title: Five short screening tests in the detection of prevalent delirium: diagnostic accuracy and performance in different neurocognitive subgroups.
abstract: Delirium is prevalent and serious, yet remains under-recognised. Systematic screening could improve detection; however, consensus is lacking as to the best approach. Our aim was to assess the diagnostic accuracy of five simple cognitive tests in delirium screening: six-item cognitive impairment test (6-CIT), clock-drawing test, spatial span forwards, months of the year backwards (MOTYB) and intersecting pentagons (IPT).
  
  
  
  A cross-sectional study was conducted. Within 36 h of admission, older medical patients were assessed for delirium using the Revised Delirium Rating Scale. They also underwent testing using the five cognitive tests outlined above. Sensitivity, specificity, positive and negative predictive values (PPV; NPV) were calculated for each method. Where appropriate, area under the receiver operating characteristic curve (AUC) was also calculated.
  
  
  
  Four hundred seventy patients were included, and 184 had delirium. Of the tests scored on a scale, the 6-CIT had the highest AUC (0.876), the optimum cut-off for delirium screening being 8/9 (sensitivity 89.9%, specificity 62.7%, NPV 91.2%, PPV 59.2%). The MOTYB, scored in a binary fashion, also performed well (sensitivity 84.6%, specificity 58.4%, NPV 87.4%, PPV 52.8). On discriminant analysis, 6-CIT was the only test to discriminate between patients with delirium and those with dementia (without delirium), Wilks' Lambda = 0.748, p < 0.001.
  
  
  
  The 6-CIT measures attention, temporal orientation and short-term memory and shows promise as a delirium screening test. This study suggests that it may also have potential in distinguishing the cognitive impairment of delirium from that of dementia in older patients. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.|Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.|Parkwood Institute, St. Joseph's Healthcare, London, Ontario, Canada.
authors.forename: N A
authors.initials: NA
authors.lastname: O'Regan
authors.affiliation: School of Applied Psychology, University College Cork, Cork, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Maughan
authors.affiliation: School of Medicine, University College Cork, Cork, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Liddy
authors.affiliation: Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Fitzgerald
authors.affiliation: Sligo Mental Health Services, Sligo, Ireland.
authors.forename: D
authors.identifier: 0000-0003-1315-1695
authors.initials: D
authors.lastname: Adamis
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: D W
authors.initials: DW
authors.lastname: Molloy
authors.affiliation: Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Meagher
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Timmons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001288:Attention / Q000502:physiology; D003071:Cognition / Q000502:physiology; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D003704:Dementia / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008570:Memory, Short-Term / Q000502:physiology; D009483:Neuropsychological Tests; D015995:Prevalence; D012372:ROC Curve; D012680:Sensitivity and Specificity
keywords: cognition; delirium; diagnosis; evaluation studies; sensitivity and specificity