Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-18T20:32:11.568Z Has data issue: false hasContentIssue false
  • English
  • Français

Attention, vigilance, and visuospatial function in hospitalized elderly medical patients: relationship to delirium syndromal status and motor subtype profile

Published online by Cambridge University Press:  18 December 2017

Cara Daly ,
Maeve Leonard ,
Henry O'Connell ,
Olugbenga Williams ,
Fahad Awan ,
Chris Exton ,
Margaret O'Connor ,
Dimitrios Adamis ,
Colum P. Dunne  and
Walter Cullen
...Show all authors
Cara Daly
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
Maeve Leonard
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
Henry O'Connell
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland Laois-Offaly Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland
Olugbenga Williams
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
Fahad Awan
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
Chris Exton
Affiliation:
Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
Margaret O'Connor
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland Department of Geriatric Medicine, University Hospital Limerick, Limerick, Ireland
Dimitrios Adamis
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland Sligo Mental Health Services, Ballytivan, Sligo, Ireland
Colum P. Dunne
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
Walter Cullen
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
David J. Meagher*
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
*
Correspondence should be addressed to: David Meagher, Professor, Graduate-Entry Medical School, University of Limerick, Ireland. Phone: 00353-61-202700. Email: david.meagher@ul.ie.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The early and effective detection of neurocognitive disorders poses a key diagnostic challenge. We examined performance on common cognitive bedside tests according to differing delirium syndromal status and clinical (motor) subtypes in hospitalized elderly medical inpatients.

Methods:

A battery of nine bedside cognitive tests was performed on elderly medical inpatients with DSM-IV delirium, subsyndromal delirium (SSD), and no delirium (ND). Patients with delirium were compared according to clinical (motor) subtypes.

Results:

A total of 198 patients (mean age 79.14 ± 8.26) were assessed with full syndromal delirium (FSD: n = 110), SSD (n = 45), and ND (n = 43). Delirium status was not associated with differences in terms of gender distribution, age, or overall medication use. Dementia burden increased with greater delirium status. Overall, the ability to meaningfully engage with the tests varied from 59% for the Vigilance B test to 85% for Spatial Span Forward test and was lowest in patients with FSD, where engagement ranged from 32% for the Vigilance B test to 77% for the Spatial Span Forwards test. The ND group was distinguished from SSD group for the Months of the year backwards, Vigilance B, global VSP, Clock Drawing test, and Interlocking Pentagons test. The SSD group was distinguished from the FSD group by Vigilance A, Spatial Span Forward, and Spatial Span Backwards. Regarding differences among motor subtypes in terms of percentage engagement and performance, the No subtype group had higher ratings across all tests. Delirious patients with no subtype had significantly lower scores on the DRS-R98 than for the other three subtype categories.

Conclusions:

Simple bedside tests of attention, vigilance, and visuospatial ability are useful in distinguishing neurocognitive disorders, including SSD from other presentations.

Keywords

deliriumdementiaphenomenologyassessmentdiagnosisclinical subtypesubsyndromal
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 4: Issue Theme: Delirium , April 2018 , pp. 493 - 501
Copyright
Copyright © International Psychogeriatric Association 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association and American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM) (1994) (pp. 143–147). Washington, DC: American Psychiatric Association.Google Scholar
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 & Psychiatry, 82, 1334–1340.CrossRefGoogle ScholarPubMed
Duppils, G. S. and Wikblad, K. (2004). Delirium: behavioural changes before and during the prodromal phase. Journal of Clinical Nursing 13, 609–616.CrossRefGoogle ScholarPubMed
European Delirium Association (2014). The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC Medicine, 12, 141.Google Scholar
Fong, T. G., Tulebraev, S. R. and Inouye, S. K. (2009). Delirium in elderly adults: diagnosis, prevention and treatment. Neurology, 5, 210–220.Google ScholarPubMed
González, M. et al. (2009). Impact of delirium on short-term mortality in elderly inpatients: a prospective cohort study. Psychosomatics, 50, 234–238.Google Scholar
Hakim, S. M., Othman, A. I. and Naoum, D. O. (2012). Early treatment with risperidone for subsyndromal delirium after on-pump cardiac surgery in the elderly a randomized trial. The Journal of the American Society of Anesthesiologists, 116, 987–997.Google ScholarPubMed
Kakuma, R. et al. (2003). Delirium in older emergency department patients discharged home: effect on survival. Journal of the American Geriatrics Society, 51, 443–450.Google Scholar
Leonard, M. et al. (2016). Attention, vigilance and visuospatial function in hospitalized elderly medical patients: relationship to neurocognitive diagnosis. Journal of Psychosomatic Research, 90, 84–90.Google Scholar
Levkoff, S. E. et al. (1994). Progression and resolution of delirium in elderly patients hospitalized for acute care. The American Journal of Geriatric Psychiatry, 2, 230–238.CrossRefGoogle ScholarPubMed
Marquis, F., Ouimet, S., Riker, R., Cossette, M. and Skrobik, Y. (2007). Individual delirium symptoms: do they matter?. Critical Care Medicine, 35, 2533–2537.CrossRefGoogle ScholarPubMed
Martins, S. and Fernandes, L. (2012). Delirium in elderly people: a review. Cognitive Impairment and Dementia–An Update, 3, 101.Google Scholar
Meagher, D. (2009). Motor subtypes of delirium: past, present and future. International Review of Psychiatry, 21, 59–73.Google Scholar
Meagher, D. et al. (2014). Frequency of delirium and subsyndromal delirium in an adult acute hospital population. The British Journal of Psychiatry, 205, 478–485.Google Scholar
Meagher, D. J. et al. (2007). Phenomenology of delirium. The British Journal of Psychiatry, 190, 135–141.CrossRefGoogle ScholarPubMed
Meagher, D., Adamis, D., Trzepacz, P. and Leonard, M., (2012). Features of subsyndromal and persistent delirium. The British Journal of Psychiatry, 200, 37–44.CrossRefGoogle ScholarPubMed
O'Hanlon, S. et al. (2014). Improving delirium care through early intervention: from bench to bedside to boardroom. Journal of Neurology, Neurosurgery and Psychiatry, 85, 207–213.Google Scholar
Ryan, D. J. et al. (2013). Delirium in an adult acute hospital population: predictors, prevalence and detection. BMJ Open, 3, e001772.CrossRefGoogle Scholar
Sepulveda, E. et al. (2016). Subsyndromal delirium compared with delirium, dementia, and subjects without delirium or dementia in elderly general hospital admissions and nursing home residents. Alzheimer's and Dementia: Diagnosis, Assessment & Disease Monitoring, 7, 1–10.Google ScholarPubMed
Silverberg, N. B. et al. (2011). Assessment of cognition in early dementia. Alzheimer's & Dementia, 7, e60–e76.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. The American Journal of Geriatric Psychiatry, 21, 1244–1253.Google Scholar
Witlox, J., Eurelings, L. S. M., de Jonghe, J. F. M., 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
World Medical Association. (2001). World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bulletin of the World Health Organisation, 79, 373–374.Google Scholar
Woodford, H. J. and George, J. (2007). Cognitive assessment in the elderly: a review of clinical methods. Qjm, 100, 469–484.Google Scholar
Zuliani, G. et al. (2013). Subsyndromal delirium and its determinants in elderly patients hospitalized for acute medical illness. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 68, 1296–1302.Google Scholar