ASSESSING ATTENTIVENESS IN OLDER HOSPITAL PATIENTS - GLOBAL ASSESSMENT VERSUS TESTS OF ATTENTION

OBJECTIVES: Impairment of attentiveness is a cardinal symptom of delir ium. We examined the relationship between bedside tests of attention a nd a global rating of attentiveness in older hospital patients and sou ght to identify cut-off points on the tests of attention that might be helpful in the diagnosis of delirium. SETTING AND PARTICIPANTS: Subje cts were 110 patients admitted to an acute geriatric unit. MEASUREMENT S: Subjects were assessed by two physicians. One physician rated globa l attentiveness on a 10-cm visual analog scale following general conve rsation with the patient. The second physician determined whether pati ents met DSM-3 criteria for delirium or dementia and administered four tests of attentiveness: Digit Span Forwards (DSF), Digit Span Backwar ds (DSB), Vigilance 'A' test (VAT), and a timed Digit Cancellation Tes t (DCT). MAIN RESULTS: Of the 87 patients who completed the study, 18 were delirious and 17 demented. There was no difference between dement ed and delirious patients on the VAT, DSF, or MMSE tests; other compar isons between demented and delirious patients and between delirious pa tients and those with neither delirium nor dementia were significant. All tests of attention except DSF were significantly correlated with t he global rating. CONCLUSION: Simple bedside tests of attention can ai d identification of delirium.