DFI — Delirium Frontal Index

What this tool is and how to interpret its evidence

The Delirium Frontal Index is a research composite derived from bedside examination of executive dysfunction and frontal-release signs. It was studied in hospitalised adults from a setting with a high prevalence of dementia, where distinguishing delirium from chronic cognitive impairment is particularly difficult. The index is intended to capture a neurological pattern associated with delirium rather than reproduce a standard psychiatric diagnostic algorithm.

Franco and colleagues compared individual signs and combined indices against study delirium classification. The resulting composite showed discrimination around the 80% range for both sensitivity and specificity, but it was developed and tested within one study population. The work is hypothesis-generating and provides insight into possible network dysfunction; it is not external validation of a ready-to-deploy general bedside tool. Exact completion time, training requirements and performance in stroke, movement disorder, critical care and lower-dementia-prevalence cohorts remain uncertain.

DFI should be included only as emerging neurological-assessment context. The page can describe the broad domains, single-study design, approximate discrimination and need for replication without reproducing every examination manoeuvre or a diagnostic recipe. It should not contribute to the core family count or be described as equivalent to a validated delirium screen. Clinicians encountering frontal signs still need a complete assessment of acute change, fluctuation, attention, arousal, baseline cognition and plausible medical causes.