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Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients

World Journal of Psychiatry 2020年第4期10卷 46-58页

作者： David J Meagher Henry O’Connell Maeve Leonard Olugbenga Williams Fahad Awan Chris Exton Michael Tenorio Margaret O’Connor Colum P Dunne walter cullen John McFarland Dimitrios Adamis Cognitive Impairment Research Group Graduate Entry Medical SchoolUniversity of LimerickLimerick V94 YVHOIreland Department of Computer Sciences University of LimerickLimerick V94 YVHOIreland School of Medicine University College DublinDublin 4 D04 V1W8Ireland Sligo Mental Health Services BallytivanSligo F91 CD34Ireland

BACKGROUND Efficient detection of delirium and comorbid delirium-dementia is a key diagnostic *** of new,efficient delirium-focused methods of cognitive assessment is a key challenge for improved detection of neurocognitive disorders in everyday clinical *** To compare the accuracy of two novel bedside tests of attention,vigilance and visuospatial function with conventional bedside cognitive tests in identifying delirium in older hospitalized *** 180 consecutive elderly medical inpatients(mean age 79.6±7.2;51%female)referred to a psychiatry for later life consultation-liaison service with delirium,dementia,comorbid delirium-dementia and cognitively intact *** were assessed cross-sectionally with conventional bedside cognitive tests[WORLD,Months Backward test(MBT),Spatial span,Vigilance A and B,Clock Drawing test and Interlocking Pentagons test]and two novel cognitive tests[Lighthouse test,Letter and Shape Drawing test(LSD)-4].RESULTS Neurocognitive diagnoses were delirium(n=44),dementia(n=30),comorbid delirium-dementia(n=60)and no neurocognitive disorder(n=46).All conventional tests had sensitivity of>70%for delirium,with best overall accuracy for the Vigilance-B(78.3%),Vigilance-A(77.8%)and MBT(76.7%)*** sustained attention component of the Lighthouse test was the most distinguishing of delirium(sensitivity 84.6%;overall accuracy 75.6%).The LSD-4 had sensitivity of 74.0%and overall accuracy 74.4%for delirium *** tests allowed for enhanced sensitivity(>90%)and overall accuracy(≥75%)with the highest overall accuracy for the combination of MBT-Vigilance A and the combined Vigilance A and B tests(both 78.3%).When analyses were repeated for those with dementia,there were similar findings with the MBTVigilance A the most accurate overall combination(80.0%).Combining the Lighthouse-SA with the LSD-4,a fail in either test had sensitivity for delirium of 91.4 with overall accuracy of 74.4%.

关键词： Visuospatial function Attention Vigilance Letter and Shape Drawing test Lighthouse test Delirium Dementia Phenomenology Assessment

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Months backward test:A review of its use in clinical studies

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World Journal of Psychiatry 2015年第3期5卷 305-314页

作者： James Meagher Maeve Leonard Laura Donoghue Niamh O'Regan Suzanne Timmons Chris Exton walter cullen Colum Dunne Dimitrios Adamis Alasdair J Maclullich David Meagher Cognitive Impairment Research Group Gradu-ate Entry Medical SchoolUniversity of Limerick University of Limerick Medical School Cognitive Impairment Research Group Centre for Interventions in InfectionInflammation and Immunity (4i)Graduate Entry Medical SchoolUniversity of Limerick Centre for Gerontology and Rehabilitation St.Finbarr’s Hospital Department of Computer Sciences University of Limerick School of Medicine and Medical Science University College Dublin Sligo Mental Health Services Edinburgh Delirium Research Group University of Edinburgh Department of Psychiatry University Hospital Limerick

AIM: To review the use of the Months Backwards Test(MBT) in clinical and research ***: We conducted a systematic review of reports relating to the MBT based upon a search of Psych INFO and MEDLINE between January 1980 and December 2014. Only reports that specifically described findings pertaining to the MBT were included. Findings were considered in terms of rating procedures, testing performance, psychometric properties, neuropsychological studies and use in clinical ***: We identified 22 data reports. The MBT is administered and rated in a variety of ways with very little consistency across studies. It has been used to assess various cognitive functions including focused and sustained attention as well as central processingspeed. Performance can be assessed in terms of the ability to accurately complete the test without errors("MB accuracy"), and time taken to complete the test("MB duration"). Completion time in cognitively intact subjects is usually 0.90). Functional magnetic resonance imaging studies comparing the months forward test and MBT indicate greater involvement of more complex networks(bilateral middle and inferior frontal gyri, the posterior parietal cortex and the left anterior cingulate gyrus) for backwards cogn

关键词： Cognition Assessment Months backward test Delirium Dementia

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