title: Subtle deficits of attention after surgery: quantifying indicators of sub syndrome delirium.
abstract: OBJECTIVE
  To determine whether attentional impairments are reliable neuropsychological markers of sub syndrome delirium.
  
  
  METHODS
  A prospective cohort study with repeated assessment beginning pre-operatively and continuing through the first post-operative week. Computerized assessments of attention and the Mini-Mental State Examination were administered with one hundred patients admitted for elective orthopedic surgery, 70 years and over and free of dementia. Acute change of cognitive status was used to identify cases of sub syndrome delirium.
  
  
  RESULTS
  There were significant differences of post-surgical performance between the 'no delirium' and 'sub-syndrome delirium' groups of reaction time, global cognition, accuracy and greater variability of reaction time (p < 0.041). There were significant within subject main effects on reaction time (p = 0.001), variability of reaction time (p = 0.022) and MMSE (p = 0.000) across the cohort; but no significant interaction effect of 'diagnosis' * 'time' on the computerized measures of attention (p > 0.195).
  
  
  CONCLUSIONS
  The distinction between people with sub syndrome delirium and no delirium is difficult to quantify but computerized measures of attention might provide a sensitive indicator. Sub syndrome delirium is an observable marker of a clinical abnormality that should be exploited to improve care management for vulnerable patients.
authors.affiliation: Wolfson Institute for Ageing and Health, Newcastle University, UK. d.lowery@nhs.net
authors.forename: David Peter
authors.initials: DP
authors.lastname: Lowery
authors.forename: Keith
authors.initials: K
authors.lastname: Wesnes
authors.forename: Nigel
authors.initials: N
authors.lastname: Brewster
authors.forename: Clive
authors.initials: C
authors.lastname: Ballard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001288:Attention / Q000502:physiology*; D003072:Cognition Disorders / Q000150:complications* / Q000175:diagnosis; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D057234:Preoperative Period; D011446:Prospective Studies; D011930:Reaction Time / Q000502:physiology