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Detecting deficits of sustained visual attention in delirium
  1. Laura J E Brown1,2,
  2. Carolyn Fordyce3,
  3. Helen Zaghdani3,
  4. John M Starr1,2,
  5. Alasdair M J MacLullich1,2
  1. 1Geriatric Medicine Unit, University of Edinburgh, Edinburgh, UK
  2. 2Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
  3. 3Department of Psychology, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr L J E Brown, School of Psychology, University of St Andrews, St Mary's College, South Street, St Andrews KY16 9JP, UK; laura.brown{at}


Background Inattention is a core clinical feature of delirium and yet the particular aspects of attentional impairment associated with this feature are poorly understood. Objective methods for assessing inattention are also lacking. A new set of computerised tests of attentional deficits designed for use in patients with delirium have been developed. Test performances in patients with delirium, dementia and cognitively normal controls are compared.

Methods Eight novel tasks measuring sustained visual attention were administered to 20 older patients with delirium using the Edinburgh Delirium Test Box, a purpose built, computerised neuropsychological testing device. Comparison groups of 18 patients with Alzheimer's dementia and 20 cognitively normal patients of similar age were also assessed. Delirium was diagnosed using the Confusion Assessment Method. General cognitive impairment was measured using the Mini-Mental State Examination.

Results Patients with delirium had significantly lower scores than both comparison groups on all sustained attention tasks (p values from 0.003 to <0.001). Performance of the dementia patients generally did not differ from the cognitively normal group. Receiver operating characteristic analyses indicated that all tasks showed good or excellent accuracy for discriminating between delirium and dementia (AUC values 0.80–0.94), and between delirium and cognitively normal (AUC values 0.89–0.99) patients.

Conclusions Patients with delirium showed marked deficits in sustained visual attention, as measured by objective neuropsychological testing. These attentional deficits were mainly mild or absent in patients with dementia and in cognitively normal controls. Objective testing of sustained visual attention has promising utility in detecting delirium, and in discriminating delirium from dementia.

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  • Funding This work was funded by a Medical Research Council Clinician Scientist Fellowship to AMJM. The work was undertaken by the University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative. Funding from the Biotechnology and Biological Sciences Research Council, the Engineering and Physical Sciences Research Council, the Economic and Social Research Council and the Medical Research Council is gratefully acknowledged. None of the funders of this work had any role in the design of the study, the collection, analysis or interpretation of the data, in the writing of the manuscript or the decision to submit it for publication.

  • Competing interests This Edinburgh Delirium Test Box and testing protocols described in this manuscript are currently the subject of a patent application.

  • Ethics approval This study was conducted with the approval of the Scotland A Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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