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Katsumi Y, Wong B, Cavallari M, Fong TG, Alsop DC, Andreano JM, Carvalho N, Brickhouse M, Jones R, Libermann TA, Marcantonio ER, Schmitt E, Shafi MM, Pascual-Leone A, Travison T, Barrett LF, Inouye SK, Dickerson BC, Touroutoglou A. Structural integrity of the anterior mid-cingulate cortex contributes to resilience to delirium in SuperAging. Brain Commun 2022; 4:fcac163. [PMID: 35822100 PMCID: PMC9272062 DOI: 10.1093/braincomms/fcac163] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/24/2022] [Accepted: 06/20/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Despite its devastating clinical and societal impact, approaches to treat delirium in older adults remain elusive, making it important to identify factors that may confer resilience to this syndrome. Here, we investigated a cohort of 93 cognitively normal older patients undergoing elective surgery recruited as part of the Successful Aging after Elective Surgery study. Each participant was classified either as a SuperAger (n = 19) or typically aging older adult (n = 74) based on neuropsychological criteria, where the former was defined as those older adults whose memory function rivals that of young adults. We compared these subgroups to examine the role of preoperative memory function in the incidence and severity of postoperative delirium. We additionally investigated the association between indices of postoperative delirium symptoms and cortical thickness in functional networks implicated in SuperAging based on structural magnetic resonance imaging data that were collected preoperatively. We found that SuperAging confers the real-world benefit of resilience to delirium, as shown by lower (i.e. zero) incidence of postoperative delirium and decreased severity scores compared with typical older adults. Furthermore, greater baseline cortical thickness of the anterior mid-cingulate cortex—a key node of the brain’s salience network that is also consistently implicated in SuperAging—predicted lower postoperative delirium severity scores in all patients. Taken together, these findings suggest that baseline memory function in older adults may be a useful predictor of postoperative delirium risk and severity and that superior memory function may contribute to resilience to delirium. In particular, the integrity of the anterior mid-cingulate cortex may be a potential biomarker of resilience to delirium, pointing to this region as a potential target for preventive or therapeutic interventions designed to mitigate the risk or consequences of developing this prevalent clinical syndrome.
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Affiliation(s)
- Yuta Katsumi
- Harvard Medical School , Boston MA , USA
- Frontotemporal Disorders Unit, Massachusetts General Hospital , Boston MA , USA
- Department of Neurology, Massachusetts General Hospital , Boston MA , USA
| | - Bonnie Wong
- Harvard Medical School , Boston MA , USA
- Frontotemporal Disorders Unit, Massachusetts General Hospital , Boston MA , USA
- Department of Psychiatry, Massachusetts General Hospital , Boston MA , USA
| | - Michele Cavallari
- Harvard Medical School , Boston MA , USA
- Center for Neurologlical Imaging, Department of Radiology, Brigham and Women’s Hospital , Boston MA , USA
| | - Tamara G Fong
- Harvard Medical School , Boston MA , USA
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife , Boston MA , USA
- Department of Neurology, Beth Israel Deaconess Medical Center , Boston MA , USA
| | - David C Alsop
- Harvard Medical School , Boston MA , USA
- Department of Medicine, Beth Israel Deaconess Medical Center , Boston MA , USA
| | - Joseph M Andreano
- Harvard Medical School , Boston MA , USA
- Department of Psychiatry, Massachusetts General Hospital , Boston MA , USA
| | - Nicole Carvalho
- Frontotemporal Disorders Unit, Massachusetts General Hospital , Boston MA , USA
- Department of Neurology, Massachusetts General Hospital , Boston MA , USA
| | - Michael Brickhouse
- Frontotemporal Disorders Unit, Massachusetts General Hospital , Boston MA , USA
- Department of Neurology, Massachusetts General Hospital , Boston MA , USA
| | - Richard Jones
- Department of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School , Providence RI , USA
| | - Towia A Libermann
- Harvard Medical School , Boston MA , USA
- Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center , Boston MA , USA
| | - Edward R Marcantonio
- Harvard Medical School , Boston MA , USA
- Department of Medicine, Beth Israel Deaconess Medical Center , Boston MA , USA
| | - Eva Schmitt
- Harvard Medical School , Boston MA , USA
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife , Boston MA , USA
| | - Mouhsin M Shafi
- Harvard Medical School , Boston MA , USA
