Attention, vigilance and visuospatial function in hospitalized elderly medical patients–relationship to delirium syndromal status and motor subtype profile

2017 ◽  
Vol 41 (S1) ◽  
pp. S490-S490
Author(s):  
C. Daly
Keyword(s):  
Neurocognitive Disorders ◽  
Cognitive Tests ◽  
Medical Patients ◽  
Diagnostic Challenge ◽  
Clock Drawing Test ◽  
Spatial Span ◽  
Visuospatial Function ◽  
Subsyndromal Delirium ◽  
Function Test ◽  
B Test

ObjectiveThe early and efficacious detection of neurocognitive disorders poses a key diagnostic challenge. We examined how nine bedside cognitive tests perform across the spectrum of delirium and motor subtypes.MethodsThe performance on a battery of nine bedside cognitive tests were compared in elderly medical inpatients with DSM-IV delirium, subsyndromal delirium, and no neurocognitive disorder and in different motor subtypes of patients with delirium.ResultsOne hundred and ninety-eight patients (mean age 79.14 ± 8.26) were assessed with no delirium (n = 43), subsyndromal delirium (n = 45), and full syndromal delirium (n = 110). The ability to meaningfully engage with the tests varied from 59% for vigilance B test to 85% for Spatial Span forward test and was found to be least in the full syndromal delirium group. The no delirium group was distinguished from the delirium groups for all the tests and from the full syndromal delirium group for the vigilance B test and global visuospatial function test. The subsyndromal delirium group differed from the full syndromal delirium group in respect of global visuospatial function test, spatial span backwards and vigilance A tests. Patients with full syndromal delirium were best identified using the interlocking pentagons test and clock drawing test. The ability to engage with testing was higher for those in the no subtype group.ConclusionsSimple bedside tests of attention, vigilance, and visuospatial ability are useful to help to distinguish neurocognitive disorders namely subsyndromal delirium from other presentations.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Attention, Vigilance and Visuospatial Functioning in Hospitalised Elderly Medical Inpatients – Relationship to Delirium Syndromal Status and Motor Subtype Profile

2017 ◽  
Vol 41 (S1) ◽  
pp. S232-S232
Author(s):  
C. Daly
Keyword(s):  
Cognitive Disorder ◽  
Neurocognitive Disorders ◽  
Cognitive Tests ◽  
Diagnostic Challenge ◽  
Spatial Span ◽  
Visuospatial Function ◽  
Subsyndromal Delirium ◽  
Function Test ◽  
Medical Inpatients ◽  
B Test

ObjectiveThe early and efficacious detection of neurocognitive disorders poses a key diagnostic challenge. We examined how bedside cognitive tests perform across the spectrum of delirium and motor subtypes.MethodsThe performance on a battery of bedside cognitive tests were compared in elderly medical inpatients with DSM-IV delirium, subsyndromal delirium, and no neuro cognitive disorder and in motor subtypes.ResultsOne hundred and ninety-eight patients (mean age 79.14 ± 8.26) were assessed with no delirium (n = 43), subsyndromal delirium (n = 45), and full syndromal delirium (n = 110). The ability to meaningfully engage with the tests varied from 59% for vigilance B test to 85% for Spatial Span forward test and was found to be least in the full syndromal delirium group. The no delirium group was distinguished from the delirium groups for all the tests and from the full syndromal delirium group for the vigilance B test and global visuospatial function test. The subsyndromal delirium group differed from the full syndromal delirium group in respect of global visuospatial function test, spatial span backwards and vigilance A tests. Patients with full syndromal delirium were best identified using the interlocking pentagons test and clock drawing test whereas those with subsyndromal delirium were best identified using interlocking pentagons test and months backwards test. Those with subsyndromal delirium were significantly better in their ability to engage than those with full syndromal delirium.ConclusionsSimple bedside tests of attention, vigilance, and visuospatial ability are useful to help to distinguish neurocognitive disorders namely subsyndromal delirium from other presentations.Disclosure of interestThe author haS not supplied his/her declaration of competing interest.

Attention, vigilance, and visuospatial function in hospitalized elderly medical patients: relationship to delirium syndromal status and motor subtype profile

2017 ◽  
Vol 30 (4) ◽  
pp. 493-501 ◽  
Author(s):  
Cara Daly ◽  
Maeve Leonard ◽  
Henry O'Connell ◽  
Olugbenga Williams ◽  
Fahad Awan ◽  
...  
Keyword(s):  
Neurocognitive Disorders ◽  
Medical Patients ◽  
Diagnostic Challenge ◽  
Clock Drawing Test ◽  
Spatial Span ◽  
Subsyndromal Delirium ◽  
Hospitalized Elderly ◽  
Medical Inpatients ◽  
Bedside Tests ◽  
B Test

