A smartphone-based test for the assessment of attention deficits in delirium: a case-control diagnostic test accuracy study in older hospitalised patients

Zoe Tieges, David J. Stott, Robert Shaw, Elaine Tang, Lisa-Marie Rutter, Eva Nouzova, Nikki Duncan, Caoimhe Clarke, Christopher J. Weir, Valentina Assi, Hannah Ensor, Jennifer H. Barnett, Jonathan Evans, Samantha Green, Kirsty Hendry, Meigan Thomson, Jenny McKeever, Duncan G. Middleton, Stuart Parks, Tim WalshAlexander J. Weir, Elizabeth Wilson, Tara Quasim, Alasdair M.J. MacLullich

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Abstract

BACKGROUND: Delirium is a common and serious acute neuropsychiatric syndrome which is often missed in routine clinical care. Inattention is the core cognitive feature. Diagnostic test accuracy (including cut-points) of a smartphone Delirium App (DelApp) for assessing attention deficits was assessed in older hospital inpatients. METHODS: This was a case-control study of hospitalised patients aged ≥65 years with delirium (with or without pre-existing cognitive impairment), who were compared to patients with dementia without delirium, and patients without cognitive impairment. Reference standard delirium assessment, which included a neuropsychological test battery, was based on Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A separate blinded assessor administered the DelApp arousal assessment (score 0-4) and attention task (0-6) yielding an overall score of 0 to 10 (lower scores indicate poorer performance). Analyses included receiver operating characteristic curves and sensitivity and specificity. Optimal cut-points for delirium detection were determined using Youden's index. RESULTS: A total of 187 patients were recruited, mean age 83.8 (range 67-98) years, 152 (81%) women; n = 61 with delirium; n = 61 with dementia without delirium; and n = 65 without cognitive impairment. Patients with delirium performed poorly on the DelApp (median score = 4/10; inter-quartile range 3.0, 5.5) compared to patients with dementia (9.0; 5.5, 10.0) and those without cognitive impairment (10.0; 10.0, 10.0). Area under the curve for detecting delirium was 0.89 (95% Confidence Interval 0.84, 0.94). At an optimal cut-point of ≤8, sensitivity was 91.7% (84.7%, 98.7%) and specificity 74.2% (66.5%, 81.9%) for discriminating delirium from the other groups. Specificity was 68.3% (56.6%, 80.1%) for discriminating delirium from dementia (cut-point ≤6). CONCLUSION: Patients with delirium (with or without pre-existing cognitive impairment) perform poorly on the DelApp compared to patients with dementia and those without cognitive impairment. A cut-point of ≤8/10 is suggested as having optimal sensitivity and specificity. The DelApp is a promising tool for assessment of attention deficits associated with delirium in older hospitalised adults, many of whom have prior cognitive impairment, and should be further validated in representative patient cohorts.
Original languageEnglish
Article numbere0227471
JournalPLoS ONE
Volume15
Issue number1
DOIs
Publication statusPublished - 24 Jan 2020

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Delirium
Smartphones
Routine Diagnostic Tests
Application programs
diagnostic techniques
dementia
testing
Dementia
Smartphone
behavior disorders
reference standards
case-control studies
confidence interval
Patient Advocacy
Sensitivity and Specificity
Neuropsychological Tests

Keywords

  • DelApp
  • delirium
  • smartphones
  • diagnostic tests
  • hospitalised patients