- Department of Neurology, Beth Israel Deaconess Medical Center , Boston MA , USA
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center , Boston MA , USA
| | - Alvaro Pascual-Leone
- Harvard Medical School , Boston MA , USA
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center , Boston MA , USA
| | - Thomas Travison
- Harvard Medical School , Boston MA , USA
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife , Boston MA , USA
| | - Lisa Feldman Barrett
- Harvard Medical School , Boston MA , USA
- Department of Psychiatry, Massachusetts General Hospital , Boston MA , USA
- Department of Psychology, Northeastern University , Boston MA , USA
| | - Sharon K Inouye
- Harvard Medical School , Boston MA , USA
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife , Boston MA , USA
- Department of Medicine, Beth Israel Deaconess Medical Center , Boston MA , USA
| | - Bradford C Dickerson
- Harvard Medical School , Boston MA , USA
- Frontotemporal Disorders Unit, Massachusetts General Hospital , Boston MA , USA
- Department of Neurology, Massachusetts General Hospital , Boston MA , USA
- Department of Psychiatry, Massachusetts General Hospital , Boston MA , USA
- Massachusetts Alzheimer’s Disease Research Center, Massachusetts General Hospital , Boston MA , USA
| | - Alexandra Touroutoglou
- Harvard Medical School , Boston MA , USA
- Frontotemporal Disorders Unit, Massachusetts General Hospital , Boston MA , USA
- Department of Neurology, Massachusetts General Hospital , Boston MA , USA
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Halladay CW, Sillner AY, Rudolph JL. Performance of Electronic Prediction Rules for Prevalent Delirium at Hospital Admission. JAMA Netw Open 2018; 1:e181405. [PMID: 30646122 PMCID: PMC6324279 DOI: 10.1001/jamanetworkopen.2018.1405] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Delirium at admission is associated with increased hospital morbidity and mortality, but it may be missed in up to 70% of cases. Use of a predictive algorithm in an electronic medical record (EMR) system could provide critical information to target assessment of those with delirium at admission. OBJECTIVES To develop and assess a prediction rule for delirium using 2 populations of veterans and compare this rule with previously confirmed rules. DESIGN, SETTING, AND PARTICIPANTS In a diagnostic study, randomly selected EMRs of hospitalized veterans from the Veterans Affairs (VA) External Peer Review Program at 118 VA medical centers with inpatient facilities were reviewed for delirium risk factors associated with the National Institute for Health and Clinical Excellence (NICE) delirium rule in a derivation cohort (October 1, 2012, to September 30, 2013) and a confirmation cohort (October 1, 2013, to March 31, 2014). Delirium within 24 hours of admission was identified using key word terms. A total of 39 377 veterans 65 years or older who were admitted to a VA medical center for congestive heart failure, acute coronary syndrome, community-acquired pneumonia, and chronic obstructive pulmonary disease were included in the study. EXPOSURE The EMR calculated delirium risk. MAIN OUTCOMES AND MEASURES Delirium at admission as identified by trained nurse reviewers was the main outcome measure. Random forest methods were used to identify accurate risk factors for prevalent delirium. A prediction rule for prevalent delirium was developed, and its diagnostic accuracy was tested in the confirmation cohort. This consolidated NICE rule was compared with previously confirmed scoring algorithms (electronic NICE and Pendlebury NICE). RESULTS A total of 27 625 patients were included in the derivation cohort (28 118 [92.2%] male; mean [SD] age, 75.95 [8.61] years) and 11 752 in the confirmation cohort (11 536 [98.2%] male; mean [SD] age, 75.43 [8.55] years). Delirium at admission was identified in 2343 patients (8.5%) in the derivation cohort and 882 patients (7.0%) in the confirmation cohort. Modeling techniques identified cognitive impairment, infection, sodium level, and age of 80 years or older as the dominant risk factors. The consolidated NICE rule (area under the receiver operating characteristic [AUROC] curve, 0.91; 95% CI, 0.91-0.92; P < .001) had significantly higher discriminatory function than the eNICE rule (AUROC curve, 0.81; 95% CI, 0.80-0.82; P < .001) or Pendlebury NICE rule (AUROC curve, 0.87; 95% CI, 0.86-0.88; P < .001). These findings were confirmed in the confirmation cohort. CONCLUSIONS AND RELEVANCE This analysis identified preexisting cognitive impairment, infection, sodium level, and age of 80 years or older as delirium screening targets. Use of this algorithm in an EMR system could direct clinical assessment efforts to patients with delirium at admission.
