Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-09T12:41:16.615Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment characteristics of delirium superimposed on dementia

Published online by Cambridge University Press:  28 June 2011

Soenke Boettger ,
Steven Passik  and
William Breitbart
Soenke Boettger*
Affiliation:
Department of Consultation – Liaison and Medical Psychiatry, Bellevue Hospital Center, New York University Langone Medical Center, New York, USA
Steven Passik
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
William Breitbart
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
*
Correspondence should be addressed to: Soenke Boettger, MD, Bellevue Hospital Center, New York University Langone Medical Center, Department of Consultation – Liaison and Medical Psychiatry, 462 First Avenue, New York, NY 10016, USA. Phone: +1 212 562 3536; Fax: +1 212 562 8985. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The course of delirium in patients with dementia who are undergoing management of delirium with antipsychotics has not previously been studied. In order to investigate the treatment characteristics of patients with delirium superimposed on dementia in contrast to delirium in the absence of dementia we performed a secondary analysis of our delirium database.

Methods: We collected sociodemographic data and medical variables in addition to using the systematic rating scales of the Memorial Delirium Assessment Scale (MDAS) and Karnofsky Scale of Performance Status (KPS). These data were recorded in the delirium database. For this analysis we extracted all data pertaining to patients with delirium and dementia (DD) and compared them to those with delirium without dementia (i.e. non-demented with delirium; NDD).

Results: Out of 111 cases with a diagnosis of delirium we acquired 22 cases with a diagnosis of DD and 89 cases with NDD. The mean age was significantly different with 77.1 years for DD and 62.7 years for NDD. The MDAS scores at baseline were significantly higher in DD (21.1) compared to NDD (17.6). Over the course of treatment, MDAS scores were significantly higher in DD with 11.7 at T3 compared with 7.0 in NDD. After three days of management, delirium resolution rates were significantly lower in DD with 18.2% compared to 53.9% in NDD, and at seven days delirium resolution rates were 50% and 83% respectively. At the endpoint of the observation period, DD had a significantly more pronounced disturbance of consciousness and impairment in the cognitive domain. KPS scores were not significantly different between DD and NDD.

Conclusion: In our sample of patients with delirium superimposed on dementia the delirium resolution rates were lower than in patients without dementia at one week of treatment. The data suggest that when delirium is superimposed on dementia the delirium may resolve at a slower rate.

