Study of cognitive functioning in a medical population

Lowy, Frederick H.; Engelsmann, F.; Lipowski, Z. J.

doi:10.1016/0010-440x(73)90025-4

Cited by 19 publications

(9 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 1973 Lowy and colleagues introduced the "Delirium Scale" (D-Scale), which included 53 19 ,1990). items assessing cognitive functioning 23 . The D-Scale has the merit of having been one of the first attempts to make a more systematic evaluation of these patients, although its rather complex design limited its use in clinical practice 17,24 .…”

Section: Discussionmentioning

confidence: 99%

Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly

Fabbri

Moreira

Garrido

et al. 2001

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

-This study has tested the validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM), a diagnostic assessment instrument for delirium developed by Inouye et al. (1990). The sample was formed by 100 patients with 60 and more years of age, admitted at the emergency service of Santa Casa de São Paulo, in the time periods between July and August, 1996, November and December, 1996 and February and March, 1997. The sensibility was 94.1% and specificity 96.4%. The assessors reliability in a sample of the 24 patients resulted in a kappa = 0.70. We have concluded that CAM is an adequate instrument to assess the presence of delirium, reliable to assess elderly patients at the emergency services.KEY WORDS: delirium ,elderly, emergency service, validity, CAM.Validação e confiabilidade da versão em língua portuguesa do confusion assessment method (CAM) para a detecção de delirium no idoso. RESUMO -O presente estudo testou a validade e confiabilidade da versão em língua portuguesa do ConfusionAssessment Method (CAM), instrumento de avaliação diagnóstica de delirium desenvolvido por Inouye e col. (1990). A amostra foi composta de 100 pacientes com idade igual ou superior a 60 anos atendidos no serviço de urgência da Santa Casa de São Paulo nos períodos de julho a agosto de 1996, novembro a dezembro de 1996 e fevereiro a março de 1997. Os resultados apontaram sensibilidade de 94,1% e especificidade de 96,4%. Confiabilidade entre avaliadores em subgrupos de 24 pacientes produziu kappa = 0,70. Concluimos que o CAM é um instrumento que afere a presença de delirium de forma adequada e que pode ser utilizado de forma confiável na avaliação de pacientes idosos atendidos em serviços de urgência. PALAVRAS-CHAVE: delirium, idoso, serviço de urgência, validação, CAM. Presently, delirium is defined as an organic brain syndrome without specific etiology, characterized by the simultaneous presence of disturbances related to consciousness and attention, perception, thinking, memory, psychomotor behavior, emotions and sleep-wake cycle 1 . Prevalence studies indicate that delirium is present in 10-24% of adults admitted to hospital and that another 32% will develop the disorder as inpatients 2,3 . Typical symptoms of delirium include reduced ability to focus and maintain attention, memory deficits, disorientation, language difficulties, illusions, hallucinations, and many other behavioral abnormalities. Infection, cardiovascular diseases, metabolic disturbances, and drug use or withdrawal are the most frequent causes of delirium 4,5 . Only 33-64% of the patients with delirium are correctly identified by practicing physician [6][7][8][9][10]

show abstract

Section: Discussionmentioning

confidence: 99%

Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly

Fabbri

Moreira

Garrido

et al. 2001

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…The Confusion Rating Scale (15), the Mini-Mental State Examination (16), the clock drawing test (17), and the Glasgow Coma Scale (18) can be useful screens. The Delirium Symptom Interview, the Confusion Assessment Method (19), and the Delirium Scale (20) can all aid in formal diagnosis. Instruments used to rate delirium severity include the Delirium Rating Scale (21) and the Memorial Delirium Assessment Scale (22).…”

