The Cognitive Test for Delirium appears to be a Useful Tool

Past Studies

Past Studies have found a high rate of delirium in a number of medical illnesses. Individuals with a traumatic brain injury who lose consciousness can experience a brief or prolonged period of altered mental abilities as they regain alertness and recover. During this state, individuals may have difficulty with thinking skills such as attention, memory and disorientation. Difficulty with sleep, mood swings, and behavior problems are also common. To date, this period had been termed “post-traumatic amnesia” specifically because of its characteristic loss of memory skills and disorientation. More recently, researchers have argued that problems with attention span are more common and that this recovery period has characteristics similar to delirium seen in other medical illnesses. Delirium is an acute confusional state that can occur when medical illness affects brain function. Symptoms of delirium include problems with attention span, disturbed sleep, and altered thinking that comes and goes over time. Other features can include altered activity levels, psychotic symptoms (hallucinations, delusions), and mood swings. Because of this, recent researchers suggest using the term “post-traumatic confusional state” instead of post-traumatic amnesia. Tests for post-traumatic amnesia focus on memory and do not measure the other symptoms seen with delirium. There are no standardized tests to assess post-traumatic confusion or delirium for individuals with traumatic brain injury. Therefore, no studies examining the adequacy of such measures for the diagnosis of delirium have been done.

This Study

This study included 65 individuals with traumatic brain injury. The participants were evaluated weekly with the Cognitive Test for Delirium and widely accepted diagnostic guidelines for delirium (the American Psychiatric Association’s DSM-IV criteria). The Cognitive Test for Delirium was developed to diagnose delirium solely on the basis of cognitive functioning (thought and emotional processing). The researchers compared the results of the tests to determine the usefulness of the Cognitive Test for Delirium.The researchers found that the Cognitive Test for Delirium is useful for detecting delirium among individuals with traumatic brain injury in the inpatient setting. The Cognitive Test for Delirium was found to have acceptable sensitivity and specificity. This indicates the likelihood that the test will identify someone whom has delirium and the likelihood that the test would identify individuals that do not have delirium. Additionally, the Cognitive Test for Delirium can be given in a short amount of time and is adaptable individuals that are unable to speak.

Who May Be Affected By These Findings

Individuals with traumatic brain injury, rehabilitation personnel, researchers

Caveats

Some participants were unable to complete the Cognitive test for delirium for various reasons, such as inability to follow instructions or to point for responses. This suggests that the assessment has some limitations for use with individuals with traumatic brain injury and deserves more study.

Bottom Line

The Cognitive Test for Delirium appears useful for diagnosing delirium in individuals with brain injury.

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