A comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium-dementia and cognitively intact controls

Abstract

Purpose: Delirium and dementia have overlapping features that complicate differential diagnosis. Delirium symptoms overshadow dementia symptoms when they co-occur, but delirium phenomenology in comorbid cases has not been compared to both conditions alone. Methods:Consecutive adults with DSM-IV delirium, dementia, comorbid deliriumdementia, and cognitively intact controls were assessed using the Revised Delirium Rating Scale (DRS-R98) and Cognitive Test for Delirium (CTD).Results : Delirium and comorbid delirium-dementia groups had comparable DRS-R98 and CTD total scores which were greater than in dementia or control groups.On the DRS-R98, multiple non-cognitive symptoms, inattention and disorientation were more severe in delirium groups compared with dementia-alone. Patients with dementia differed from both delirium groups on the CTD test of attention. Spatial span backwards was significantly lower in all patients with cognitive impairment (delirium, comorbid delirium-dementia, dementia alone) compared to controls, whereas spatial span forwards distinguished delirium groups from dementia. Conclusions:Delirium phenomenology is similar with or without comorbid dementia. A wide range of neuropsychiatric symptoms distinguish delirium from dementia. Spatial span forward is disproportionately diminished in delirium , suggesting usefulness as a differentiating screening test. Declaration of interest:The authors wish to acknowledge the support and cooperation of nursing and medical staff at Milford Hospice Palliative care centre.

Phenotype of subsyndromal delirium using pooled multicultural Delirium Rating Scale—Revised-98 data

“…Unfortunately these symptoms are not captured by two commonly used tools, the Mini-Mental State Examination (MMSE) and the CAM [29] so we cannot recommend their use to detect SSD. A test of simple visual attention span may be the best single cognitive test for delirium detection [15,30] and measures two of the five domains in the above list. The 3-item Delirium Diagnostic Tool-Provisional (DDT-Pro), which quantitates only the core domains, highly distinguished delirious from nondelirious post-traumatic brain injury patients [20] and might be evaluated as a possible tool for SSD.…”

A Point Prevalence Study of Delirium in Italian Nursing Homes

“…Furthermore, Meagher et al [28] have shown that disorientation is more common in patients with delirium or delirium superimposed on dementia than in those with dementia without delirium. The challenge of diagnosing delirium in the presence of dementia, due to the overlapping of symptoms in these two syndromes, is well known [26,29,30] and no ideal assessment instrument has been proposed yet.…”

Instrumentos para el diagnóstico de delirium en hispanohablantes: artículo de revisión

“…La sedación y el coma se descartan previamente mediante la RASS y sus ítems pueden ser evaluados de forma no verbal en caso de necesidad. Esta herramienta incluye pruebas específicas para evaluar la atención y guía al evaluador para que la administre de forma estandarizada, lo que con demencia puede ser difícil por cuanto es un factor de riesgo muy frecuente que comparte síntomas con el síndrome de delirium 1,[23][24][25][26][27] .…”