Geriatric Medicine Unit, University of Edinburgh, Edinburgh, UK.
J Neurol Neurosurg Psychiatry. 2011 Dec;82(12):1334-40. doi: 10.1136/jnnp.2010.208827. Epub 2010 Jun 28.
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.
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.
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.
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.
注意力不集中是谵妄的核心临床特征，但与该特征相关的注意力损伤的具体方面仍知之甚少。也缺乏评估注意力不集中的客观方法。已经开发了一套新的用于评估谵妄患者注意力缺陷的计算机测试。比较了在谵妄、痴呆和认知正常对照组中患者的测试表现。
使用专门设计的计算机神经心理测试设备——爱丁堡谵妄测试盒，对 20 名患有谵妄的老年患者进行了 8 项新的注意力持续测试任务。还对 18 名阿尔茨海默病痴呆患者和 20 名年龄相近认知正常患者的对照组进行了评估。使用意识混乱评估方法诊断谵妄。使用简易精神状态检查测量一般认知障碍。
与两个对照组相比，所有持续注意力任务中，谵妄患者的得分明显较低（p 值均为 0.003 至<0.001）。痴呆患者的表现通常与认知正常组无差异。受试者工作特征分析表明，所有任务在区分谵妄和痴呆（AUC 值 0.80-0.94）以及区分谵妄和认知正常（AUC 值 0.89-0.99）患者方面均具有良好或优异的准确性。
通过客观神经心理测试，患有谵妄的患者表现出明显的持续视觉注意力缺陷。在痴呆患者和认知正常对照者中，这些注意力缺陷主要为轻度或不存在。持续视觉注意力的客观测试在检测谵妄以及区分谵妄和痴呆方面具有良好的应用前景。
