Need for new methods to study delirium

Regal, Paul

doi:10.1111/imj.12236

Cited by 4 publications

(3 citation statements)

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“…However, the opposite processoverdiagnosis -is prevalent. 1 Labelling acute behavioural change in dementia as a delirium instead of behavioural and psychological symptoms of dementia (BPSD) is the leading reason for this. There are many reasons for overdiagnosis; in a country with a national health service, general practitioners (GPs) experience diffi culty in convincing hospitals to admit patients with BPSD, whereas labelling it 'delirium' is the instant ticket to hospital admission.…”

Section: Delirium: a Synthesis Of Current Knowledgementioning

confidence: 99%

“…2 The underdiagnosis of delirium is a frequent problem and might be partly related to the fl uctuation of symptoms throughout the day. 1 Missing delirium symptoms could prevent appropriate treatment of the underlying disorder of the patient and could be seen as a medical omission. We agree there is no need for the admission of patients with behavioural and psychological symptoms of dementia (BPSD) to hospital, but this diagnosis is not always easy for a general practitioner (GP) with limited time for observation.…”

Section: Overview Responsementioning

confidence: 99%

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Delirium: a synthesis of current knowledge

Regal

2014

Clinical Medicine

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Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine@rcplondon.ac.uk Sarcopenic obesity: under recognised and over treated?Editor -Cruz-Jentoft and Landi's fi ne review of the growing importance of sarcopenia (Clin Med April 2014 pp 183-6) omitted to discuss the increasingly recognised condition of sarcopenic obesity. At an individual level the classifi cation of overweight and obesity by body mass index (BMI) as a measure of (excess) fat and lean tissue mass is increasingly recognised as fl awed, 1 and many older people with apparently 'healthy' BMIs may in fact be sarcopenic. 2 Meta-analyses consistently show that mortality and morbidity associated with overweight and obesity only increase at a BMI above 30 kg/m 2 in the elderly. In addition, the incidence of cardiovascular disease, mortality and all-cause mortality is higher in those with sarcopenic obesity than those who are 'simply' obese. Sarcopenia probably lies at the heart of the so-called obesity paradox -the fi nding that modest overweight is benefi cial. Thus in the elderly, weight loss interventions are best offered to patients who are obese rather than overweight (by BMI defi nition) and who have functional impairments, metabolic complications or obesity-related diseases that can benefi t from weight loss. Physical activity and exercise should form part of any weight loss therapy, but are of particular importance in the elderly. ■ NICK FINER Consultant endocrinologist and bariatric physician,

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Section: Delirium: a Synthesis Of Current Knowledgementioning

confidence: 99%

Section: Overview Responsementioning

confidence: 99%

Delirium: a synthesis of current knowledge

Regal

2014

Clinical Medicine

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“…Inouye et al omitted references and personal communications that undermined their views (logical fallacy of suppressed evidence). 7 – 9 Karl Popper, a champion of logic in medicine, advocated bold audacious models and methods which could easily be disproven. Only 1.6% of key delirium articles (18/1,118) used gold standards of speed, amplitude, and criticality of cognitive decline or rapid reversibility.…”

Section: Introductionmentioning

confidence: 99%

A new delirium phenotype with rapid high amplitude onset and nearly as rapid reversal: Central Coast Australia Delirium Intervention Study

Regal¹

2015

CIA

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BackgroundTraditional models for delirium based on the Diagnostic and Statistical Manual for Mental Disorders and its 1990 offspring, the Confusion Assessment Method (CAM), were not designed to distinguish behavioral and psychological symptoms of dementia from rapid cognitive decline. We examined a new diagnostic criterion for delirium plus exclusion of behavioral and psychological symptoms of dementia and recent inattention with a 25% decline in digit span forward (DSF).MethodsThis was a prospective, randomized controlled trial comparing management of prevalent delirium in general medical with that in geriatric medical wards in a 370-bed hospital north of Sydney. Inclusion criteria were age ≥65 years and prevalent delirium in the emergency department based on: CAM; proof that CAM elements were not better explained by behavioral and psychological symptoms of dementia; proof of recent inattention on DSF; evidence of cognitive decline not due to sedatives or antipsychotics in the emergency department. Measurements included the Instrumental Activities of Daily Living (IADL, 22-item), Selective IADL (8-item), Mini-Mental State Examination, DSF daily, Delirium Index daily, and Apathy Evaluation Scale. Pre-delirium scores from past cognitive tests and best scores were imputed after admission. Relative change (RC) was calculated as absolute change/test range and RC/MPC ratio was calculated as RC after admission/maximal possible change.ResultsA total of 130 subjects were recruited but 14 with subsyndromal delirium were excluded, leaving 116 subjects (mean age 83.6 years). Forty-eight percent had prior dementia. RC from pre-delirium to admission was 42% for the Mini-Mental State Examination, 41% for Selective IADL, 34% for 5-DSF, 54% for 6-DSF, and 37% for the Apathy Evaluation Scale. Improvements after admission (RC and RC/MPC ratios) were 32%/98% for 5-DSF, 54%/82% for 6-DSF, and 45%/80% for the Delirium Index. General medicine and geriatric medicine groups had similar outcomes.ConclusionThis delirium phenotype selects for a rapid high amplitude critical decline in attention, executive function, IADL, and apathy that recovers almost as rapidly.

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Delirium reversibility and instrumental activities of daily living

Regal

2015

Geriatrics Gerontology Int

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Need for new methods to study delirium

Cited by 4 publications

References 3 publications

Delirium: a synthesis of current knowledge

Delirium: a synthesis of current knowledge

A new delirium phenotype with rapid high amplitude onset and nearly as rapid reversal: Central Coast Australia Delirium Intervention Study

Delirium reversibility and instrumental activities of daily living

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