title: The neuropsychology of delirium: advancing the science of delirium assessment.
abstract: The diagnosis of delirium depends on eliciting its features through mental status examination and informant history. However, there is marked heterogeneity in how these features are assessed, from binary subjective clinical judgement to more comprehensive methods supported by cognitive testing. The aim of this article is to review the neuropsychological research in delirium and suggest future directions in research and clinical practice.
  
  
  
  We reviewed the neuropsychological literature on formal assessment and quantification of the different domains in delirium, focusing on the core feature of inattention.
  
  
  
  Few studies have characterised and quantified the features of delirium using objective methods commonly employed in neuropsychological research. The existing evidence confirms that patients with delirium usually show impairments on objective tests of attention compared with cognitively intact controls and, in most cases, compared with patients with dementia. Further, abnormal level of arousal appears to be a specific indicator of delirium. The neuropsychological evidence base for impairments in other cognitive domains in delirium, including visual perception, language and thought processes, is small.
  
  
  
  Delirium diagnosis requires accurate testing for its features, but there is little neuropsychological research examining the nature of these features, or evaluating the reliability, validity and discriminatory power of existing assessment processes. More research using the neuropsychological approach has enormous potential to improve and standardise delirium assessment methods of the individual features of delirium, such as inattention, and in developing more robust reference standards to enable greater comparability between studies.
authors.affiliation: Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK.|Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
authors.forename: Zoë
authors.identifier: 0000-0002-3820-3917
authors.initials: Z
authors.lastname: Tieges
authors.affiliation: Institute of Health and Well Being, University of Glasgow, Glasgow, UK.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Evans
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Karin J
authors.initials: KJ
authors.lastname: Neufeld
authors.affiliation: Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK.|Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
authors.forename: Alasdair M J
authors.identifier: 0000-0003-3159-9370
authors.initials: AMJ
authors.lastname: MacLullich
mesh_terms: D001143:Arousal / Q000502:physiology; D001288:Attention / Q000502:physiology; D003693:Delirium / Q000175:diagnosis* / Q000523:psychology; D003704:Dementia / Q000523:psychology; D006801:Humans; D008568:Memory / Q000502:physiology; D009483:Neuropsychological Tests; D015203:Reproducibility of Results; D013850:Thinking / Q000502:physiology; D014796:Visual Perception
keywords: arousal; attention; cognitive tests; delirium; neuropsychological assessment; objective measurement