Abstract
ObjectiveThe 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.MethodsWe reviewed the neuropsychological literature on formal assessment and quantification of the different domains in delirium, focusing on the core feature of inattention.ResultsFew 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.ConclusionsDelirium 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.
Highlights
The term delirium refers to a syndrome of cognitive, psychiatric and motor abnormalities that are commonly observed in acutely medically unwell patients, following surgery or trauma, or in the context of drug intoxication or withdrawal
Current diagnostic criteria focus on inattention as the central feature of delirium (European Delirium Association and American Delirium Society, 2014); at least one other cognitive deficit and acute onset are required to make the diagnosis (Table 1)
We identified studies up to October 2016 published in English, which objectively examined a number of pre-specified neuropsychological domains in delirium
Summary
The term delirium refers to a syndrome of cognitive, psychiatric and motor abnormalities that are commonly observed in acutely medically unwell patients, following surgery or trauma, or in the context of drug intoxication or withdrawal. The mental status changes arise rapidly, over hours to days, and often fluctuate. Most cases of delirium resolve within days, around 20% persist for weeks or months (Cole, 2010). Several mental status abnormalities are typically considered to be part of the delirium syndrome. These include inattention, altered level of consciousness and cognitive deficits including memory, perception and language impairments. Delirium characterisation in the major classification systems has shown some change
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