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Development of a smartphone application for the objective detection of attentional deficits in delirium

Published online by Cambridge University Press:  06 March 2015

Zoë Tieges ,
Antaine Stíobhairt ,
Katie Scott ,
Klaudia Suchorab ,
Alexander Weir ,
Stuart Parks ,
Susan Shenkin  and
Alasdair MacLullich
Zoë Tieges*
Affiliation:
Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
Antaine Stíobhairt
Affiliation:
Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK Department of Psychology, University of Edinburgh, Edinburgh, UK
Katie Scott
Affiliation:
Department of Psychology, University of Edinburgh, Edinburgh, UK
Klaudia Suchorab
Affiliation:
Department of Psychology, University of Edinburgh, Edinburgh, UK
Alexander Weir
Affiliation:
Medical Devices Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
Stuart Parks
Affiliation:
Medical Devices Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
Susan Shenkin
Affiliation:
Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
Alasdair MacLullich
Affiliation:
Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
*
Correspondence should be addressed to: Zoë Tieges, Edinburgh Delirium Research Group, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK. Phone: +44 (0) 131 242 6482; Fax: +44 (0)131 242 6370: Email: Zoe.Tieges@ed.ac.uk.
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Abstract

Background:

Delirium is an acute, severe deterioration in mental functioning. Inattention is the core feature, yet there are few objective methods for assessing attentional deficits in delirium. We previously developed a novel, graded test for objectively detecting inattention in delirium, implemented on a computerized device (Edinburgh Delirium Test Box (EDTB)). Although the EDTB is effective, tests on universally available devices have potential for greater impact. Here we assessed feasibility and validity of the DelApp, a smartphone application based on the EDTB.

Methods:

This was a preliminary case-control study in hospital inpatients (aged 60–96 years) with delirium (N = 50), dementia (N = 52), or no cognitive impairment (N = 54) who performed the DelApp assessment, which comprises an arousal assessment followed by counting of lights presented serially. Delirium was assessed using the Confusion Assessment Method and Delirium Rating Scale-Revised-98 (DRS-R98), and cognition with conventional tests of attention (e.g. digit span) and the short Orientation-Memory-Concentration Test (OMCT).

Results:

DelApp scores (maximum score = 10) were lower in delirium (scores (median(IQR)): 6 (4–7)) compared to dementia (10 (9–10)) and control groups (10 (10–10), p-values < 0.001). Receiver operating characteristic (ROC) analyses revealed excellent accuracy of the DelApp for discriminating delirium from dementia (AUC = 0.93), and delirium from controls (AUC = 0.99, p-values < 0.001). DelApp and DRS-R98 severity scores were moderately well correlated (Kendall's tau = −0.60, p < 0.001). OMCT scores did not differ between delirium and dementia.

Conclusions:

The DelApp test showed good performance, supporting the utility of objectively measuring attention in delirium assessment. This study provides evidence of the feasibility of using a smartphone test for attentional assessment in hospital inpatients with possible delirium, with potential applications in research and clinical practice.

Keywords

deliriumattentionobjectivemeasurementneuropsychologicalsmartphonedementiacognition
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 8 , August 2015 , pp. 1251 - 1262
Copyright
Copyright © International Psychogeriatric Association 2015 

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