ABSTRACTBackground:The early and effective detection of neurocognitive disorders poses a key diagnostic challenge. We examined performance on common cognitive bedside tests according to differing delirium syndromal status and clinical (motor) subtypes in hospitalized elderly medical inpatients.Methods:A battery of nine bedside cognitive tests was performed on elderly medical inpatients with DSM-IV delirium, subsyndromal delirium (SSD), and no delirium (ND). Patients with delirium were compared according to clinical (motor) subtypes.Results:A total of 198 patients (mean age 79.14 ± 8.26) were assessed with full syndromal delirium (FSD: n = 110), SSD (n = 45), and ND (n = 43). Delirium status was not associated with differences in terms of gender distribution, age, or overall medication use. Dementia burden increased with greater delirium status. Overall, the ability to meaningfully engage with the tests varied from 59% for the Vigilance B test to 85% for Spatial Span Forward test and was lowest in patients with FSD, where engagement ranged from 32% for the Vigilance B test to 77% for the Spatial Span Forwards test. The ND group was distinguished from SSD group for the Months of the year backwards, Vigilance B, global VSP, Clock Drawing test, and Interlocking Pentagons test. The SSD group was distinguished from the FSD group by Vigilance A, Spatial Span Forward, and Spatial Span Backwards. Regarding differences among motor subtypes in terms of percentage engagement and performance, the No subtype group had higher ratings across all tests. Delirious patients with no subtype had significantly lower scores on the DRS-R98 than for the other three subtype categories.Conclusions:Simple bedside tests of attention, vigilance, and visuospatial ability are useful in distinguishing neurocognitive disorders, including SSD from other presentations.

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

2020 ◽  
Vol 10 (4) ◽  
pp. 46-58
Author(s):  
David J Meagher ◽  
Henry O’Connell ◽  
Maeve Leonard ◽  
Olugbenga Williams ◽  
Fahad Awan ◽  
...  
Keyword(s):  
Cognitive Tests ◽  
Medical Patients

A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study

2020 ◽  
Author(s):  
Richard A. Buckley ◽  
Kelly J. Atkins ◽  
Erika Fortunato ◽  
Brendan Silbert ◽  
David A. Scott ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Screening Tool ◽  
Neurocognitive Disorders ◽  
Clock Drawing Test ◽  
Digital Clock ◽  
Clock Drawing ◽  
Drawing Test

Attention, vigilance and visuospatial function in hospitalized elderly medical patients: Relationship to neurocognitive diagnosis

2016 ◽  
Vol 90 ◽  
pp. 84-90 ◽  
Author(s):  
Maeve Leonard ◽  
Henry O'Connell ◽  
Olugbenga Williams ◽  
Fahad Awan ◽  
Chris Exton ◽  
...  
Keyword(s):  
Medical Patients ◽  
Visuospatial Function ◽  
Hospitalized Elderly

Long term cognitive outcome in tuberculosis meningitis

2020 ◽  
pp. 10.1212/CPJ.0000000000000950
Author(s):  
Valakunja Harikrishna Ganaraja ◽  
Rajeshwaran Jamuna ◽  
Chandrashekhar Nagarathna ◽  
Jitender Saini ◽  
Manjunath Netravathi
Keyword(s):  
Neuropsychological Tests ◽  
Digit Span ◽  
Verbal Learning ◽  
Clock Drawing Test ◽  
Spatial Span ◽  
Span Test ◽  
Drawing Test ◽  
Tnf Α ◽  
Ifn Γ ◽  
Naming Test

ObjectiveData on cognitive changes in patients of tuberculous meningitis (TBM) are sparse. We aimed to study the cognitive profile of grade I TBM patients and correlate with the cytokine values.MethodsProspectively 60 (M:F-31:29) patients of grade I TBM were recruited. Clinical details, CSF estimation of cytokines, neuropsychological assessment was done and correlation were done.ResultsMean age of presentation and duration of symptoms were 32.2 (32.2 ± 10.1) years and 29.9 (29.9 ± 25.9) days respectively. Definitive evidence of mycobacterial infection was observed in 28.3%. Mean levels of tumor necrosis factor-α (TNF-α), interferon (IFN-γ) and interleukin-6 (IL-6) were 11.57 ± 30.35, 197.02 ± 186.64, and 127.03 ± 88.71 pg/mL respectively. TNF-α levels were significantly elevated in definitive TBM (p = 0.044). Neuropsychological tests revealed impaired Auditory verbal learning test (88.3%) followed by complex figure test (50%), spatial span test (50%), clock drawing test (48.3%), Digit span test (35%), Color trail test 1 and 2 (30% and 33.3% respectively) and animal naming test (28.3%). Elevated levels of IFN-γ and IL-6 in TBM were directly correlated with the number of impaired neuropsychological tests. During follow up, significant improvement was noticed in Animal naming test (p = 0.005), Clock drawing test (p = 0.003), color trail test 2 (0.02), spatial span test (p = 0.012) and digit span test (0.035). Verbal learning did not show any significant change. Overall Neuropsychological tests showed better recovery of attention, working memory, category fluency and minimal recovery of verbal learning.ConclusionsThere is subclinical evidence of cognitive impairment in patients of TBM and this correlated with elevated cytokines. Both the frontal and temporal lobes show varying degree of cognitive impairment.

