Identifying Delirium in Persons With Moderate or Severe Dementia: Review of Challenges and an Illustrative Approach.

Autor:	Fong TG; Departments of Neurology (TGF, FA), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA. Electronic address: AgingBrainCenter@hsl.harvard.edu., Hshieh TT; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA; Department of Medicine (TTH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Tabloski PA; Boston College William F Connell School of Nursing (PAT), Boston, MA., Metzger ED; Departments of Psychiatry (EDM), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA., Arias F; Departments of Neurology (TGF, FA), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA., Heintz HL; Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA., Patrick RE; Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA., Lapid MI; Mayo Clinic (MIL), Rochester, MN., Schmitt EM; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA., Harper DG; Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA., Forester BP; Division of Geriatric Psychiatry (HLH, REP, DGH, BPF), McLean Hospital, Harvard Medical School, Belmont, MA., Inouye SK; Departments of Medicine (SKI), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (TGF, TTH, FA, EMS, SKI), Boston, MA.
Jazyk:	angličtina
Zdroj:	The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry [Am J Geriatr Psychiatry] 2022 Oct; Vol. 30 (10), pp. 1067-1078. Date of Electronic Publication: 2022 Apr 21.
DOI:	10.1016/j.jagp.2022.04.003
Abstrakt:	Delirium and dementia are common causes of cognitive impairment among older adults, which often coexist. Delirium is associated with poor clinical outcomes, and is more frequent and more severe in patients with dementia. Identifying delirium in the presence of dementia, also described as delirium superimposed on dementia (DSD), is particularly challenging, as symptoms of delirium such as inattention, cognitive dysfunction, and altered level of consciousness, are also features of dementia. Because DSD is associated with poorer clinical outcomes than dementia alone, detecting delirium is important for reducing morbidity and mortality in this population. We review a number of delirium screening instruments that have shown promise for use in DSD, including the 4-DSD, combined Six Item Cognitive Impairment Test (6-CIT) and 4 'A's Test (4AT), Confusion Assessment Method (CAM), and the combined UB2 and 3D-CAM (UB-CAM). Each has advantages and disadvantages. We then describe the operationalization of a CAM-based approach in a current ECT in dementia project as an example of modifying an existing instrument for patients with moderate to severe dementia. Ultimately, any instrument modified will need to be validated against a standard clinical reference, in order to fully establish its sensitivity and specificity in the moderate to severe dementia population. Future work is greatly needed to advance the challenging area of accurate identification of delirium in moderate or severe dementia. Competing Interests: DISCLOSURES TGF TTH, PAT, EDM, FA HLH, MIL, EMS, DGH, and SKI report no conflicts with any product mentioned or concepts discussed in this article. REP has received research funding support outside of this project from support from Biogen Inc, Eisai, and Rogers Family Foundation. BPF has received has received research funding support outside of this project from the National Institute on Aging, Spier Family Foundation, Rogers Family Foundation, Biogen, and Eisai. BPF has received consultation fees from Patina Health and also serves on the Pharmacy & Therapeutics Committee for CVS Health. This work is support by grants from theNational Institute on AgingR01AG061100-05(BF/MIL);R01AG051591(BF);R33AG071744(SKI); 2R01AG044518(SKI). This work is dedicated to the memory of Joshua B. I. Helfand. (Copyright © 2022 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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