Diagnosing delirium superimposed on dementia in elderly emergency department patients

Abstract

Delirium and delirium superimposed on dementia (DSD) have a high prevalence in elderly populations presenting to the emergency department (ED). Despite their prevalence, diagnosis remains a problem and has led to increased healthcare costs and adverse health outcomes. Various tools and diagnostic screening tests exist to aid clinicians in their diagnosis but the need for a simple, sensitive and specific tool that can be used in a busy ED setting still exists. The objective of this study is to further validate two cognitive screening assessments, the 6-Item Cognitive Impairment Test (6-CIT) and Vigilance A Test, for their use in the ED as a screening test for delirium and DSD. The study will be a prospective cohort study performed at a tertiary academic medical center with elderly patients greater than 65 years old. The diagnostic accuracy of the 6-CIT and Vigilance A tests administered by emergency medicine attending physicians will be compared to a reference standard expert assessment performed by a psychiatrist. Patients will be assessed within 3 hours of presenting to the ED. Sensitivity, specificity, positive and negative predictive values with 95% confidence intervals will be calculated. The goal of the study is to determine whether the 6-CIT and Vigilance A tests can accurately exclude delirium and dementia in elderly ED patients, which would have future implications for their use as a time-efficient screening tool in these populations.