The “SuperAgers” construct in clinical practice: neuropsychological assessment of illiterate and educated elderly

2019 ◽  
Vol 32 (2) ◽  
pp. 191-198 ◽  
Author(s):  
Everton Balduino ◽  
Brian Alvarez Ribeiro de Melo ◽  
Larissa de Sousa Mota da Silva ◽  
José Eduardo Martinelli ◽  
Juliana Francisca Cecato
Keyword(s):  
Educational Level ◽  
Formal Education ◽  
Cognitive Reserve ◽  
Population Aging ◽  
The Elderly ◽  
Positive Influence ◽  
Cognitive Tests ◽  
Clock Drawing Test ◽  
State Examination ◽  
Years Of Schooling

ABSTRACTIntroduction:The demographic transition is a global event intensified during the last decades that represents population aging. Thus, the studies directed to the elderly 80 years of age or more with preserved cognitive functions (named SuperAgers) emerges as a possible path to full comprehension of the health of those aging with acceptable levels of functionality and independency.Objective:To evaluate the cognitive performance of the elderly over 80 years old, associating the results to their educational level.Method:We evaluated 144 healthy elders with 80 years or more through the following cognitive tests Mini-Mental State Examination (MMSE), Cambridge Cognitive Examination (CAMCOG), Clock Drawing Test (CDT), and Verbal Fluency Test (VF) and compared the tests’ scores with their educational level segmented in years of formal education, being the groups ILLITR (<1 year of schooling), 1TO4 (from 1 to 4 years of schooling), and 5MORE (>5 years of schooling).Results:There was positive influence of educational level on the cognitive tests’ score, which indicates higher cognitive reserve of the elderly with higher educational levels.Conclusion:The functionality and independence of the so-called SuperAgers is determined by the cognitive reserve acquired throughout life, mainly developed by the years of formal education.

scholarly journals The Use of MoCA and Other Cognitive Tests in Evaluation of Cognitive Impairment in Elderly Patients Undergoing Arthroplasty

2016 ◽  
Vol 7 (4) ◽  
pp. 183-187 ◽  
Author(s):  
Jukka Puustinen ◽  
Liisa Luostarinen ◽  
Markku Luostarinen ◽  
Veijo Pulliainen ◽  
Heini Huhtala ◽  
...  
Keyword(s):  
Higher Education ◽  
Cognitive Impairment ◽  
Elderly Patients ◽  
Care Center ◽  
Cognitive Tests ◽  
Clock Drawing Test ◽  
Health Care Center ◽  
Clock Drawing ◽  
Primary Arthroplasty

Objective: To examine the prevalence and effect of cognitive impairment on treatment outcomes in elderly patients undergoing arthroplasty and to describe the feasibility of cognitive tests. Materials and Methods: The participants were 52 patients with a mean age of 78 years 11 months (SD: 3.3), waiting for primary arthroplasty. We translated Montreal Cognitive Assessment (MoCA) into Finnish and compared it with Mini-Mental State Examination (MMSE), Mini-Cog, and clock-drawing tests prior to and 3 months after the surgery. The ability to perform activities of daily living, depression, quality of life, and years of education were evaluated. Results: The mean MoCA score on the first visit was 20.7 (SD: 4.1). The pre- and postoperative cognitive tests implied there were no changes in cognitive functioning. Unambiguous delirium was detected in 6 patients. Delirium was not systematically assessed and consequently hypoactive delirium cases were possibly missed. Both MMSE and Mini-Cog found 3/6 of those and clock drawing and MoCA 6/6. Low preoperative MoCA, MMSE, and Mini-Cog scores predicted follow-up treatment in health-care center hospitals ( P = .02, .011, and .044, respectively). During the 5-year follow-up period, 11/52 patients died. Higher education was the only variable associated with survival. The survivors had attained the median of 8 (range: 4-19) years of education compared with 6 (range: 4-8) years among the deceased. Conclusion: The prevalence of cognitive impairment among older patients presenting for arthroplasty is high and mostly undiagnosed. It is feasible to use the MoCA to identify cognitive impairment preoperatively in this group. The clock-drawing test was abnormal in all patients with postoperative delirium, which could be used as a screening test. Higher education predicted survival on a 5-year follow-up period.

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