Prevalence of delirium among outpatients with dementia

Hasegawa, Noriko; Hashimoto, Mamoru; Yuuki, Seiji; Honda, Kazuki; Yatabe, Yasushi; Araki, Kunio; Ikeda, Manabu

doi:10.1017/s1041610213001191

Cited by 37 publications

(31 citation statements)

References 30 publications

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“…In addition, one-third of dementia patients with multiple NPS had comorbid delirium. Hasegawa et al 16 compared dementia to comorbid delirium–dementia in respect of NPI ratings in memory clinic attenders. They found significantly higher total NPI scores for comorbid delirium–dementia, with similar scores across the groups for most individual items except for greater agitation in comorbid delirium–dementia.…”

Section: Discussionmentioning

confidence: 99%

Comparison of cognitive and neuropsychiatric profiles in hospitalised elderly medical patients with delirium, dementia and comorbid delirium–dementia

et al. 2016

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Objectives Differentiation of delirium and dementia is a key diagnostic challenge but there has been limited study of features that distinguish these conditions. We examined neuropsychiatric and neuropsychological symptoms in elderly medical inpatients to identify features that distinguish major neurocognitive disorders. Setting University teaching hospital in Ireland. Participants and measures 176 consecutive elderly medical inpatients (mean age 80.6±7.0 years (range 60–96); 85 males (48%)) referred to a psychiatry for later life consultation-liaison service with Diagnostic and Statistical Manual of Mental Disorders (DSM) IV delirium, dementia, comorbid delirium–dementia and cognitively intact controls. Participants were assessed cross-sectionally with comparison of scores (including individual items) for the Revised Delirium Rating Scale (DRS-R98), Cognitive Test for Delirium (CTD) and Neuropsychiatric Inventory (NPI-Q). Results The frequency of neurocognitive diagnoses was delirium (n=50), dementia (n=32), comorbid delirium–dementia (n=62) and cognitively intact patients (n=32). Both delirium and comorbid delirium–dementia groups scored higher than the dementia group for DRS-R98 and CTD total scores, but all three neurocognitively impaired groups scored similarly in respect of total NPI-Q scores. For individual DRS-R98 items, delirium groups were distinguished from dementia groups by a range of non-cognitive symptoms, but only for impaired attention of the cognitive items. For the CTD, attention (p=0.002) and vigilance (p=0.01) distinguished between delirium and dementia. No individual CTD item distinguished between comorbid delirium–dementia and delirium. For the NPI-Q, there were no differences between the three neurocognitively impaired groups for any individual item severity. Conclusions The neurocognitive profile of delirium is similar with or without comorbid dementia and differs from dementia without delirium. Simple tests of attention and vigilance can help to distinguish between delirium and other presentations. The NPI-Q does not readily distinguish between neuropsychiatric disturbances in delirium versus dementia. Cases of suspected behavioural and psychological symptoms of dementia should be carefully assessed for possible delirium.

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Section: Discussionmentioning

confidence: 99%

Comparison of cognitive and neuropsychiatric profiles in hospitalised elderly medical patients with delirium, dementia and comorbid delirium–dementia

et al. 2016

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“…50 Furthermore, patients with DLB also appear to be more acutely sensitive to minor insults (even subclinical events) and, thus, more delirium “prone.” Consequently, and unsurprisingly, delirium is more commonly diagnosed in DLB than AD 51 with 32% of outpatients with DLB experiencing delirium as opposed to 15% of outpatients with AD. 52 …”

