Quantifying the association between computerised measures of attention and confusion assessment method defined delirium: a prospective study of older orthopaedic surgical patients, free of dementia

TY - JOUR

T1 - Quantifying the association between computerised measures of attention and confusion assessment method defined delirium: a prospective study of older orthopaedic surgical patients, free of dementia

AU - Lowery, David Peter

AU - Wesnes, Keith

AU - Brewster, Nigel

AU - Ballard, Clive

PY - 2008

Y1 - 2008

N2 - Objective To determine whether attentional impairments are reliable neuropsychological markers of delirium. Method A prospective cohort. of one hundred patients admitted for elective orthopaedic surgery, 70 years and over, and free of dementia were recruited from an Orthopaedic unit in a university teaching hospital. Computerized assessments of attention and the Mini Mental State Examination were administered pre and post operatively. The Confusion Assessment Method was used to evaluate signs and symptoms of delirium. Results Over the first post operative week after surgery people with delirium scored lower on the MMSE (F = 23.53 (1, 53); p = 0.000); and performed less accurately (F = 20.02 (1, 55); p = 0.000). slower (F = 14.58 (1, 54); p = 0.000) and with greater variability of reaction time (F = 31.52 (1, 53); p = 0.000) than people without delirium. The group with delirium's neuropsychological performance was marked by a quadratic trend of accuracy (F = 10.5 (1, 8); p = 0.018) across the first post operative week. Conversely the group without delirium demonstrate quadratic trends for reaction time (F = 6.91 (1, 49); p = 0.011); and linear trends for the variability of reaction time (F = 7.06 (1, 49); p = 0.011) over this period. Conclusions To date the absence of any well validated neuropsychological markers of delirium has hindered progress of research of delirium. The data within this study suggest key indices of attention and in particular fluctuating cognition may offer excellent discriminative utility for this clinically important condition. Copyright (C) 2008 John Wiley & Sons, Ltd.

AB - Objective To determine whether attentional impairments are reliable neuropsychological markers of delirium. Method A prospective cohort. of one hundred patients admitted for elective orthopaedic surgery, 70 years and over, and free of dementia were recruited from an Orthopaedic unit in a university teaching hospital. Computerized assessments of attention and the Mini Mental State Examination were administered pre and post operatively. The Confusion Assessment Method was used to evaluate signs and symptoms of delirium. Results Over the first post operative week after surgery people with delirium scored lower on the MMSE (F = 23.53 (1, 53); p = 0.000); and performed less accurately (F = 20.02 (1, 55); p = 0.000). slower (F = 14.58 (1, 54); p = 0.000) and with greater variability of reaction time (F = 31.52 (1, 53); p = 0.000) than people without delirium. The group with delirium's neuropsychological performance was marked by a quadratic trend of accuracy (F = 10.5 (1, 8); p = 0.018) across the first post operative week. Conversely the group without delirium demonstrate quadratic trends for reaction time (F = 6.91 (1, 49); p = 0.011); and linear trends for the variability of reaction time (F = 7.06 (1, 49); p = 0.011) over this period. Conclusions To date the absence of any well validated neuropsychological markers of delirium has hindered progress of research of delirium. The data within this study suggest key indices of attention and in particular fluctuating cognition may offer excellent discriminative utility for this clinically important condition. Copyright (C) 2008 John Wiley & Sons, Ltd.

U2 - 10.1002/gps.2059

DO - 10.1002/gps.2059

M3 - Article

SN - 1099-1166

VL - 23

SP - 1253

EP - 1260

JO - International Journal of Geriatric Psychiatry

JF - International Journal of Geriatric Psychiatry

IS - 12

ER -