Skip to main content Accessibility help

Assessment of inattention in the context of delirium screening: one size does not fit all!

  • Philippe Voyer (a1) (a2), Nathalie Champoux (a3), Johanne Desrosiers (a4), Philippe Landreville (a5), Johanne Monette (a6), Maryse Savoie (a7), Pierre-Hugues Carmichael (a2), Sylvie Richard (a2) and Annick Bédard (a2)...



Despite its high prevalence and deleterious consequences, delirium often goes undetected in older hospitalized patients and long-term care (LTC) residents. Inattention is a core symptom of this syndrome. The aim of this study was to explore the usefulness of ten simple and objective attention tests that would enable efficient delirium screening among this population.


This was a secondary analysis (n = 191) of a validation study conducted in one acute care hospital (ACH) and one LTC facility among older adults with, or without, cognitive impairment. The attention test tasks (n = 10) were drawn from the Concentration subscale the Hierarchic Dementia Scale (HDS). Delirium was defined as meeting the criteria for DSM-5 delirium. The Confusion Assessment Method (CAM) was used to determine the presence of delirium symptoms.


The Months of the Year Backward (MOTYB) test, which 57% of participants completed successfully, showed the best balance between sensitivity and specificity (82.6%; 95% CI [61.2–95.0], and 62.5%; 95% CI [54.7–69.8] respectively) for the entire group. Subgroup analyses revealed that no test had both sensitivity and specificity over 50% in participants with cognitive impairment indicated in their medical chart.


Our results revealed that these tests varied greatly in performance and none can be earmarked to become a single-item screening tool for delirium among older patients and residents with, or without, cognitive impairment. The presence of premorbid cognitive impairment may necessitate more extensive assessments of delirium, especially when a change in general status or mental state is observed.


Corresponding author

Correspondence should be addressed to: Dr P. Voyer, Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, room 3445, 1050, rue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada. Phone: +1-418-656-2131, Ext.: 8799; Fax: +1-418-656-7747. Email:


Hide All
Adamis, D., Sharma, N., Whelan, P. J. and Macdonald, A. J. (2010). Delirium scales: a review of current evidence. Aging and Mental Health, 14, 543555.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Bellelli, G. et al. (2014). Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age and Ageing, 43, 496502.
Bickel, H. (1996). The hierarchic dementia scale: usage. International Psychogeriatrics, 8, 213224.
Bravo, G., Dubois, M. F., Hebert, R., De Wals, P. and Messier, L. (2002). A prospective evaluation of the Charlson comorbidity index for use in long-term care patients. Journal of the American Geriatrics Society, 50, 740745.
Brummel, N. E., Vasilevskis, E. E., Han, J. H., Boehm, L., Pun, B. T. and Ely, E. W. (2013). Implementing delirium screening in the ICU: secrets to success. Critical Care Medicine, 41, 21962208.
Buntinx, F., Niclaes, L., Suetens, C., Jans, B., Mertens, R. and Van den Akker, M. (2002). Evaluation of Charlson's comorbidity index in elderly living in nursing homes. Journal of Clinical Epidemiology, 55, 11441147.
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373383.
Cole, M. G. and Dastoor, D. P. (1987). A new hierarchic approach to the measurement of dementia. Accurate results within 15 to 30 minutes. Psychosomatics, 28, 298301, 304.
Cole, M. G. et al. (2014). Core symptoms not meeting criteria for delirium are associated with cognitive and functional impairment and mood and behavior problems in older long-term care residents. International Psychogeriatrics, 26, 11811189.
Desrosiers, J., Bravo, G., Hebert, R. and Dubuc, N. (1995). Reliability of the revised functional autonomy measurement system (SMAF) for epidemiological research. Age and Ageing, 24, 402406.
Engelborghs, S. et al. (2006). Neuropsychological and behavioural correlates of CSF biomarkers in dementia. Neurochemistry International, 48, 286295.
Flaherty, J. H. et al. (2007). Delirium is a serious and under-recognized problem: why assessment of mental status should be the sixth vital sign. Journal of the American Medical Directors Association, 8, 273275.
Hébert, R., Carrier, R. and Bilodeau, A. (1988). The functional autonomy measurement system (SMAF): description and validation of an instrument for the measurement of handicaps. Age and Ageing, 17, 293302.
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113, 941948.
Inouye, S. K., Westendorp, R. G. and Saczynski, J. S. (2014). Delirium in elderly people. Lancet, 383, 911922.
Kolanowski, A. M., Fick, D. M., Yevchak, A. M., Hill, N. L., Mulhall, P. M. and McDowell, J. A. (2012). Pay attention! the critical importance of assessing attention in older adults with dementia. Journal of Gerontological Nursing, 38, 2327.
Landreville, P., Voyer, P. and Carmichae, P. H. (2013). Relationship between delirium and behavioral symptoms of dementia. International Psychogeriatrics, 25, 635643.
O'Regan, N. A. et al. (2014). Attention! A good bedside test for delirium?. Journal of Neurology, Neurosurgery, and Psychiatry, 85, 11221131.
Rizzo, J. A., Bogardus, S. T. Jr., Leo-Summers, L., Williams, C. S., Acampora, D. and Inouye, S. K. (2001). Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value?. Medical Care, 39, 740752.
Ronnberg, L. and Ericsson, K. (1994). Reliability and validity of the Hierarchic dementia scale. International Psychogeriatrics, 6, 8794.
Voyer, P. et al. (2015). Recognizing acute delirium as part of your routine [RADAR]: a validation study. BMC Nursing, 14, 19.
Wei, L. A., Fearing, M. A., Sternberg, E. J. and Inouye, S. K. (2008). The confusion assessment method: a systematic review of current usage. Journal of the American Geriatrics Society, 56, 823830.
Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. Journal of the American Medical Association, 304, 443451.
Wong, C. L., Holroyd-Leduc, J., Simel, D. L. and Straus, S. E. (2010). Does this patient have delirium?: value of bedside instruments. Journal of the American Medical Association, 304, 779786.


Assessment of inattention in the context of delirium screening: one size does not fit all!

  • Philippe Voyer (a1) (a2), Nathalie Champoux (a3), Johanne Desrosiers (a4), Philippe Landreville (a5), Johanne Monette (a6), Maryse Savoie (a7), Pierre-Hugues Carmichael (a2), Sylvie Richard (a2) and Annick Bédard (a2)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed