• Lisa-Marie Rutter, Eva Nouzova, David J Stott, Christopher J Weir, Valentina Assi, Jennifer H Barnett, Caoimhe Clarke, Nikki Duncan, Jonathan Evans, Samantha Green, Kirsty Hendry, Meigan McGinlay, Jenny McKeever, Duncan G Middleton, Stuart Parks, Robert Shaw, Elaine Tang, Tim Walsh, Alexander J Weir, Elizabeth Wilson, Tara Quasim, MacLullichAlasdair M JAMJEdinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK.Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK., and Zoë Tieges.
• Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK.
• BMC Geriatr. 2018 Sep 17; 18 (1): 217.

BackgroundDelirium is a common and serious clinical syndrome which is often missed in routine clinical care. The core cognitive feature is inattention. We developed a novel bedside neuropsychological test for assessing inattention in delirium implemented on a smartphone platform (DelApp). We aim to evaluate the diagnostic performance of the DelApp in a representative cohort of older hospitalised patients.MethodsThis is a prospective study of older non-scheduled hospitalised patients (target n = 500, age ≥ 65), recruited from elderly care and acute orthopaedic wards. Exclusion criteria are: non-English speakers; severe vision or hearing impairment; photosensitive epilepsy. A structured reference standard delirium assessment based on DSM-5 criteria will be used, which includes a cognitive test battery administered by a trained assessor (Orientation-Memory-Concentration Test, Abbreviated Mental Test-10, Delirium Rating Severity Scale-Revised-98, digit span, months and days backwards, Vigilance A' test) and assessment of arousal (Observational Scale of Level of Arousal, Richmond Agitation Sedation Scale). Prior change in cognition will be documented using the Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be categorized as delirium (with/without dementia), possible delirium, dementia, no cognitive impairment, or undetermined. A separate assessor (blinded to diagnosis and assessments) will administer the DelApp index test within 3 h of the reference standard assessment. The DelApp comprises assessment of arousal (score 0-4) and sustained attention (score 0-6), yielding a total score between 0 and 10 (higher score = better performance). Outcomes (length of stay, mortality and discharge location) will be collected at 12 weeks. We will evaluate a priori cutpoints derived from a previous case-control study. Measures of the accuracy of DelApp will include sensitivity, specificity, positive and negative predictive values, and area under the ROC curve. We plan repeat assessments on up to 4 occasions in a purposive subsample of 30 patients (15 delirium, 15 no delirium) to examine changes over time.DiscussionThis study evaluates the diagnostic test accuracy of a novel smartphone test for delirium in a representative cohort of older hospitalised patients, including those with dementia. DelApp has the potential to be a convenient, objective method of improving delirium assessment for older people in acute care.Trial RegistrationClinical trials.gov, NCT02590796 . Registered on 29 Oct 2015. Protocol version 5, dated 25 July 2016.

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