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Development of a smartphone application for the objective detection of attentional deficits in delirium

Published online by Cambridge University Press:  06 March 2015

Zoë Tieges ,
Antaine Stíobhairt ,
Katie Scott ,
Klaudia Suchorab ,
Alexander Weir ,
Stuart Parks ,
Susan Shenkin  and
Alasdair MacLullich
Zoë Tieges*
Affiliation:
Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
Antaine Stíobhairt
Affiliation:
Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK Department of Psychology, University of Edinburgh, Edinburgh, UK
Katie Scott
Affiliation:
Department of Psychology, University of Edinburgh, Edinburgh, UK
Klaudia Suchorab
Affiliation:
Department of Psychology, University of Edinburgh, Edinburgh, UK
Alexander Weir
Affiliation:
Medical Devices Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
Stuart Parks
Affiliation:
Medical Devices Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
Susan Shenkin
Affiliation:
Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
Alasdair MacLullich
Affiliation:
Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
*
Correspondence should be addressed to: Zoë Tieges, Edinburgh Delirium Research Group, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK. Phone: +44 (0) 131 242 6482; Fax: +44 (0)131 242 6370: Email: [email protected].
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Abstract

Background:

Delirium is an acute, severe deterioration in mental functioning. Inattention is the core feature, yet there are few objective methods for assessing attentional deficits in delirium. We previously developed a novel, graded test for objectively detecting inattention in delirium, implemented on a computerized device (Edinburgh Delirium Test Box (EDTB)). Although the EDTB is effective, tests on universally available devices have potential for greater impact. Here we assessed feasibility and validity of the DelApp, a smartphone application based on the EDTB.

Methods:

This was a preliminary case-control study in hospital inpatients (aged 60–96 years) with delirium (N = 50), dementia (N = 52), or no cognitive impairment (N = 54) who performed the DelApp assessment, which comprises an arousal assessment followed by counting of lights presented serially. Delirium was assessed using the Confusion Assessment Method and Delirium Rating Scale-Revised-98 (DRS-R98), and cognition with conventional tests of attention (e.g. digit span) and the short Orientation-Memory-Concentration Test (OMCT).

Results:

DelApp scores (maximum score = 10) were lower in delirium (scores (median(IQR)): 6 (4–7)) compared to dementia (10 (9–10)) and control groups (10 (10–10), p-values < 0.001). Receiver operating characteristic (ROC) analyses revealed excellent accuracy of the DelApp for discriminating delirium from dementia (AUC = 0.93), and delirium from controls (AUC = 0.99, p-values < 0.001). DelApp and DRS-R98 severity scores were moderately well correlated (Kendall's tau = −0.60, p < 0.001). OMCT scores did not differ between delirium and dementia.

Conclusions:

The DelApp test showed good performance, supporting the utility of objectively measuring attention in delirium assessment. This study provides evidence of the feasibility of using a smartphone test for attentional assessment in hospital inpatients with possible delirium, with potential applications in research and clinical practice.

