Lighthouse-SA — Lighthouse sustained-attention test

What this tool is and how to interpret its evidence

The Lighthouse test is an Android-smartphone cognitive task developed to assess awareness, focused attention and sustained attention in older hospital patients. Its three sections use a standardised visual stimulus, with the sustained-attention component, Lighthouse-SA, providing the strongest delirium discrimination. Digital delivery can improve consistency compared with loosely administered bedside tasks. An exact total completion time was not reported, and study raters were specifically trained. Visual recognition, hearing or instruction comprehension, motor response and arousal can all affect feasibility.

Meagher and colleagues studied 180 older medical inpatients referred to a later-life psychiatry service: 44 had delirium, 30 dementia, 60 delirium with dementia and 46 no neurocognitive diagnosis. In this cross-sectional comparison, Lighthouse-SA had sensitivity of 84.6%, specificity of 63.2% and overall accuracy of 75.6%. The enriched referral sample and fixed test sequence limit generalisability. Recognition and focused-attention sections performed less well, and no independent external validation was identified.

Lighthouse is genuinely delirium-focused, but it measures cognitive components rather than the syndrome's acute change, fluctuation and clinical cause. It should therefore appear as an emerging objective-attention test, outside the mature independent-family count. The page may summarise the three-section architecture and study results without copying the exact stimulus sequences. Readers can consult the open primary article for full methods. A failed task should prompt broader assessment, not be presented as a stand-alone delirium diagnosis.