Cite this

Tieges, Zoe ; Stott, David J. ; Shaw, Robert ; Tang, Elaine ; Rutter, Lisa-Marie ; Nouzova, Eva ; Duncan, Nikki ; Clarke, Caoimhe ; Weir, Christopher J. ; Assi, Valentina ; Ensor, Hannah ; Barnett, Jennifer H. ; Evans, Jonathan ; Green, Samantha ; Hendry, Kirsty ; Thomson, Meigan ; McKeever, Jenny ; Middleton, Duncan G. ; Parks, Stuart ; Walsh, Tim ; Weir, Alexander J. ; Wilson, Elizabeth ; Quasim, Tara ; MacLullich, Alasdair M.J. / A smartphone-based test for the assessment of attention deficits in delirium: a case-control diagnostic test accuracy study in older hospitalised patients. In: PLoS ONE . 2020 ; Vol. 15, No. 1.
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title = "A smartphone-based test for the assessment of attention deficits in delirium: a case-control diagnostic test accuracy study in older hospitalised patients",
abstract = "BACKGROUND: Delirium is a common and serious acute neuropsychiatric syndrome which is often missed in routine clinical care. Inattention is the core cognitive feature. Diagnostic test accuracy (including cut-points) of a smartphone Delirium App (DelApp) for assessing attention deficits was assessed in older hospital inpatients. METHODS: This was a case-control study of hospitalised patients aged ≥65 years with delirium (with or without pre-existing cognitive impairment), who were compared to patients with dementia without delirium, and patients without cognitive impairment. Reference standard delirium assessment, which included a neuropsychological test battery, was based on Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A separate blinded assessor administered the DelApp arousal assessment (score 0-4) and attention task (0-6) yielding an overall score of 0 to 10 (lower scores indicate poorer performance). Analyses included receiver operating characteristic curves and sensitivity and specificity. Optimal cut-points for delirium detection were determined using Youden's index. RESULTS: A total of 187 patients were recruited, mean age 83.8 (range 67-98) years, 152 (81{\%}) women; n = 61 with delirium; n = 61 with dementia without delirium; and n = 65 without cognitive impairment. Patients with delirium performed poorly on the DelApp (median score = 4/10; inter-quartile range 3.0, 5.5) compared to patients with dementia (9.0; 5.5, 10.0) and those without cognitive impairment (10.0; 10.0, 10.0). Area under the curve for detecting delirium was 0.89 (95{\%} Confidence Interval 0.84, 0.94). At an optimal cut-point of ≤8, sensitivity was 91.7{\%} (84.7{\%}, 98.7{\%}) and specificity 74.2{\%} (66.5{\%}, 81.9{\%}) for discriminating delirium from the other groups. Specificity was 68.3{\%} (56.6{\%}, 80.1{\%}) for discriminating delirium from dementia (cut-point ≤6). CONCLUSION: Patients with delirium (with or without pre-existing cognitive impairment) perform poorly on the DelApp compared to patients with dementia and those without cognitive impairment. A cut-point of ≤8/10 is suggested as having optimal sensitivity and specificity. The DelApp is a promising tool for assessment of attention deficits associated with delirium in older hospitalised adults, many of whom have prior cognitive impairment, and should be further validated in representative patient cohorts.",
keywords = "DelApp, delirium, smartphones, diagnostic tests, hospitalised patients",
author = "Zoe Tieges and Stott, {David J.} and Robert Shaw and Elaine Tang and Lisa-Marie Rutter and Eva Nouzova and Nikki Duncan and Caoimhe Clarke and Weir, {Christopher J.} and Valentina Assi and Hannah Ensor and Barnett, {Jennifer H.} and Jonathan Evans and Samantha Green and Kirsty Hendry and Meigan Thomson and Jenny McKeever and Middleton, {Duncan G.} and Stuart Parks and Tim Walsh and Weir, {Alexander J.} and Elizabeth Wilson and Tara Quasim and MacLullich, {Alasdair M.J.}",
note = "Acceptance in SAN OA article - update AAM to VoR upon publication; NYP 16/1/20 DC",
year = "2020",
month = "1",
day = "24",
doi = "10.1371/journal.pone.0227471",
language = "English",
volume = "15",
journal = "PLoS ONE",
issn = "1932-6203",
publisher = "PLOS",
number = "1",

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Tieges, Z, Stott, DJ, Shaw, R, Tang, E, Rutter, L-M, Nouzova, E, Duncan, N, Clarke, C, Weir, CJ, Assi, V, Ensor, H, Barnett, JH, Evans, J, Green, S, Hendry, K, Thomson, M, McKeever, J, Middleton, DG, Parks, S, Walsh, T, Weir, AJ, Wilson, E, Quasim, T & MacLullich, AMJ 2020, 'A smartphone-based test for the assessment of attention deficits in delirium: a case-control diagnostic test accuracy study in older hospitalised patients', PLoS ONE , vol. 15, no. 1, e0227471. https://doi.org/10.1371/journal.pone.0227471

A smartphone-based test for the assessment of attention deficits in delirium: a case-control diagnostic test accuracy study in older hospitalised patients. / Tieges, Zoe; Stott, David J.; Shaw, Robert; Tang, Elaine; Rutter, Lisa-Marie; Nouzova, Eva; Duncan, Nikki; Clarke, Caoimhe; Weir, Christopher J. ; Assi, Valentina; Ensor, Hannah; Barnett, Jennifer H.; Evans, Jonathan; Green, Samantha; Hendry, Kirsty; Thomson, Meigan; McKeever, Jenny; Middleton, Duncan G.; Parks, Stuart; Walsh, Tim; Weir, Alexander J.; Wilson, Elizabeth; Quasim, Tara; MacLullich, Alasdair M.J.

In: PLoS ONE , Vol. 15, No. 1, e0227471, 24.01.2020.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A smartphone-based test for the assessment of attention deficits in delirium: a case-control diagnostic test accuracy study in older hospitalised patients

AU - Tieges, Zoe

AU - Stott, David J.

AU - Shaw, Robert

AU - Tang, Elaine

AU - Rutter, Lisa-Marie

AU - Nouzova, Eva

AU - Duncan, Nikki

AU - Clarke, Caoimhe

AU - Weir, Christopher J.

AU - Assi, Valentina

AU - Ensor, Hannah

AU - Barnett, Jennifer H.

AU - Evans, Jonathan

AU - Green, Samantha

AU - Hendry, Kirsty

AU - Thomson, Meigan

AU - McKeever, Jenny

AU - Middleton, Duncan G.