Keywords

deliriumattentionobjectivemeasurementneuropsychologicalsmartphonedementiacognition
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 8 , August 2015 , pp. 1251 - 1262
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn.Arlington, VA: American Psychiatric Publishing.Google Scholar
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.CrossRefGoogle Scholar
Bronnick, K., Emre, M., Lane, R., Tekin, S. and Aarsland, D. (2007). Profile of cognitive impairment in dementia associated with Parkinson's disease compared with Alzheimer's disease. Journal of Neurology, Neurosurgery and Psychiatry, 78, 1064–1068.CrossRefGoogle ScholarPubMed
Brouillette, R. M.et al. (2013). Feasibility, reliability, and validity of a smartphone based application for the assessment of cognitive function in the elderly. PloS One, 8, e65925.CrossRefGoogle ScholarPubMed
Brown, L. J., Fordyce, C., Zaghdani, H., Starr, J. M. and MacLullich, A. M. (2011). Detecting deficits of sustained visual attention in delirium. Journal of Neurology, Neurosurgery and Psychiatry, 82, 1334–1340.CrossRefGoogle ScholarPubMed
Buchanan, T., Heffernan, T. M., Parrott, A. C., Ling, J., Rodgers, J. and Scholey, A. B. (2010). A short self-report measure of problems with executive function suitable for administration via the Internet. Behavior Research Methods, 42, 709–714.CrossRefGoogle Scholar
DeLong, E. R., DeLong, D. M. and Clarke-Pearson, D. L. (1988). Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics, 44, 837–845.CrossRefGoogle ScholarPubMed
Field, A. P., Miles, J. N. V. and Field, Z. C. (2012). Discovering Statistics Using R. London: SAGE Publications.Google Scholar
Greneche, J., Krieger, J., Bertrand, F., Erhardt, C., Maumy, M. and Tassi, P. (2011). Short-term memory performances during sustained wakefulness in patients with obstructive sleep apnea-hypopnea syndrome. Brain and Cognition, 75, 39–50.CrossRefGoogle ScholarPubMed
Hall, R. J., Meagher, D. J. and MacLullich, A. M. (2012). Delirium detection and monitoring outside the ICU. Best Practice & Research: Clinical Anaesthesiology, 26, 367–383.Google ScholarPubMed
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113, 941–948.CrossRefGoogle Scholar
Iverson, G. L. (2001). Interpreting change on the WAIS-III/WMS-III in clinical samples. Archives of Clinical Neuropsychology, 16, 183–191.CrossRefGoogle ScholarPubMed
Jorm, A. F. and Jacomb, P. A. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychological Medicine, 19, 1015–1022.CrossRefGoogle ScholarPubMed
Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R. and Schimmel, H. (1983). Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. American Journal of Psychiatry, 140, 734–739.Google Scholar
Kean, J. and Ryan, K. (2008). Delirium detection in clinical practice and research: critique of current tools and suggestions for future development. Journal of Psychosomatic Research, 65, 255–259.CrossRefGoogle ScholarPubMed
Lines, C. R., Dawson, C., Preston, G. C., Reich, S., Foster, C. and Traub, M. (1991). Memory and attention in patients with senile dementia of the Alzheimer type and in normal elderly subjects. Journal of Clinical and Experimental Neuropsychology, 13, 691–702.CrossRefGoogle ScholarPubMed
Marcantonio, E. R. (2008). Clinical management and prevention of delirium. Psychiatry, 7, 42–48.CrossRefGoogle Scholar
Meagher, D. J., Leonard, M., Donnelly, S., Conroy, M., Saunders, J. and Trzepacz, P. T. (2010). A comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium-dementia and cognitively intact controls. Journal of Neurology, Neurosurgery and Psychiatry, 81, 876–881.CrossRefGoogle ScholarPubMed
Metzler-Baddeley, C. (2007). A review of cognitive impairments in dementia with Lewy bodies relative to Alzheimer's disease and Parkinson's disease with dementia. Cortex, 43, 583–600.CrossRefGoogle ScholarPubMed
Morandi, A.et al. (2012). Tools to detect delirium superimposed on dementia: a systematic review. Journal of the American Geriatrics Society, 60, 2005–2013.CrossRefGoogle ScholarPubMed
Morris, J. C.et al. (1989). The Consortium to Establish a Registry for Alzheimer's disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology, 39, 1159–1165.Google Scholar
O’Keeffe, S. T. and Gosney, M. A. (1997). Assessing attentiveness in older hospital patients: global assessment versus tests of attention. Journal of the American Geriatrics Society, 45, 470–473.CrossRefGoogle ScholarPubMed
O’Regan, N. A.et al. (2014). Attention! A good bedside test for delirium? Journal of Neurology, Neurosurgery and Psychiatry, 85, 1122–1131.CrossRefGoogle ScholarPubMed
Perry, R. J., Watson, P. and Hodges, J. R. (2000). The nature and staging of attention dysfunction in early (minimal and mild) Alzheimer's disease: relationship to episodic and semantic memory impairment. Neuropsychologia, 38, 252–271.CrossRefGoogle ScholarPubMed
Prytherch, D. R., Smith, G. B., Schmidt, P. E. and Featherstone, P. I. (2010). ViEWS–Towards a national early warning score for detecting adult inpatient deterioration. Resuscitation, 81, 932–937.CrossRefGoogle ScholarPubMed
R Core Team (2014). R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing.Google Scholar
Siddiqi, N., House, A. O. and Holmes, J. D. (2006). Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age and Ageing, 35, 350–364.CrossRefGoogle ScholarPubMed
Tieges, Z., Brown, L. J. and Maclullich, A. M. (2014). Objective assessment of attention in delirium: a narrative review. International Journal of Geriatric Psychiatry, 29, 1185–1197.CrossRefGoogle ScholarPubMed
Tieges, Z., McGrath, A., Hall, R. J. and Maclullich, A. M. (2013). Abnormal level of arousal as a predictor of delirium and inattention: an exploratory study. American Journal of Geriatric Psychiatry, 21, 1244–1253.CrossRefGoogle ScholarPubMed
Trzepacz, P. T., Mittal, D., Torres, R., Kanary, K., Norton, J. and Jimerson, N. (2001). Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. Journal of Neuropsychiatry and Clinical Neurosciences, 13, 229–242.CrossRefGoogle ScholarPubMed
Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA, 304, 443–451.CrossRefGoogle ScholarPubMed