title: Evaluating attention in delirium: A comparison of bedside tests of attention.
abstract: OBJECTIVE
  Impaired attention is a core diagnostic feature for delirium. The present study examined the discriminating properties for patients with delirium versus those with dementia and/or no neurocognitive disorder of four objective tests of attention: digit span, vigilance "A" test, serial 7s subtraction and months of the year backwards together with global clinical subjective rating of attention.
  
  
  METHODS
  This as a prospective study of older patients admitted consecutively in a general hospital. Participants were assessed using the Confusion Assessment Method, Delirium Rating Scale-98 Revised and Montreal Cognitive Assessment scales, and months of the year backwards. Pre-existing dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria.
  
  
  RESULTS
  The sample consisted of 200 participants (mean age 81.1 ± 6.5 years; 50% women; pre-existing cognitive impairment in 126 [63%]). A total of 34 (17%) were identified with delirium (Confusion Assessment Method +). The five approaches to assessing attention had statistically significant correlations (P < 0.05). Discriminant analysis showed that clinical subjective rating of attention in conjunction with the months of the year backwards had the best discriminatory ability to identify Confusion Assessment Method-defined delirium, and to discriminate patients with delirium from those with dementia and/or normal cognition. Both of these approaches had high sensitivity, but modest specificity.
  
  
  CONCLUSIONS
  Objective tests are useful for prediction of non-delirium, but lack specificity for a delirium diagnosis. Global attentional deficits were more indicative of delirium than deficits of specific domains of attention. Geriatr Gerontol Int 2016; 16: 1028-1035.
authors.affiliation: Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland.|Department of Psychiatry, Research and Academic Institute of Athens, Athens, Greece.
authors.forename: Dimitrios
authors.identifier: http://orcid.org/0000-0003-1315-1695
authors.initials: D
authors.lastname: Adamis
authors.affiliation: Cognitive Impairment Research Group (CIRG), Graduate-Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Meagher
authors.affiliation: Medical Student Sligo Medical Academy, NUI Galway, Sligo, Ireland.
authors.forename: Orla
authors.initials: O
authors.lastname: Murray
authors.affiliation: Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland.
authors.forename: Donagh
authors.initials: D
authors.lastname: O'Neill
authors.affiliation: Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland.
authors.forename: Edmond
authors.initials: E
authors.lastname: O'Mahony
authors.affiliation: Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland.
authors.forename: Owen
authors.initials: O
authors.lastname: Mulligan
authors.affiliation: Department of Psychiatry, Sligo Mental Health Services, Sligo, Ireland.
authors.forename: Geraldine
authors.initials: G
authors.lastname: McCarthy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006769:Hospitals, General; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D009483:Neuropsychological Tests; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: attention; attention tests; delirium; older people; psychometrics