Assessing attentiveness in older hospital patients: global assessment versus tests of attention.
OBJECTIVE
Impairment of attentiveness is a cardinal symptom of delirium. We examined the relationship between bedside tests of attention and a global rating of attentiveness in older hospital patients and sought to identify cut-off points on the tests of attention that might be helpful in the diagnosis of delirium.


METHODS
Subjects were 110 patients admitted to an acute geriatric unit.


METHODS
Subjects were assessed by two physicians. One physician rated global attentiveness on a 10-cm visual analog scale following general conversation with the patient. The second physician determined whether patients met DSM-3 criteria for delirium or dementia and administered four tests of attentiveness: Digit Span Forwards (DSF), Digit Span Backwards (DSB), Vigilance "A' test (VAT), and a timed Digit Cancellation Test (DCT).


RESULTS
Of the 87 patients who completed the study, 18 were delirious and 17 demented. There was no difference between demented and delirious patients on the VAT, DSF, or MMSE tests; other comparisons between demented and delirious patients and between delirious patients and those with neither delirium nor dementia were significant. All tests of attention except DSF were significantly correlated with the global rating.


CONCLUSIONS
Simple bedside tests of attention can aid identification of delirium.
O'Keeffe
S T
ST
Department of Geriatric Medicine, Royal Liverpool University Hospital, England.
Gosney
M A
MA
D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D003693:Delirium / Q000175:diagnosis*; D003704:Dementia / Q000175:diagnosis; D006760:Hospitalization; D006801:Humans; D007406:Interview, Psychological; D016013:Likelihood Functions; D011581:Psychological Tests; D012680:Sensitivity and Specificity