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Paddick SM, Gamassa E, Mwaluwinga N, Lewis EG, Duinmaijer A, Urasa S, Tucker L, Mukaetova-Ladinska E, Cosker G, Dekker M, Kisoli A, Cletus J, Lissu C, Dotchin C, Gray W, Walker R. Preliminary evaluation of a smartphone application (DelApp) for identification of delirium in sub-Saharan Africa. Acta Neuropsychiatr 2023:1-28. [PMID: 37345466 DOI: 10.1017/neu.2023.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
OBJECTIVE In sub-Saharan Africa (SSA), there are no validated screening tools for delirium in older adults, despite the known vulnerability of older people to delirium and the associated adverse outcomes. This study aimed to assess the effectiveness of a brief smartphone-based assessment of arousal and attention (DelApp) in identification of delirium amongst older adults admitted to the medical department of a tertiary referral hospital in Northern Tanzania. METHOD Consecutive admissions were screened using the DelApp during a larger study of delirium prevalence and risk factors. All participants subsequently underwent detailed clinical assessment for delirium by a research doctor. Delirium and dementia were identified against DSM-5 criteria by consensus. RESULTS Complete data for 66 individuals were collected of whom 15 (22.7%) had delirium, 24.5% had dementia without delirium and 10.6% delirium superimposed on dementia. Sensitivity and specificity of the DelApp for delirium were 0.87 and 0.62 respectively (AUROC 0.77) and 0.88 and 0.73 (AUROC 0.85) for major cognitive impairment (dementia and delirium combined). Lower DelApp score was associated with age, significant visual impairment (<6/60 acuity), illness severity, reduced arousal and DSM-5 delirium on univariable analysis, but on multivariable logistic regression only arousal remained significant. CONCLUSION In this setting, the DelApp performed well in identifying delirium and major cognitive impairment but did not differentiate delirium and dementia. Performance is likely to have been affected by confounders including uncorrected visual impairment and reduced level of arousal without delirium. Negative predictive value was nevertheless high, indicating excellent "rule out" value in this setting.
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Affiliation(s)
- S M Paddick
- Institute of Translational and Clinical Medicine, Newcastle University, Newcastle upon Tyne, UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - E Gamassa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - N Mwaluwinga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - E G Lewis
- Charité - Universitätsmedizin Berlin CVK: Campus Virchow-Klinikum Institute of Tropical Medicine and International Health, Berlin, Germany
| | - A Duinmaijer
- Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania
| | - S Urasa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - L Tucker
- The London School of Hygiene & Tropical Medicine, London, UK
| | | | - G Cosker
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Dekker
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - A Kisoli
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - J Cletus
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Lissu
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - C Dotchin
- Institute of Population Sciences, Newcastle University, Newcstle upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - W Gray
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - R Walker
- Institute of Population Sciences, Newcastle University, Newcstle upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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Paddick SM, Lewis EG, Duinmaijer A, Banks J, Urasa S, Tucker L, Kisoli A, Cletus J, Lissu C, Kissima J, Dotchin C, Gray WK, Muaketova-Ladinska E, Cosker G, Walker RW. Identification of delirium and dementia in older medical inpatients in Tanzania: A comparison of screening and diagnostic methods. J Neurol Sci 2017; 385:156-163. [PMID: 29406898 DOI: 10.1016/j.jns.2017.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 11/20/2017] [Accepted: 12/05/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND In sub-Saharan Africa, there are no validated screening tools for delirium in older adults. This study assesses clinical utility of two instruments, the IDEA cognitive screen and the Confusion Assessment Method (CAM) for identification of delirium in older adults admitted to medical wards of a tertiary referral hospital in Tanzania. METHOD The IDEA cognitive screen and CAM were administered to a consecutive cohort of older individuals on admission to Kilimanjaro Christian Medical Centre using a blinded protocol. Consensus diagnosis for delirium was established against DSM-5 criteria and dementia by DSM-IV criteria. RESULTS Of 507 admission assessments, 95 (18.7%) had DSM-5 delirium and 95 (18.7%) had DSM-IV dementia (33 (6.5%) delirium superimposed on dementia). The CAM and IDEA cognitive screen had very good diagnostic accuracy for delirium (AUROC curve 0.94 and 0.87 respectively). However, a number of participants (10.5% and 16.4% respectively) were unable to complete these screening assessments due to reduced consciousness, or other causes of reduced verbal response and were excluded from this analysis; many of whom met DSM-5 criteria for delirium. Secondary analysis suggests that selected cognitive and observational items from the CAM and IDEA cognitive screen may be as effective as the full screening tools in identifying delirium even in unresponsive patients. CONCLUSION Both instruments appeared useful for delirium screening in this inpatient setting, but had significant limitations. The combination of assessment items identified may form the basis of a brief, simple delirium screening tool suitable for use by non-specialist clinicians. Further development work is needed.
