TY - JOUR
T1 - The Diagnosis of Delirium Superimposed on Dementia
T2 - An Emerging Challenge
AU - Morandi, Alessandro
AU - Davis, Daniel
AU - Bellelli, Giuseppe
AU - Arora, Rakesh C.
AU - Caplan, Gideon A.
AU - Kamholz, Barbara
AU - Kolanowski, Ann
AU - Fick, Donna Marie
AU - Kreisel, Stefan
AU - MacLullich, Alasdair
AU - Meagher, David
AU - Neufeld, Karen
AU - Pandharipande, Pratik P.
AU - Richardson, Sarah
AU - Slooter, Arjen J.C.
AU - Taylor, John P.
AU - Thomas, Christine
AU - Tieges, Zoë
AU - Teodorczuk, Andrew
AU - Voyer, Philippe
AU - Rudolph, James L.
N1 - Publisher Copyright:
© 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2017/1/1
Y1 - 2017/1/1
N2 - 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.
AB - 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.
KW - Alzheimer disease
KW - Delirium
KW - Lewy Body dementia
KW - delirium superimposed on dementia
KW - dementia
KW - diagnosis
UR - http://www.scopus.com/inward/record.url?scp=84994745235&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2016.07.014
DO - 10.1016/j.jamda.2016.07.014
M3 - Review article
C2 - 27650668
AN - SCOPUS:84994745235
SN - 1525-8610
VL - 18
SP - 12
EP - 18
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 1
ER -