5-62.6) | 77.0% (70.9-82.2) | 81.3% (57.2-93.4) | 77.8% (67.8-85.9) |
| GVS | 75.0% (62.1-85.3) | 40.0% (22.7-59.4) | 71.4% ( 64.3-77.6) | 44.4% (30.1-59.8) | 63.3% (52.5-73.3) |
| CDT | 78.3% (65.8-87.9) | 46.7% (28.3 -65.7) | 74.6% (67.2-80.8) | 51.9% (36.8-66.6) | 67.8% (57.1-77.3) |
| IPT | 76.7% (64.0-86.6) | 60.0% (40.6-77.3) | 79.3% (70.8-85.9) | 56.3% (42.7-68.9) | 71.1% (60.6-80.2) |
Table 4 Performance on Letter and Shape Drawing test and Lighthouse components (number completing correctly and %)
| Overall group (n = 180) | Delirium (n = 44) | Comorbid delirium-dementia (n = 60) | Dementia (n = 30) | NNCD (n = 46) | |
| LH-identification | 60 (33) | 16 (36) | 11 (18) | 10 (33) | 24 (52) |
| LH-FA | 83 (46) | 18 (41) | 14 (23) | 20 (66) | 31 (67) |
| LH-SA | 64 (36) | 9 (21) | 7 (12) | 18 (60) | 30 (65) |
| LSD | 84 (48) | 17 (39) | 10 (17) | 19 (63) | 38 (83) |
Table 5 Accuracy of Lighthouse components and Letter and Shape Drawing test for delirium diagnosis in the overall population (n = 180) and in those with dementia (n = 90)
| Sensitivity (95%CI) | Specificity (95%CI) | Positive predictive value (95%CI) | Negative predictive value (95%CI) | Overall accuracy (95%CI) | ||
| Overall population (n = 180) | ||||||
| LH-ID | 74.0% (64.5-82.1) | 44.7% (33.3-6.6) | 64.7% (59.2-69.8) | 55.7% (45.5- 65.5) | 61.7% (54.1-68.8) | |
| LH-FA | 69.2% (59.4-77.9) | 67.1% (55.4-77.5) | 74.2% (67.1-80.3) | 61.5% (53.4- 68.9) | 68.3% (61.0-75.1) | |
| LH-SA | 84.6% (76.2-90.9) | 63.2% (51.3-73.9) | 75.9% (69.8-81.0) | 75.0% (64.9-82.9) | 75.6% (68.6-81.6) | |
| LSD | 74.0% (64.5-82.1) | 75.0% (63.7-84.2) | 80.2% (73.0-85.9) | 67.9% (59.8-75.0) | 74.4% (67.4-80.6) | |
| Dementia population (n = 90) | ||||||
| LH-ID | 81.7% (69.6-90.5) | 33.3% (17.3-52.8) | 71.0% (64.9-76.4) | 47.6% ( 30.3-65.5) | 65.6% (54.8-75.3) | |
| LH-FA | 76.7% (64.0-86.6) | 66.7% (47.2-82.7) | 82.1% (73.1-88.6) | 58.8% (45.8-70.7) | 73.3% (63.0-82.1) | |
| LH-SA | 88.3% (77.4-95.2) | 60.0% (40.6-77.3) | 81.5% (73.8-87.4) | 72.0% (54.7-84.6) | 78.9% (69.0-86.8) | |
| LSD | 83.3% (71.5-91.7) | 63.3 % (43.9-80.1) | 82.0% (73.7-88.1) | 65.5% (50.4- 78.1) | 76.7% (66.6- 84.9) | |
Table 6 Most accurate combinations of conventional bedside tests and the combined sustained attention of Lighthouse/Letter and Shape Drawing Test
| Sensitivity (95%CI) | Specificity (95%CI) | Positive predictive value (95%CI) | Negative predictive value (95%CI) | Overall accuracy (95%CI) | |
| Overall population (n = 180) | |||||
| MBT plus GVS | 93.3% (86.6-97.3) | 48.7% (37.0-60.4) | 71.3% (66.5-75.7) | 84.1% (71.4-91.8) | 74.4% (67.4-80.6) |
| Vig A plus GVS | 92.3% (85.4-96.6) | 57.9% (46.0-69.1) | 75.0% (69.6-79.7) | 84.6% (73.3-91.7) | 77.8% (71.0-83.6) |
| Vig A plus Vig B | 93.3% (86.6-97.3) | 57.9% (46.0-69.1) | 75.2% (69.9-79.9) | 86.3% (75.0-93.0) | 78.3% (71.6-84.1) |
| MBT plus Vig A | 90.4% (83.0-95.3) | 61.8 % (50.0-72.8) | 76.4% (70.7-81.3) | 82.5% (71.8- 89.7) | 78.3% (71.6- 84.1) |
| LSD-4 plus Lighthouse-SA | 91.4% (84.2-96.0) | 51.3 % (39.6-63.0) | 72.0 % (66.9-76.5) | 81.3% (69.1-89.4) | 74.4% (67.4-80.6) |
| Dementia population (n = 90) | |||||
| MBT plus GVS | 93.3% (83.8-98.1) | 30.0% (14.7-49.4) | 72.7% (67.6-77.3) | 69.2% 43.0-87.0) | 72.2% (61.8-81.2) |
| Vig A plus GVS | 95.0% (86.1-98.9) | 33.3% (17.3- 52.8) | 74.0% (68.7- 78.7) | 76.9% (49.8-91.8) | 74.4% (64.2- 83.1) |
| Vig A plus Vig B | 95.0% (86.1-98.9) | 43.3% (25.5-62.6) | 77.0% (70.9-82.2) | 81.3 (57.2-93.4) | 77.8% (67.8-85.9) |
| MBT plus Vig A | 95.0% (86.1-98.9) | 50.0% (31.3-68.7) | 79.2% (72.6-84.5) | 83.3% (61.1-94.1) | 80.0% (70.3-87.7) |
| LSD-4 plus LH-SA | 95.0% (86.1-99.0) | 43.3% (25.5-62.6) | 77.0% (70.9-82.2) | 81.3% (57.2-93.4) | 77.8% (67.8-85.9) |
- Citation: 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
- URL: https://www.wjgnet.com/2220-3206/full/v10/i4/46.htm
- DOI: https://dx.doi.org/10.5498/wjp.v10.i4.46