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Affiliation(s)
- S M Paddick
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
| | - E G Lewis
- Charité - Universitätsmedizin Berlin, CVK: Campus Virchow-Klinikum, Institute of Tropical Medicine and International Health, Berlin, Germany
| | - A Duinmaijer
- Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania
| | - J Banks
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - S Urasa
- Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - L Tucker
- The London School of Hygiene & Tropical Medicine, London, UK
| | - A Kisoli
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - J Cletus
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Lissu
- Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - J Kissima
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - W K Gray
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - E Muaketova-Ladinska
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Institute of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK and Leicestershire Partnership NHS Trust, Leicester, UK
| | - G Cosker
- Institute of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK and Leicestershire Partnership NHS Trust, Leicester, UK
| | - R W Walker
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Paddick S, Lewis E, Duinmaijer A, Banks J, Tucker L, Kisoli A, Cletus J, Urasa S, Lissu C, Kissima J, Dotchin C, Gray W, Mukaetova-Ladinska E, Cosker G, Walker R. Identification of delirium and dementia in older medical inpatients in Tanzania: A comparison of screening and diagnostic methods. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Eaton P, Kellet-Wright J, Flatt A, Paddick SM, Irwin C, McCartney J, Thornton J, Yarwood V, Duinmaijer A, Kisoli A, Urasa S, Howlett W, Walker R, Dotchin C, Gray WK. 42RISK FACTORS FOR HIV-ASSOCIATED NEUROCOGNITIVE DISORDER IN OLDER PEOPLE IN NORTHERN TANZANIA. Age Ageing 2017. [DOI: 10.1093/ageing/afx110.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Paddick SM, Dotchin C, Gray W, Kisoli A, Kisima J, Chaote P, Walker R. 79UTILITY OF THE MINI-MENTAL STATE EXAMINATION (MMSE) FOR IDENTIFICATION OF DEMENTIA IN A LOW-LITERACY SETTING IN RURAL TANZANIA. Age Ageing 2015. [DOI: 10.1093/ageing/afv116.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Paddick SM, Gray WK, Dotchin C, Kisoli A, Mbowe G, Kisima J, Mkenda S, Lwezaula F, Mushi D, Teodorczuk A, Ogunniyi A, Walker R. VALIDATION OF THE IDEA COGNITIVE SCREENING TOOL FOR OLDER ADULTS IN HOSPITAL INPATIENT, OUTPATIENT AND RURAL COMMUNITY SETTINGS IN TANZANIA. J Neurol Neurosurg Psychiatry 2015. [DOI: 10.1136/jnnp-2015-311750.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Paddick SM, Gray WK, Dotchin C, Kisoli A, Mbowe G, Kisima J, Lwezaula F, Mkenda S, Mushi D, Teodorczuk A, Ogunniyi A, Walker R. PREVALENCE OF DELIRIUM IN OLDER HOSPITALISED ADULTS IN TANZANIA. THE IDEA (IDENTIFICATION AND INTERVENTIONS FOR DEMENTIA IN ELDERLY AFRICANS) STUDY. J Neurol Neurosurg Psychiatry 2015. [DOI: 10.1136/jnnp-2015-311750.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Paddick SM, Kisoli A, Longdon A, Dotchin C, Gray WK, Chaote P, Teodorczuk A, Walker R. The prevalence and burden of behavioural and psychological symptoms of dementia in rural Tanzania. Int J Geriatr Psychiatry 2015; 30:815-23. [PMID: 25351844 DOI: 10.1002/gps.4218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/26/2014] [Accepted: 09/04/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Behavioural and psychological symptoms (BPS) in dementia are common in high-income countries, but there are few data from sub-Saharan Africa. Our aim was to estimate the prevalence and pattern of BPS and associated caregiver distress in rural Tanzania. METHODS Prevalent cases of dementia (aged 70 and over) were identified during a community-based door-to-door study in six rural villages in Tanzania. Following cognitive screening, a stratified sample (over-sampled for people with dementia) of cases underwent a detailed clinical assessment including the brief 12 item neuropsychiatric inventory (NPI-Q), which assesses BPS and associated caregiver distress over the preceding 30 days. RESULTS Of 78 people with dementia, at least one current BPS was reported by 69 (88.4%), with 40 (51.3%) reporting 3 or more symptoms. In 172 people with no cognitive impairment, 110 (64.0%) reported at least one symptom and 48 (27.9%) reported 3 or more. In dementia cases, the most frequent symptoms reported were anxiety (47.4%), agitation/aggression (38.5%), night-time behavioural disturbance (34.6%), irritability (33.3%) and depression (33.3%). CONCLUSION The frequency of BPS in dementia in this rural Tanzanian population is high and comparable to that reported in prevalence studies from high income countries. Symptoms were also common, although to a lesser degree, amongst cognitively intact subjects. BPS are likely to have a significant impact on quality of life for elderly persons and their carers in low-income settings. Low-cost interventions, such as community-based therapy and education, are needed.
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Affiliation(s)
- S-M Paddick
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - A Kisoli
- Hai District Hospital, Boma'ngombe, Tanzania
| | - A Longdon
- South Devon Healthcare Trust, Torquay, UK
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - W K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK
| | - P Chaote
- Hai District Hospital, Boma'ngombe, Tanzania
| | - A Teodorczuk
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK.,Northumberland, Tyne and Wear NHS Trust, Newcastle Upon Tyne, UK
| | - R Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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