Keywords

deliriumdementiadelirium superimposed on dementiacognitive disordertreatment characteristics
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 10 , December 2011 , pp. 1671 - 1676
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. Washington, DC: American Psychiatric Association.Google Scholar
Bond, S. M., Neelon, V. J. and Belyea, M. J. (2006). Delirium in hospitalized older patients with cancer. Oncolology Nursing Forum, 33, 1075–1083.CrossRefGoogle ScholarPubMed
Breitbart, W. and Strout, D. (2000). Delirium in the terminally ill. Clinics in Geriatric Medicine, 16, 357–372.CrossRefGoogle ScholarPubMed
Breitbart, W., Rosenfeld, B., Roth, A., Smith, M. J., Cohen, K. and Passik, S. (1997). The Memorial Delirium Assessment Scale. Journal of Pain and Symptom Management, 13, 128–137.CrossRefGoogle ScholarPubMed
Bucht, G., Gustafson, Y. and Sandberg, O. (1999). Epidemiology of delirium. Dementia and Geriatric Cognitive Disorders, 10, 315–318.CrossRefGoogle ScholarPubMed
Cole, M. G. (2004). Delirium in elderly patients. American Journal of Geriatric Psychiatry, 12, 7–21.CrossRefGoogle ScholarPubMed
Inouye, S. K. (1998). Delirium in hospitalized older patients. Clinics in Geriatric Medicine, 14, 745–764.CrossRefGoogle ScholarPubMed
Inouye, S. K. (2006). Delirium in older persons. New England Journal of Medicine, 354, 1157–1165.CrossRefGoogle ScholarPubMed
Jeste, D. V. et al. (2008). ACNP White Paper: update on use of antipsychotic drugs in elderly persons with dementia. Neuropsychopharmacology, 33, 957–970.CrossRefGoogle ScholarPubMed
Karnofsky, D. A. and Burchenal, J. (1949). The clinical evaluation of chemotherapeutic agents in cancer. In Macleod, C. M. (ed.), Evaluation of Chemotherapeutic Agents (pp. 191–205). New York: Columbia University Press.Google Scholar
Kazmierski, J. et al. (2008). Clinical utility and use of DSM-IV and ICD-10 criteria and the Memorial Delirium Assessment Scale in establishing a diagnosis of delirium after cardiac surgery. Psychosomatics, 49, 73–76.CrossRefGoogle ScholarPubMed
Kiely, D. K., Jones, R. N., Bergmann, M. A., Murphy, K. M., Orav, E. J. and Marcantonio, E. R. (2006). Association between delirium resolution and functional recovery among newly admitted postacute facility patients. Journal of Gerontolology, Series A: Biological Science and Medical Science, 61, 204–208.CrossRefGoogle ScholarPubMed
Lawlor, P. G., Nekolaichuk, C., Gagnon, B., Mancini, I. L., Pereira, J. L. and Bruera, E. D. (2000). Clinical utility, factor analysis, and further validation of the memorial delirium assessment scale in patients with advanced cancer: assessing delirium in advanced cancer. Cancer, 88, 2859–2867.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Levkoff, S. E. et al. (1992). Delirium: the occurrence and persistence of symptoms among elderly hospitalized patients. Archives of Internal Medicine, 152, 334–340.CrossRefGoogle ScholarPubMed
Levkoff, S. E. et al. (1994). Progression and resolution of delirium in elderly patients hospitalized for acute care. American Journal of Geriatric Psychiatry, 2, 230–238.CrossRefGoogle ScholarPubMed
Lingjaerde, O., Ahlfors, U. G., Bech, P., Dencker, S. J. and Elgen, K. (1987). The UKU side effect rating scale: a new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatrica Scandinavica, 334 (Suppl.) 1–100.CrossRefGoogle Scholar
Lipowski, Z. J. (1989). Delirium in the elderly patient. New England Journal of Medicine, 320, 578–582.Google ScholarPubMed
Massie, M. J., Holland, J. and Glass, E. (1983). Delirium in terminally ill cancer patients. American Journal of Psychiatry, 140, 1048–1050.Google ScholarPubMed
McCusker, J., Cole, M., Dendukuri, N., Han, L. and Belzile, E. (2003). The course of delirium in older medical inpatients: a prospective study. Journal of General Internal Medicine, 18, 696–704.CrossRefGoogle ScholarPubMed
McNicoll, L., Pisani, M. A., Zhang, Y., Ely, E. W., Siegel, M. D. and Inouye, S. K. (2003). Delirium in the intensive care unit: occurrence and clinical course in older patients. Journal of the American Geriatrics Society, 51, 591–598.CrossRefGoogle ScholarPubMed
Meagher, D. et al. (2008a). A new data-based motor subtype schema for delirium. Journal of Neuropsychiatry and Clinical Neurosciences, 20, 185–193.CrossRefGoogle ScholarPubMed
Meagher, D. J. et al. (2008b). Motor symptoms in 100 patients with delirium versus control subjects: comparison of subtyping methods. Psychosomatics, 49, 300–308.CrossRefGoogle ScholarPubMed
Meagher, D. J., O'Hanlon, D., O'Mahony, E., Casey, P. R. and Trzepacz, P. T. (2000). Relationship between symptoms and motoric subtype of delirium. Journal of Neuropsychiatry and Clinical Neurosciences, 12, 51–56.CrossRefGoogle ScholarPubMed
Moraga, A. V. and Rodriguez-Pascual, C. (2007). Acurate diagnosis of delirium in elderly patients. Current Opininion in Psychiatry, 20, 262–267.CrossRefGoogle ScholarPubMed
Rahkonen, T., Makela, H., Paanila, S., Halonen, P., Sivenius, J. and Sulkava, R. (2000). Delirium in elderly people without severe predisposing disorders: etiology and 1-year prognosis after discharge. International Journal of Psychogeriatrics, 12, 473–481.CrossRefGoogle ScholarPubMed
Rockwood, K. (1993). The occurrence and duration of symptoms in elderly patients with delirium. Journal of Gerontolology, 48, M162–M166.CrossRefGoogle ScholarPubMed
Schneider, L. S., Dagerman, K. S. and Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA, 294, 1934–1943.CrossRefGoogle ScholarPubMed
Trzepacz, P. T., Breitbart, W., Franklin, J., Levenson, J., Martini, R. and Wang, P. (1999). Practice guideline for the treatment of patients with delirium. American Journal of Psychiatry, 156, 1–20.Google Scholar