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Affiliation(s)
- Christopher W. Halladay
- Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | | | - James L. Rudolph
- Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island
- Brown University, Warren Alpert Medical School and School of Public Health, Providence, Rhode Island
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Marra A, Jackson JC, Ely EW, Graves AJ, Schnelle JF, Dittus RS, Wilson A, Han JH. Focusing on Inattention: The Diagnostic Accuracy of Brief Measures of Inattention for Detecting Delirium. J Hosp Med 2018; 13:551-557. [PMID: 29578552 PMCID: PMC6502509 DOI: 10.12788/jhm.2943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Delirium is frequently missed in most clinical settings. Brief delirium assessments are needed. OBJECTIVE To determine the diagnostic accuracy of reciting the months of year backwards (MOTYB) from December to July (MOTYB-6) and December to January (MOTYB-12) for delirium as diagnosed by a psychiatrist and to explore the diagnostic accuracies of the following other brief attention tasks: (1) spell the word "LUNCH" backwards, (2) recite the days of the week backwards, (3) 10-letter vigilance "A" task, and (4) 5 picture recognition task. DESIGN Preplanned secondary analysis of a prospective observational study. SETTING Emergency department located within an academic, tertiary care hospital. PARTICIPANTS 234 acutely ill patients who were =65 years old. MEASUREMENTS The inattention tasks were administered by a physician. The reference standard for delirium was a comprehensive psychiatrist assessment using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Sensitivities and specificities were calculated. RESULTS Making any error on the MOTYB-6 task had a sensitivity of 80.0% (95% confidence interval [CI], 60.9%-91.1%) and specificity of 57.1% (95% CI, 50.4%- 63.7%). Making any error on the MOTYB-12 task had a sensitivity of 84.0% (95% CI, 65.4%-93.6%) and specificity of 51.9% (95% CI, 45.2%-58.5%). The best combination of sensitivity and specificity was reciting the days of the week backwards task; if the patient made any error, this was 84.0% (95% CI, 65.4%-93.6%) sensitive and 81.9% (95% CI, 76.1%-86.5%) specific. CONCLUSIONS MOTYB-6 and MOTYB-12 had very good sensitivities but had modest specificities for delirium, limiting their use as a standalone assessment. Reciting the days of the week backwards appeared to have the best combination of sensitivity and specificity for delirium.
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Affiliation(s)
- Annachiara Marra
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples, Federico II, Naples, Italy
| | - James C Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Services Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Research Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - E Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Services Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Research Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy J Graves
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John F Schnelle
- Research Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert S Dittus
- Center for Health Services Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda Wilson
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jin H Han
- Center for Health Services Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Oldham MA, Flaherty JH, Rudolph JL. Debating the Role of Arousal in Delirium Diagnosis: Should Delirium Diagnosis Be Inclusive or Restrictive? J Am Med Dir Assoc 2017; 18:629-631. [DOI: 10.1016/j.jamda.2017.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
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Han JH, Brummel NE, Chandrasekhar R, Wilson JE, Liu X, Vasilevskis EE, Girard TD, Carlo ME, Dittus RS, Schnelle JF, Ely EW. Exploring Delirium's Heterogeneity: Association Between Arousal Subtypes at Initial Presentation and 6-Month Mortality in Older Emergency Department Patients. Am J Geriatr Psychiatry 2017; 25:233-242. [PMID: 27623552 PMCID: PMC5321606 DOI: 10.1016/j.jagp.2016.05.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 04/29/2016] [Accepted: 05/25/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To determine how delirium subtyped by level of arousal at initial presentation affects 6-month mortality. DESIGN This was a preplanned secondary analysis of two prospective cohort studies. SETTING Academic tertiary care emergency department (ED). PARTICIPANTS 1,084 ED patients who were 65 years old or older. MEASUREMENTS At the time of enrollment, trained research personnel performed the Confusion Assessment Method for the Intensive Care Unit and the Richmond Agitation Sedation Score to determine delirium and level of arousal, respectively. Patients were categorized as having no delirium, delirium with normal arousal, delirium with decreased arousal, or delirium with increased arousal. Death was ascertained by medical record review and the Social Security Death Index. Cox proportional hazard regression was used to analyze the association between delirium arousal subtypes and 6-month mortality. RESULTS Delirium with normal arousal was the only subtype that was significantly associated with increased 6-month mortality (hazard ratio [HR]: 3.1, 95% confidence interval [CI]: 1.3-7.4) compared with the no delirium group after adjusting for confounders. The HRs for delirium with decreased and increased arousal were 1.4 (95% CI: 0.9-2.1) and 1.3 (95% CI: 0.3-5.4), respectively. CONCLUSIONS Delirious ED patients with normal arousal at initial presentation had a threefold increased hazard of death within 6 months compared with patients without delirium. There was a trend towards increased hazard of death in delirious ED patients with decreased arousal, but this relationship did not reach statistical significance. These data suggest that subtyping delirium by arousal may have prognostic value but requires confirmation with a larger study.
