A comparison of delirium diagnosis in elderly medical inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 criteria

Adamis, Dimitrios; Rooney, Siobhán; Meagher, David; Mulligan, Owen; McCarthy, Geraldine

doi:10.1017/s1041610214002853

Cited by 43 publications

(41 citation statements)

References 31 publications

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“…CAM is a widely used measure of delirium and is highly correlated with DSM-5 criteria for delirium (Adamis et al, 2015); but it is possible the method for delirium detection may have affected the present findings. Additionally, delirium was not assessed on the day of surgery or after hospital discharge, thus it is also possible that some episodes of delirium were not captured, and the full duration may have been truncated in some cases.…”

Section: Discussionmentioning

confidence: 79%

Alzheimer's-related cortical atrophy is associated with postoperative delirium severity in persons without dementia

Racine

Fong

Travison

et al. 2017

Neurobiology of Aging

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Patients with dementia due to Alzheimer’s disease (AD) have increased risk of developing delirium. This study investigated the relationship between a magnetic resonance imaging (MRI)-derived biomarker associated with preclinical AD and postoperative delirium. Participants were older adults (≥70 years) without dementia who underwent preoperative MRI and elective surgery. Delirium incidence and severity were evaluated daily during hospitalization. Cortical thickness was averaged across a published set of a priori brain regions to derive a measure known as the “AD signature.” Logistic and linear regression was used, respectively, to test whether the AD signature was associated with delirium incidence in the entire sample (N=145) or with the severity of delirium among those who developed delirium (N=32). Thinner cortex in the AD signature did not predict incidence of delirium (odds ratio=1.15, p=.38), but was associated with greater delirium severity among those who developed delirium (b=−1.2, p=.014). These results suggest that thinner cortices, perhaps reflecting underlying neurodegeneration due to preclinical AD, may serve as a vulnerability factor that increases severity once delirium occurs.

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Section: Discussionmentioning

confidence: 79%

Alzheimer's-related cortical atrophy is associated with postoperative delirium severity in persons without dementia

Racine

Fong

Travison

et al. 2017

Neurobiology of Aging

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“…The Confusion Assessment Method (CAM) was used for all nonintubated patients. 20 For patients who still were intubated, the CAM-ICU was used. 21 The assessment was performed by trained research assistants.…”

Section: Methodsmentioning

confidence: 99%

“…22 A diagnosis of delirium was performed by a consensus panel following Diagnostic and Statistical Manual of Mental Disorders-IV-TR criteria. 20 The consensus panel included a psychiatrist, anesthesiologist, and research assistants who were completely blinded from the results of cerebral autoregulation monitoring. Multiple measures were taken to ensure quality assurance.…”

Section: Methodsmentioning

confidence: 99%

Blood Pressure Deviations From Optimal Mean Arterial Pressure During Cardiac Surgery Measured With a Novel Monitor of Cerebral Blood Flow and Risk for Perioperative Delirium: A Pilot Study

Hori¹,

Max²,

Laflam³

et al. 2016

Journal of Cardiothoracic and Vascular Anesthesia

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Objective The aim of this study was to evaluate whether excursions of blood pressure from the optimal mean arterial pressure during and after cardiac surgery are associated with postoperative delirium identified using a structured examination. Design Prospective, observational study. Setting University hospital. Participants The study included 110 patients undergoing cardiac surgery. Interventions Patients were monitored using ultrasound-tagged near-infrared spectroscopy to assess optimal mean arterial pressure by cerebral blood flow autoregulation monitoring during cardiopulmonary bypass and the first 3 hours in the intensive care unit. Measurements and Main Results The patients were tested preoperatively and on postoperative days 1 to 3 with the Confusion Assessment Method or Confusion Assessment Method for the Intensive Care Unit, the Delirium Rating Scale-Revised-98, and the Mini Mental State Examination. Summative presence of delirium on postoperative days 1 through 3, as defined by the consensus panel following Diagnostic and Statistical Manual of Mental Disorders-IV-TR criteria, was the primary outcome. Delirium occurred in 47 (42.7%) patients. There were no differences in blood pressure excursions above and below optimal mean arterial pressure between patients with and without summative presence of delirium. Secondary analysis showed blood pressure excursions above the optimal mean arterial pressure to be higher in patients with delirium (mean ± SD, 33.2 ± 26.51 mmHgxh v 23.4 ± 16.13 mmHgxh; p ¼ 0.031) and positively correlated with the Delirium Rating Scale score on postoperative day 2 (r = 0.27, p = 0.011). Conclusions Summative presence of delirium was not associated with perioperative blood pressure excursions; but on secondary exploratory analysis, excursions above the optimal mean arterial pressure were associated with the incidence and severity of delirium on postoperative day 2.

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“…Subjects derived from two prospective cross‐sectional studies that used similar methods of assessment for delirium status and phenomenology obtained by our extended delirium research teams are as follows: (1) a sample of 200 consecutive elderly acute general medical admissions to a university teaching hospital in Sligo (Ireland) [26], and (2) a group of 200 consecutive patients admitted to a skilled nursing home (NH) in Reus (Spain) [27].…”

Section: Methodsmentioning

confidence: 99%

Subsyndromal delirium compared with delirium, dementia, and subjects without delirium or dementia in elderly general hospital admissions and nursing home residents

Sepúlveda

Leonard

Vásquez

et al. 2016

Alz & Dem Diag Ass & Dis Mo

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IntroductionSubsyndromal delirium (SSD) complicates diagnosis of delirium and dementia, although there is little research comparing their symptom profiles.MethodsCross-sectional study of 400 elderly patients' admission to a general hospital or nursing home diagnosed with delirium, SSD, dementia, or no-delirium/no-dementia (NDND). Symptom profiles were assessed using the Delirium Rating Scale-Revised-98 (DRS-R98).ResultsTwenty percent patients had delirium, 19.3% had SSD, 29.8% had dementia-only, and 31% had NDND. Eighty-one percent of subsyndromal and 76% of delirium groups had comorbid dementia. DRS-R98 scores showed ascending severity from NDND < dementia-only < SSD < delirium. DRS-R98 scores for items evaluating the three core symptom domains (cognitive, higher-order thinking, and circadian) distinguished SSD from delirium and both from nondelirium groups. DRS-R98 profiles were essentially the same in delirium and SSD subgroups with or without dementia, although total scale scores were generally higher when in comorbid subgroups.DiscussionSSD shared characteristic core domain symptoms with delirium, which distinguished each from nondelirium groups, although severity was intermediate in the subsyndromal group. Delirium core symptoms overshadowed the dementia phenotype when comorbid. Milder disturbances of delirium core domain symptoms are highly suggestive of SSD.

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A comparison of delirium diagnosis in elderly medical inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 criteria

Cited by 43 publications

References 31 publications

Alzheimer's-related cortical atrophy is associated with postoperative delirium severity in persons without dementia

Alzheimer's-related cortical atrophy is associated with postoperative delirium severity in persons without dementia

Blood Pressure Deviations From Optimal Mean Arterial Pressure During Cardiac Surgery Measured With a Novel Monitor of Cerebral Blood Flow and Risk for Perioperative Delirium: A Pilot Study

Subsyndromal delirium compared with delirium, dementia, and subjects without delirium or dementia in elderly general hospital admissions and nursing home residents

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