Section: Differential Diagnosismentioning

confidence: 99%

Postoperative Delirium

Fricchione¹,

Nejad²,

Esses³

et al. 2008

AJP

View full text Add to dashboard Cite

Mr. A, a 50-year-old English-speaking Korean man, presented to the hospital with right scapular pain. CT of the chest showed two masses, and a CT-guided fine-needle aspiration biopsy study revealed poorly differentiated non-smallcell carcinoma of the lung. MRI of the brain, with and without gadolinium, showed neither a mass lesion nor abnormal enhancement suggestive of metastatic disease. Mr. A's medical history was significant for hepatitis C virus infection. He had a 40-pack-year history of cigarette smoking and a remote history of cocaine use. He acknowledged drinking three or four alcoholic beverages weekly but answered "no" to the four items of the CAGE questionnaire.Mr. A underwent two cycles of etoposide and cisplatin 50/50 chemotherapy, irradiation of the upper lobe of the right lung, and excision of this lobe and the overlying chest wall. Postoperatively, he was aware of his hospitalization and experienced pain at the excision site, which was controlled with fentanyl and bupivacaine epidural infusion. On the second postoperative day, Mr. A became less communicative and more agitated. Epidural infusions were stopped. No focal neurological deficits were found. That evening, he began to cry out unin-telligibly and attempted to get out of bed. Soft restraints were applied. Because he was thought to be in alcohol withdrawal, lorazepam was administered intravenously in 1 mg doses every 2 hours (total 4 mg), with no reduction in agitation. Haloperidol (5 mg i.v.) was then administered with slight effect, and psychiatric consultation was requested.Mr. A's temperature was 100°F, pulse 135 bpm, and blood pressure 160/90 mm Hg. He was awake and moved all limbs vigorously, trying to wrest himself from the restraints. Although he attempted to respond when addressed in his native Korean, he produced no intelligible speech. He did not appear to be responding to internal stimuli. Rigidity, tremor, myoclonus, and asterixis were absent. ECG revealed sinus tachycardia with a corrected QT interval (QTc) of 413 msec. The patient's WBC count was 5300/µl, hemoglobin concentration 6.6 g/dl, hematocrit 18.7%, and mean corpuscular volume (MCV) 94 fl. His transaminase and bilirubin levels were normal. His sodium concentration was 134 mmol/liter, potassium 3.8 mmol/liter, chloride 101 mmol/ liter, bicarbonate 27.4 mmol/liter, BUN 27 mg/dl, creatinine 0.6 mg/dl, glucose 126 mg/dl, magnesium 1.4 meq/liter, and albumin 4.0 g/dl. Arterial blood analysis revealed a pH of 7.42, a PO 2 of 185 mm Hg, and a PCO 2 of 44 mm Hg on oxygen delivered at 4 liters/minute by nasal prong. The patient's blood alcohol level on admission was 0.Potassium and magnesium were administered intravenously. Haloperidol was administered intravenously in two 5-mg boluses, separated by 30 minutes, and the patient fell asleep. When roused, he was calm but disoriented and unable to answer questions accurately. His heart rate fell to 90 bpm and his systolic blood pressure decreased to 130 mm Hg. The patient was judged not to be in alcohol withdrawal, and lorazepam wa...

show abstract

“…We identifi ed 10 rating scales (in 16 reports) with published IRR data (see table 1 ). An additional 5 reports [26][27][28][29][30] were rejected for lacking such information although one study whilst not reporting IRR, identifi ed it as an important issue [29] . We assessed IRR studies according to questions developed from standard health measurement textbooks [4,31] (Appendix).…”

Section: Methodsmentioning

confidence: 99%

Inter-Rater Reliability of Delirium Rating Scales

Bhat¹,

Rockwood²

2005

Neuroepidemiology

View full text Add to dashboard Cite

Delirium continues to be under-recognized despite use of rating scales with apparently high inter-rater reliability. We analyzed the inter-reliability data of published rating scales for delirium using a standard questionnaire to evaluate if the inter-rater reliability was assessed rigorously. Most studies employed a heterogeneous group of cognitively disordered elderly, however other aspects of inter-rater reliability estimation were less than rigorous. This suggests that the reported reliability may be spuriously high, which may have implications on the ability of clinicians to discriminate delirium from other causes of cognitive impairment in practice. The methodology of assessing inter-rater reliability of delirium scales needs to improve and reliability should be evaluated when the settings of administration change substantially.

show abstract

Study of cognitive functioning in a medical population

Cited by 19 publications

References 12 publications

Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly

Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly

Postoperative Delirium

Inter-Rater Reliability of Delirium Rating Scales

Contact Info

Product

Resources

About