Section: Dementia With Lewy Bodies and The Influence On Tests Used Tomentioning

confidence: 99%

The Diagnosis of Delirium Superimposed on Dementia: An Emerging Challenge

Morandi

Davis

Bellelli

et al. 2017

Journal of the American Medical Directors Association

159

116

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Delirium occurring in patients with dementia is referred to as delirium superimposed on dementia (DSD). People who are older with dementia and who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision are considered the standard reference for the diagnosis of delirium and include criteria of impairments in cognitive processes such as attention, additional cognitive disturbances, or altered level of arousal. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision does not provide guidance regarding specific tests for assessment of the cognitive process impaired in delirium. Importantly, the assessment or inclusion of preexisting cognitive impairment is also not addressed by these standards. The challenge of DSD gets more complex as types of dementia, particularly dementia with Lewy bodies, which has features of both delirium and dementia, are considered. The objective of this article is to critically review key elements for the diagnosis of DSD, including the challenge of neuropsychological assessment in patients with dementia and the influence of particular tests used to diagnose DSD. To address the challenges of DSD diagnosis, we present a framework for guiding the focus of future research efforts to develop a reliable reference standard to diagnose DSD. A key feature of a reliable reference standard will improve the ability to clinically diagnose DSD in facility-based patients and research studies.

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“…It is characterized by attention deficits, cognitive dysfunction, and neuropsychiatric symptoms that begin acutely and fluctuate throughout the day. Delirium affects 10-40% of hospitalized patients, 11-39% of nursing home patients, and 16-19% of elderly outpatients referred for cognitive screening to psychiatric clinics (De Lange et al, 2013;Hasegawa et al, 2013;Siddiqi et al, 2006;Stroomer-van Wijk et al, 2016). Cognitive impairment is an important risk factor for developing delirium (Hasegawa et al, 2013;Kazmierski et al, 2014;Oldham et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

A short delirium caregiver questionnaire for triage of elderly outpatients with cognitive impairment: a development and test accuracy study

Luijendijk

Quispel-Aggenbach

Wijk

et al. 2019

Int. Psychogeriatr.

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Objectives: Delirium is often missed in older outpatients. Caregivers can give valuable information that might improve identification rates. The aim of this study was to develop a short and sensitive delirium caregiver questionnaire (DCQ) for triage of elderly outpatients with cognitive impairment by telephone. Design, setting, and participants: The pilot questionnaire was administered to 112 caregivers of patients who were referred for dementia screening to our clinic for geriatric psychiatry, and the final DCQ to 234 other caregivers. Measurements: In phase I (2013–2014), we tested a pilot questionnaire with 17 items. Health professionals who established delirium diagnoses were blinded to the results. We then used the results and other information available at referral to construct the final DCQ with seven items. During phase II (2015–2016), we investigated the test accuracy of the final DCQ in a subsequent cohort. In both phases, the patients received a structured diagnostic workup. Time between referral and first visit was a secondary outcome. Results: The final DCQ consisted of the following items: emergency visit required, sleeping disorder, fluctuating course, hallucinations, suspicious thoughts, previous delirium, and recent discharge from hospital. DCQ results indicated that urgent intake was required in 85 of 234 patients. Sensitivity was 73.5% (95% CI: 58.9–85.1%) and specificity 73.5% (95% CI: 66.5–79.7%). The mean number of days to first visit dropped from 31.6 to 11.2 in delirious patients (p = 0.001). Conclusions: Triage with the easy-to-use DCQ among patients referred for cognitive screening leads to earlier assessment and higher detection rates of delirium.

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Prevalence of delirium among outpatients with dementia

Abstract: The frequency of delirium varies with each dementia type. In addition, delirium decreases activities of daily living, exaggerates behavioral and psychological symptoms dementia, and is associated with CVD in patients with neurodegenerative dementias.

Cited by 37 publications

References 30 publications

Comparison of cognitive and neuropsychiatric profiles in hospitalised elderly medical patients with delirium, dementia and comorbid delirium–dementia

Comparison of cognitive and neuropsychiatric profiles in hospitalised elderly medical patients with delirium, dementia and comorbid delirium–dementia

The Diagnosis of Delirium Superimposed on Dementia: An Emerging Challenge

A short delirium caregiver questionnaire for triage of elderly outpatients with cognitive impairment: a development and test accuracy study

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