AU - Parks, Stuart

AU - Walsh, Tim

AU - Weir, Alexander J.

AU - Wilson, Elizabeth

AU - Quasim, Tara

AU - MacLullich, Alasdair M.J.

N1 - Acceptance in SAN OA article - update AAM to VoR upon publication; NYP 16/1/20 DC

PY - 2020/1/24

Y1 - 2020/1/24

N2 - BACKGROUND: Delirium is a common and serious acute neuropsychiatric syndrome which is often missed in routine clinical care. Inattention is the core cognitive feature. Diagnostic test accuracy (including cut-points) of a smartphone Delirium App (DelApp) for assessing attention deficits was assessed in older hospital inpatients. METHODS: This was a case-control study of hospitalised patients aged ≥65 years with delirium (with or without pre-existing cognitive impairment), who were compared to patients with dementia without delirium, and patients without cognitive impairment. Reference standard delirium assessment, which included a neuropsychological test battery, was based on Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A separate blinded assessor administered the DelApp arousal assessment (score 0-4) and attention task (0-6) yielding an overall score of 0 to 10 (lower scores indicate poorer performance). Analyses included receiver operating characteristic curves and sensitivity and specificity. Optimal cut-points for delirium detection were determined using Youden's index. RESULTS: A total of 187 patients were recruited, mean age 83.8 (range 67-98) years, 152 (81%) women; n = 61 with delirium; n = 61 with dementia without delirium; and n = 65 without cognitive impairment. Patients with delirium performed poorly on the DelApp (median score = 4/10; inter-quartile range 3.0, 5.5) compared to patients with dementia (9.0; 5.5, 10.0) and those without cognitive impairment (10.0; 10.0, 10.0). Area under the curve for detecting delirium was 0.89 (95% Confidence Interval 0.84, 0.94). At an optimal cut-point of ≤8, sensitivity was 91.7% (84.7%, 98.7%) and specificity 74.2% (66.5%, 81.9%) for discriminating delirium from the other groups. Specificity was 68.3% (56.6%, 80.1%) for discriminating delirium from dementia (cut-point ≤6). CONCLUSION: Patients with delirium (with or without pre-existing cognitive impairment) perform poorly on the DelApp compared to patients with dementia and those without cognitive impairment. A cut-point of ≤8/10 is suggested as having optimal sensitivity and specificity. The DelApp is a promising tool for assessment of attention deficits associated with delirium in older hospitalised adults, many of whom have prior cognitive impairment, and should be further validated in representative patient cohorts.

AB - BACKGROUND: Delirium is a common and serious acute neuropsychiatric syndrome which is often missed in routine clinical care. Inattention is the core cognitive feature. Diagnostic test accuracy (including cut-points) of a smartphone Delirium App (DelApp) for assessing attention deficits was assessed in older hospital inpatients. METHODS: This was a case-control study of hospitalised patients aged ≥65 years with delirium (with or without pre-existing cognitive impairment), who were compared to patients with dementia without delirium, and patients without cognitive impairment. Reference standard delirium assessment, which included a neuropsychological test battery, was based on Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A separate blinded assessor administered the DelApp arousal assessment (score 0-4) and attention task (0-6) yielding an overall score of 0 to 10 (lower scores indicate poorer performance). Analyses included receiver operating characteristic curves and sensitivity and specificity. Optimal cut-points for delirium detection were determined using Youden's index. RESULTS: A total of 187 patients were recruited, mean age 83.8 (range 67-98) years, 152 (81%) women; n = 61 with delirium; n = 61 with dementia without delirium; and n = 65 without cognitive impairment. Patients with delirium performed poorly on the DelApp (median score = 4/10; inter-quartile range 3.0, 5.5) compared to patients with dementia (9.0; 5.5, 10.0) and those without cognitive impairment (10.0; 10.0, 10.0). Area under the curve for detecting delirium was 0.89 (95% Confidence Interval 0.84, 0.94). At an optimal cut-point of ≤8, sensitivity was 91.7% (84.7%, 98.7%) and specificity 74.2% (66.5%, 81.9%) for discriminating delirium from the other groups. Specificity was 68.3% (56.6%, 80.1%) for discriminating delirium from dementia (cut-point ≤6). CONCLUSION: Patients with delirium (with or without pre-existing cognitive impairment) perform poorly on the DelApp compared to patients with dementia and those without cognitive impairment. A cut-point of ≤8/10 is suggested as having optimal sensitivity and specificity. The DelApp is a promising tool for assessment of attention deficits associated with delirium in older hospitalised adults, many of whom have prior cognitive impairment, and should be further validated in representative patient cohorts.

KW - DelApp

KW - delirium

KW - smartphones

KW - diagnostic tests

KW - hospitalised patients

U2 - 10.1371/journal.pone.0227471

DO - 10.1371/journal.pone.0227471

M3 - Article

VL - 15

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 1

M1 - e0227471

ER -