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Evaluation of bedside tests of attention and arousal assessing delirium in Parkinson’s disease, dementia and older adults

Lookup NU author(s): Dr Rachael Lawson, Dr Sarah Richardson, daisy Kershaw, Professor Bloss Stephan, Professor Carol Brayne, Dr Alison Yarnall, Professor John-Paul Taylor, Professor David Burn, Emeritus Professor Stuart Parker, Dr Louise Allan

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by IOS Press, 2021.

For re-use rights please refer to the publisher's terms and conditions.


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 LB. 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.


Publication metadata

Author(s): Lawson RA, Richardson SJ, Kershaw D, Davis D, Stephan B, Robinson L, Brayn C, Barnes L, Yarnall AJ, Taylor JP, Burn DJ, Parker S, Allan LM

Publication type: Article

Publication status: Published

Journal: Journal of Parkinson's Disease

Year: 2021

Issue: ePub ahead of Print

Online publication date: 21/11/2021

Acceptance date: 22/10/2021

Date deposited: 15/11/2021

ISSN (print): 1877-7171

ISSN (electronic): 1877-718X

Publisher: IOS Press

URL: https://doi.org/10.3233/JPD-212849

DOI: 10.3233/JPD-212849

Notes: Rachael Lawson and Sarah Richardson are joint first authors


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