Delirium Superimposed on Dementia and Mild Cognitive Impairment

Abstract

Dementia is an illness that progressively affects cognition, emotion, and functional status. It can be complicated by delirium, an acute disturbance of consciousness and cognition that develops over a short course with fluctuating symptoms. Patients with dementia who experience delirium tend to have slower resolution of symptoms, more adverse events, and poorer outcomes. There are significant health care expenditures associated with delirium. Many health care providers fail to recognize and diagnose delirium. The confusion assessment method is a suggested tool for diagnosing delirium. Delirium is multifactorial, occurring in an individual who has a predisposing factor (dementia is the number 1 risk factor) and is exposed to further precipitating risk factors that are often preventable. The main focus of treatment and management of delirium should be on prevention, which can be achieved through assessing patients for predisposing and precipitating factors. If a patient does develop delirium, a reassessment of precipitating factors is the first step in treatment, and then nonpharmacologic or pharmacologic treatment can be considered. The use of antipsychotics or melatonin to treat delirium in dementia is considered off-label.

Cross-cultural adaptation and validation of the 3D-CAM Chinese version in surgical ICU patients

“…In a prospective cohort study of 101 non-ICU geriatric patients (aged ≥75 years), the authors reported that the 3D-CAM was superior than the CAM-ICU in diagnosing delirium [28]. Delirium assessment in patients with cognitive impairment or dementia is a challenging task [29]. Lack of an efficient instrument is considered the main reason of mis-and underdiagnosis of delirium in this population [29,30].…”

“…Delirium assessment in patients with cognitive impairment or dementia is a challenging task [29]. Lack of an efficient instrument is considered the main reason of mis-and underdiagnosis of delirium in this population [29,30]. Marcantonio and colleagues [16] reported that the sensitivity and specificity of the 3D-CAM in dementia patients was 96% and of 86%, respectively.…”

Delirium Superimposed on Dementia in Perioperative Period and Intensive Care

“…Both of these disorders increase each other’s risk of development [ 3 , 4 ] and are more common among the elderly [ 1 , 5 ]. Both delirium and dementia have a common pathological mechanism, which results in many similarities in the clinical presentation, creating additional diagnostic difficulties [ 6 ].…”

Exploratory and Confirmatory Factor Analyses of Delirium Symptoms in a Sample of Nursing Home Residents

“…However, delirium often goes underdiagnosed by clinicians and is frequently inadequately managed (Gower, Gatewood, & Kang, 2012; Press et al, 2009). It is probable that delirium is often overlooked or misdiagnosed (Farrell & Ganzini, 1995) because its recognition can be particularly difficult in older patients who often have physical and psychiatric comorbidities that may contribute to cognitive, affective, and/or behavioral changes (Gagliardi, 2008; Gonzalez, de Pablo, & Valdes, 2003; Kolanowski et al, 2015; Marchington, Carrier, & Lawlor, 2012; Roden & Simmons, 2014). Findings in a recent survey on family caregivers’ knowledge of delirium (Bull, Boaz, & Sjostedt, 2014) indicate that family caregivers appear to confuse symptoms of delirium with dementia, which illustrates that delirium symptom identification is a challenge across the continuum of care.…”

“…Findings in a recent survey on family caregivers’ knowledge of delirium (Bull, Boaz, & Sjostedt, 2014) indicate that family caregivers appear to confuse symptoms of delirium with dementia, which illustrates that delirium symptom identification is a challenge across the continuum of care. One case study suggests that the diagnosis of delirium is frequently missed or misdiagnosed as depression in patients with hypoactive forms of delirium because of the overlap in symptoms between the two diagnoses (Roden & Simmons, 2014).…”