Daytime assessment of attention and orientation is associated with clinical outcomes in patients with delirium: A prospective observational study

Background Delirium is a common neuropsychiatric syndrome in hospitalized patients and is associated with increased mortality and poor outcomes. This study examined whether a brief bedside assessment of attention and orientation is associated with clinical outcomes in delirium. Methods This prospective observational study included acutely hospitalized patients with delirium who underwent psychiatric consultation at a general hospital. Attention and orientation were assessed during the initial daytime bedside consultation using a brief cognitive assessment completed within a few minutes. Patients were classified into high cognitive function (HCF) and low cognitive function (LCF) groups based on receiver operating characteristic analysis. Primary outcomes were delirium remission at 1 week and mortality at 6 months. Multivariable logistic regression and Cox proportional hazards models were used to examine associations between cognitive performance and outcomes, adjusting for major covariates. Results Ultimately, 65 patients were included. Delirium remission at 1 week occurred in 90.0% and 22.2% of patients in the HCF and LCF groups, respectively. The overall 6-month mortality rate was 30.8%, with rates of 5.0% and 42.2% in the HCF and LCF groups, respectively. In multivariable analyses, LCF was independently associated with higher 6-month mortality (hazard ratio 13.51, 95% confidence interval [CI] 1.52–120.6; odds ratio 32.7, 95% CI 2.12–503.5). The HCF group showed higher odds of delirium remission at 1 week (odds ratio 18.3, 95% CI 2.45–136.0). Conclusions A simple cognitive assessment focused on attention and orientation may provide useful prognostic information for delirium management in general hospitals.