Evaluation of Bedside Tests of Attention and Arousal Assessing Delirium in Parkinson’s Disease, Dementia, and Older Adults

Article type: Research Article

Authors: Lawson, Rachael A.^{a; *; 1} | Richardson, Sarah J.^{a; b; c; 1} | Kershaw, Daisy^{a; b} | Davis, Daniel^d | Stephan, Blossom C.M.^e | Robinson, Louise^f | Brayne, Carol^g | Barnes, Linda^g | Burn, David J.^a | Yarnall, Alison J.^{a; b; c} | Taylor, John-Paul^{a; b} | Parker, Stuart^f | Allan, Louise M.^h

Affiliations: [a] Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK | [b] NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK | [c] Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK | [d] MRC Unit for Lifelong Health and Ageing at UCL, London, UK | [e] Institute of Mental Health, School of Medicine, Nottingham University, Nottingham, UK | [f] Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK | [g] Cambridge Public Health, Department of Psychiatry, University of Cambridge, Cambridge, UK | [h] Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK

Correspondence: [*] Correspondence to: Rachael A. Lawson, Clinical Ageing Re-search Unit, Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK. Tel.: +44191 208 1277; E-mail: [email protected].

Note: [1] These authors contributed equally to this work.

Abstract: Background:Delirium is a serious acute neuropsychiatric condition associated with altered attention and arousal. Objective:To evaluate simple bedside tests for attention and arousal to detect delirium in those with and without Parkinson’s disease (PD) and dementia. Methods:Participants from two prospective delirium studies were pooled comprising 30 with PD without cognitive impairment, 24 with Lewy body cognitive impairment (PD dementia or dementia with Lewy bodies), 16 with another dementia and 179 PD and dementia-free older adults. Participants completed standardised delirium assessments including tests of attention: digit span, Memorial Delirium Assessment Scale (MDAS) attention and months of the year backwards; and arousal: Glasgow Coma Scale (GSC), Observational Scale of Level of Arousal (OSLA), Modified Richmond Agitation Scale and MDAS consciousness. Delirium was diagnosed using the DSM-5 criteria. Results:On their first admission, 21.7%participants had prevalent delirium. Arousal measures accurately detected delirium in all participants (p < 0.01 for all), but only selected attention measures detected delirium in PD and dementia. In PD and dementia-free older adults, impaired digit span and OSLA were the optimal tests to detect delirium (area under the curve [AUC] = 0.838, p < 0.001) while in PD and dementia the optimal tests were MDAS attention and GCS (AUC=0.90 and 0.84, respectively, p < 0.001 for both). Conclusion:Simple bedside tests of attention and arousal at a single visit could accurately detect delirium in PD, dementia and PD and dementia-free older adults; however, the optimal tests differed between groups. Combined attention and arousal scores increased accuracy, which could have clinical utility to aid the identification of delirium neurodegenerative disorders.

Keywords: Delirium, Parkinson disease, dementia, attention, arousal, diganosis

DOI: 10.3233/JPD-212849

Journal: Journal of Parkinson's Disease, vol. 12, no. 2, pp. 655-665, 2022