Cognitive visual perceptual deficits in patients with delirium

Background: Delirium is a neuropsychiatric disorder characterised by severe cognitive impairment, but the specific neuropsychological profile of this condition has not yet been clearly delineated. Psychiatric symptoms of perceptual disturbance-such as hallucinations, illusions and misperceptions-are common in delirium, suggesting that patients may have deficits in the cognitive systems underlying visual perception. Methods: Five neuropsychological tests of visual perception were administered to 17 older patients with delirium, as well as to two control groups comprising 14 patients with Alzheimer's dementia and 18 cognitively normal patients. The Mini Mental State Examination and the Consortium to Establish a Registry for Alzheimer's Disease verbal memory test were also administered to assess the specificity of any perceptual impairments. Results: Patients with delirium scored significantly lower than cognitively normal patients on all perceptual tasks and significantly lower than patients with dementia on three of these tasks. Mini Mental State Examination scores did not differ between the delirium and dementia groups, and patients with delirium showed significantly better verbal recognition performance than those with dementia. Conclusions: Patients with delirium have specific visual perceptual deficits that cannot be accounted for by general cognitive impairment. These novel findings provide insights into the neural mechanisms underling delirium and might help to improve clinical detection and management of the disorder. The results also support previous suggestions that cognitive perceptual deficits play a causal role in eliciting psychiatric symptoms of perceptual disturbance.