Attention, vigilance and visuospatial function in hospitalized elderly medical patients–relationship to delirium syndromal status and motor subtype profile

Abstract

ObjectiveThe early and efficacious detection of neurocognitive disorders poses a key diagnostic challenge. We examined how nine bedside cognitive tests perform across the spectrum of delirium and motor subtypes.MethodsThe performance on a battery of nine bedside cognitive tests were compared in elderly medical inpatients with DSM-IV delirium, subsyndromal delirium, and no neurocognitive disorder and in different motor subtypes of patients with delirium.ResultsOne hundred and ninety-eight patients (mean age 79.14 ± 8.26) were assessed with no delirium (n = 43), subsyndromal delirium (n = 45), and full syndromal delirium (n = 110). The ability to meaningfully engage with the tests varied from 59% for vigilance B test to 85% for Spatial Span forward test and was found to be least in the full syndromal delirium group. The no delirium group was distinguished from the delirium groups for all the tests and from the full syndromal delirium group for the vigilance B test and global visuospatial function test. The subsyndromal delirium group differed from the full syndromal delirium group in respect of global visuospatial function test, spatial span backwards and vigilance A tests. Patients with full syndromal delirium were best identified using the interlocking pentagons test and clock drawing test. The ability to engage with testing was higher for those in the no subtype group.ConclusionsSimple bedside tests of attention, vigilance, and visuospatial ability are useful to help to distinguish neurocognitive disorders namely subsyndromal delirium from other presentations.Disclosure of interestThe author has not supplied his/her declaration of competing interest.