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Affiliation(s)
- Jin H Han
- Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN; Department of Emergency Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN.
| | - Nathan E Brummel
- Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN; Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN
| | - Rameela Chandrasekhar
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Jo Ellen Wilson
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN
| | - Xulei Liu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Eduard E Vasilevskis
- Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN; Section of Hospital Medicine, Vanderbilt University School of Medicine, Nashville, TN; Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN; Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN
| | - Timothy D Girard
- Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN; Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN; Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN
| | - Maria E Carlo
- Division of Geriatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Robert S Dittus
- Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN; Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN
| | - John F Schnelle
- Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN; Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN; Division of Geriatrics, Vanderbilt University School of Medicine, Nashville, TN; Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN
| | - E Wesley Ely
- Center for Quality Aging, Vanderbilt University School of Medicine, Nashville, TN; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN; Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN; Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, TN
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Rudolph JL. Arousal, Attention, and an Abundance of Opportunity to Advance Delirium Care. J Am Med Dir Assoc 2016; 17:775-6. [DOI: 10.1016/j.jamda.2016.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
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Gavinski K, Carnahan R, Weckmann M. Validation of the delirium observation screening scale in a hospitalized older population. J Hosp Med 2016; 11:494-7. [PMID: 26970312 PMCID: PMC4931982 DOI: 10.1002/jhm.2580] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/18/2016] [Accepted: 02/13/2016] [Indexed: 11/08/2022]
Abstract
Delirium is challenging to diagnose in older populations. It is often reversible, and when detected, treatment can improve patient outcomes. Delirium detection currently relies on trained staff to conduct neurocognitive interviews. The Delirium Observation Screening Scale (DOS) is a screen designed to allow faster, easier identification of delirium. In this validation study, conducted at an academic tertiary care center, we attempted to determine the accuracy of the DOS as a delirium screening tool in hospitalized patients over 64 years old. We compared DOS results to a validated delirium diagnostic tool, the Delirium Rating Scale-Revised-98. We also assess the user-friendliness of the DOS by nurses via electronic survey. In 101 assessments of 54 patients, the DOS had sensitivity of 90% and specificity of 91% for delirium. The DOS is an accurate and easy way to screen for delirium in older inpatients. Journal of Hospital Medicine 2016;11:494-497. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Katherine Gavinski
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Ryan Carnahan
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Michelle Weckmann
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Hamilton DE, Press VG, Twu NM, Yuen TC, Azu CN, Churpek MM, Edelson DP. Testing the functional assessment of mentation: A mobile application based assessment of mental status. J Hosp Med 2016; 11:463-6. [PMID: 26882263 PMCID: PMC4931986 DOI: 10.1002/jhm.2557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/08/2016] [Accepted: 01/17/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Altered mental status is a significant predictor of mortality in hospitalized patients and a prerequisite component to the diagnosis of delirium. However, the detection of altered mental status is often incomplete, inaccurate, and resource intensive. OBJECTIVE To identify the clinical utility and feasibility of the Functional Assessment of Mentation (FAM(TM) ), a mobile application for evaluating attention and recall. DESIGN Prospective observational pilot study. SETTING Tertiary care medical center. PARTICIPANTS Nine hundred thirty-one adult subjects (612 nonhospitalized and 319 hospitalized). MEASUREMENTS Score distribution and time to FAM(TM) completion were compared between nonhospitalized and hospitalized subjects (as well as between hospitalized subjects discharged home and those not discharged home). Additionally, in the hospitalized subgroup, FAM(TM) was compared to the Glasgow Coma Scale (GCS), using the Short Portable Mental Status Questionnaire (SPMSQ) as our criterion standard for altered mental status assessment. RESULTS Median time to completion of FAM(TM) was 55 seconds (interquartile range [IQR], 45-67 seconds). Our data identified a graded reduction in score comparing nonhospitalized subjects to hospitalized subjects discharged home and not discharged home (median 5 [IQR 4-7] vs 5 [IQR 3-6] vs 3 [IQR 1-5]; P < 0.001). In the hospitalized subset, FAM(TM) scores were more highly correlated to SPMSQ (Spearman ρ = 0.27, P < 0.001) compared to GCS (Spearman ρ = 0.05, P = 0.40). CONCLUSIONS FAM(TM) is a rapid and clinically feasible tool that can identify minor alterations in mental status often missed by GCS. Journal of Hospital Medicine 2016;11:463-466. 2016 Society of Hospital Medicine.
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Han JH, Vasilevskis EE. Ultrabrief delirium assessments--are they ready for primetime? J Hosp Med 2015; 10:694-5. [PMID: 26374673 PMCID: PMC4593759 DOI: 10.1002/jhm.2478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Jin H Han
- Department of Emergency Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eduard E Vasilevskis
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center, Nashville, Tennessee
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