Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-22T20:00:09.408Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of delirium among outpatients with dementia

Published online by Cambridge University Press:  22 July 2013

N. Hasegawa ,
M. Hashimoto ,
S. Yuuki ,
K. Honda ,
Y. Yatabe ,
K. Araki  and
M. Ikeda
N. Hasegawa
Affiliation:
Department of Psychiatry, Kobe University Graduate School of Medicine, Hyogo, Japan Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan Kumamoto Mental Health Hospital, Kumamoto, Japan
M. Hashimoto
Affiliation:
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
S. Yuuki
Affiliation:
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan Kumamoto Mental Health Hospital, Kumamoto, Japan
K. Honda
Affiliation:
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
Y. Yatabe
Affiliation:
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
K. Araki
Affiliation:
Kumamoto Mental Health Hospital, Kumamoto, Japan
M. Ikeda*
Affiliation:
Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan Kumamoto Mental Health Hospital, Kumamoto, Japan
*
Correspondence should be addressed to: Dr. Manabu Ikeda, MD, PhD, Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan. Phone: +81-96-373-5184; Fax: +81-96-373-5186. Email: [email protected].
Get access

Abstract

Background:

Delirium and dementia are highly interrelated. However, few comprehensive epidemiological studies have examined this altered state of consciousness superimposed on dementia. We investigated the frequency of delirium in patients with dementia, its prevalence in patients with each dementia type, and its association with cerebrovascular disease (CVD) in patients with neurodegenerative dementias.

Methods:

We studied 261 consecutive outpatients in the memory clinic of a psychiatric hospital between April 2010 and September 2011. All patients underwent routine laboratory tests and computed tomography (CT), and their Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Physical Self-Maintenance Scale (PSMS), and Delirium Rating Scale – Revised 98 scores were recorded. The diagnosis of delirium was based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. CVD was detected by CT.

Results:

Among the 206 patients with dementia, delirium was present in 40 (19.4%). The proportion of patients who experienced episodes of delirium was 14.7% in the Alzheimer's disease, 34.4% in the vascular dementia, 31.8% in the dementia with Lewy bodies, and none in frontotemporal lobar degeneration. Delirium was frequently observed in patients with dementia and CVD. The NPI total and agitation subscale scores were significantly higher in dementia patients with delirium than in those without delirium. PSMS scores were significantly lower for patients with delirium than for patients without delirium.

Conclusions:

The frequency of delirium varies with each dementia type. In addition, delirium decreases activities of daily living, exaggerates behavioral and psychological symptoms dementia, and is associated with CVD in patients with neurodegenerative dementias.

Keywords

deliriumdementiacerebrovascular diseasebehavioral and psychological symptoms of dementianeuropsychiatric inventory
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 11 , November 2013 , pp. 1877 - 1883
Copyright
Copyright © International Psychogeriatric Association 2013 

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

Bennett, D. A., Wilson, R. S., Gilley, D. W. and Fox, J. H. (1990). Clinical diagnosis of Binswanger's disease. Journal of Neurology, Neurosurgery & Psychiatry, 53, 961–965.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Davis, D. H.et al. (2012). Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain, 135, 2809–2816.CrossRefGoogle Scholar
de Lange, E., Verhaak, P. F. and van der Meer, K. (2012). Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long-term care: a review. International Journal of Geriatric Psychiatry, 28, 127–134.CrossRefGoogle ScholarPubMed
Erkinjuntti, T., Wikström, J., Palo, J. and Autio, L. (1986). Dementia among medical inpatients. evaluation of 2000 consecutive admissions. Archives of Internal Medicine, 146, 1923–1926.CrossRefGoogle ScholarPubMed
Fick, D. M., Agostini, J. V. and Inouye, S. K. (2002). Delirium superimposed on dementia: a systematic review. Journal of American Geriatric Society, 50, 1723–1232.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Fong, T. G.et al. (2009). Delirium accelerates cognitive decline in Alzheimer's disease. Neurology, 72, 1570–1575.CrossRefGoogle Scholar
Hirono, N.et al. (1997). Japanese version of the Neuropsychiatric Inventory: a scoring system for neuropsychiatric disturbance in dementia patients. No To Shinkei, 49, 266–271.Google ScholarPubMed
Hokoishi, K.et al. (2001). Inter-rater reliability of the Physical Self-Maintenance scale and the Instrumental Activities of Daily Living scale in a variety of health professional representatives. Aging & Mental Health, 5, 38–40.CrossRefGoogle Scholar
Ikeda, M.et al. (2001). Increased prevalence of vascular dementia in Japan: a community-based epidemiological study. Neurology, 57, 839–844.CrossRefGoogle ScholarPubMed
Kato, M., Kishi, Y., Okuyama, T., Trzepacz, P. T. and Hosaka, T. (2010). Japanese version of the Delirium Rating Scale, Revised-98 (DRS-R98-J): reliability and validity. Psychosomatics, 51, 425–431.Google ScholarPubMed
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Leys, D.et al. (1999). Vascular dementia: the role of cerebral infarcts. Alzheimer's Disease Associated Disorders, 13 (Suppl 3), S38–S48.Google ScholarPubMed
MacLullich, A. M., Beaglehole, A., Hall, R. J. and Meagher, D. J. (2009). Delirium and long-term cognitive impairment. International Review of Psychiatry, 21, 30–42.CrossRefGoogle ScholarPubMed
McKeith, I. G.et al. (2005). Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology, 65, 1863–1872.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS–ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’ disease. Neurology, 34, 939–944.CrossRefGoogle Scholar
Meagher, D. and Trzepacz, P. T. (2007). Phenomenological distinctions needed in DSM- V: delirium, subsyndromal delirium, and dementias. The Journal of Neuropsychiatry & Clinical Neurosciences, 19, 468–470.CrossRefGoogle ScholarPubMed
Meagher, D. J., Leonard, M., Donnelly, S., Conroy, M., Saunders, J. and Trzepacz, P. T. (2010). A comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium-dementia and cognitively intact controls. Journal of Neurology, Neurosurgery & Psychiatry, 81, 876–881.CrossRefGoogle ScholarPubMed
Melkas, S.et al. (2012). Post-stroke delirium in relation to dementia and long-term mortality. International Journal of Geriatric Psychiatry, 27, 401–408.CrossRefGoogle ScholarPubMed
Neary, D.et al. (1998). Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology, 51, 1546–1554.CrossRefGoogle ScholarPubMed
Robertsson, B., Blennow, K., Gottfries, C. G. and Wallin, A. (1998). Delirium in dementia. International Journal of Geriatric Psychiatry, 13, 49–56.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Román, G. C.et al. (1993). Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 43, 250–260.CrossRefGoogle ScholarPubMed
Trzepacz, P. T., Mittal, D., Torres, R., Kanary, K., Norton, J. and Jimerson, N. (2001). Validation of the Delirium Rating Scale – Revised-98: comparison with the delirium rating scale and the cognitive test for delirium. Journal of Neuropsychiatry & Clinical Neurosciences, 13, 229–242.CrossRefGoogle ScholarPubMed
Weiner, M. F. (2012). Impact of delirium on the course of Alzheimer's disease. Archives of Neurology, 17, 1–2.Google Scholar
Yoshitake, T.et al. (1995). Incidence and risk factors of vascular dementia and Alzheimer's disease in a defied elderly Japanese population: the Hisayama Study. Neurology, 45, 1161–1168.CrossRefGoogle Scholar
Young, J. and Inouye, S. K. (2007). Delirium in older people. BMJ, 334, 842–846.CrossRefGoogle ScholarPubMed