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Delirium superimposed on dementia: a survey of delirium specialists shows a lack of consensus in clinical practice and research studies

Published online by Cambridge University Press:  22 December 2015

Sarah Richardson ,
Andrew Teodorczuk ,
Giuseppe Bellelli ,
Daniel H. J. Davis ,
Karin J. Neufeld ,
Barbara A. Kamholz ,
Marco Trabucchi ,
Alasdair M. J. MacLullich  and
Alessandro Morandi
Sarah Richardson*
Affiliation:
Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, UK
Andrew Teodorczuk
Affiliation:
School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
Giuseppe Bellelli
Affiliation:
Department of Medicine and Surgery, University of Milano-Bicocca; Geriatric Unit, S. Gerardo Hospital, Monza, Italy; and Geriatric Research Group, Brescia, Italy
Daniel H. J. Davis
Affiliation:
University College London, London, UK
Karin J. Neufeld
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Barbara A. Kamholz
Affiliation:
Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
Marco Trabucchi
Affiliation:
Department of Neuropharmacology, Università Tor Vergata, Rome, Italy; and Geriatric Research Group, Brescia, Italy
Alasdair M. J. MacLullich
Affiliation:
University of Edinburgh, Edinburgh, UK
Alessandro Morandi
Affiliation:
Department of Rehabilitation and Aged Care “Fondazione Camplani” Hospital, Cremona, Italy; and Geriatric Research Group, Brescia, Italy
*
Correspondence should be addressed to: Sarah Richardson, 3rd floor Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, NE4 5 PL, UK. Phone: 0191 2081314. Email: [email protected].
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Abstract

Background:

Despite advances in delirium knowledge and the publication of best practice guidelines, uncertainties exist regarding assessment of Delirium Superimposed on Dementia (DSD). An international survey of delirium specialists was undertaken to evaluate current practice.

Methods:

Invitations to participate in an online survey were distributed by email among members of four international delirium associations with additional publication on their websites. The survey covered the assessment and diagnosis of DSD in clinical practice and research studies. Questions were structured around current practice and attitudes.

Results:

The 205 responders were mostly confident that they could detect DSD with 60% rating their confidence at 7 or above on a likert scale of 0 (none) to 10 (excellent). Seventy-six percent felt that Dementia with Lewy Bodies (DLB) was the most challenging dementia subtype in which to diagnose DSD. Several scales were used to assess for the presence of DSD including the Confusion Assessment Method (CAM) (54%), DSM-5 criteria (25%) and CAM-ICU (15%). Responders stated that attention (71%), fluctuation in cognitive status (65%), and arousability (41%) were the most clinically useful features to assess when diagnosing DSD. Motor fluctuations were also deemed important but 61% had no specific test to monitor these.

Conclusions:

The largest survey of DSD practice to date demonstrates that despite good levels of confidence in recognizing DSD, there exists a lack of consensus concerning assessment and diagnosis globally. These findings suggest the need for the development of more research leading to precise diagnostic criteria and comprehensive guidelines regarding the assessment and diagnosis of DSD.

Keywords

deliriumdementiaknowledgeEuropean delirium associationdelirium superimposed on dementiasurveyclinical practice
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 5 , May 2016 , pp. 853 - 861
Copyright
Copyright © International Psychogeriatric Association 2015 

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