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Delirium superimposed on dementia versus delirium in the absence of dementia: Phenomenological differences

Published online by Cambridge University Press:  26 November 2009

Soenke Boettger ,
Steven Passik  and
William Breitbart
Soenke Boettger
Affiliation:
Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, New York
Steven Passik
Affiliation:
Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, New York
William Breitbart*
Affiliation:
Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: William Breitbart, Memorial Sloan Kettering Cancer Center, Department of Psychiatry, 641 Lexington Avenue, New York, NY 10022. E-mail: [email protected]
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Abstract

Objective:

To examine differences in the phenomenological characteristics of delirium superimposed on dementia compared to those observed in delirious patients without dementia, based on the rating items of the Memorial Delirium Assessment Scale (MDAS).

Methods:

We conducted an analysis of a prospectively collected clinical delirium database utilized to record and monitor the care of delirious patients treated at Memorial Sloan-Kettering Cancer Center (MSKCC). Sociodemographic, medical variables, and MDAS total score and individual item ratings were analyzed in respect to differences between delirium in the demented (DD) versus delirium in the nondemented (ND).

Results:

We were able to examine data collected on 100 delirious patients: 82 ND patients and 18 DD patients. Patients in the DD group, compared to the ND group, had significantly greater levels of disturbance of consciousness and impairments in all cognitive domains (i.e., orientation, short term memory, concentration, organization of thought process). Severe symptoms were more common in the DD group compared to the ND group on all the MDAS cognitive items as well as in disturbance of consciousness. There were no significant differences between the DD and ND groups in terms of presence or severity of hallucinations, delusions, psychomotor behavior, and sleep–wake cycle disturbance.

Significance of results:

Delirium superimposed on dementia has phenomenological differences compared to delirium in the absence of dementia. There are no significant differences in the severity of hallucinations, delusions, psychomotor behavior, or sleep–wake cycle disturbances. However, level of disturbance in consciousness (arousal and awareness) and impairments in multiple cognitive domains are significantly more severe in patients with delirium superimposed on dementia.

Keywords

DeliriumDementiaPhenomenologyDelirium superimposed on dementia
Type
Original Articles
Information
Palliative & Supportive Care , Volume 7 , Issue 4 , December 2009 , pp. 495 - 500
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.Google Scholar
Bond, S.M., Neelon, V.J. & Belyea, M.J. (2006). Delirium in hospitalized older patients with cancer. Oncology Nursing Forum, 33, 1075–1083.CrossRefGoogle ScholarPubMed
Breitbart, W., Rosenfeld, B., Roth, A., et al. (1997). The Memorial Delirium Assessment Scale. Journal of Pain and Symptom Management, 13, 128–137.CrossRefGoogle ScholarPubMed
Breitbart, W. & Strout, D. (2000). Delirium in the terminally ill. Clinics in Geriatric Medicine, 16, 357–372.CrossRefGoogle ScholarPubMed
Bucht, G., Gustafson, Y. & 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
Cole, M.G., McCusker, J., Dendukuri, N., et al. (2002). Symptoms of delirium among elderly medical inpatients with or without dementia. Journal of Neuropsychiatry and Clinical Neuroscience, 14, 167–175.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
Lipowski, Z.J. (1989). Delirium in the elderly patient. New England Journal of Medicine, 320, 578–582.Google ScholarPubMed
Liptzin, B., Levkoff, S.E., Gottlieb, G.L., et al. (1993). Delirium. Journal of Neuropsychiatry and Clinical Neuroscience, 5, 154–160.Google ScholarPubMed
Massie, M.J., Holland, J. & Glass, E. (1983). Delirium in terminally ill cancer patients. American Journal of Psychiatry, 140, 1048–1050.Google ScholarPubMed
McCusker, J., Cole, M., Dendukuri, N., et al. (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., et al. (2003). Delirium in the intensive care unit: Occurrence and clinical course in older patients. Journal of the American Geriatric Society, 51, 591–598.CrossRefGoogle ScholarPubMed
Meagher, D., Moran, M., Raju, B., et al. (2008 a). A new data-based motor subtype schema for delirium. Journal of Neuropsychiatry and Clinical Neuroscience, 20, 185–193.CrossRefGoogle ScholarPubMed
Meagher, D.J., Moran, M., Raju, B., et al. (2008 b). 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., et al. (2000). Relationship between symptoms and motoric subtype of delirium. Journal of Neuropsychiatry and Clinical Neuroscience, 12, 51–56.CrossRefGoogle ScholarPubMed
Moraga, A.V. & Rodriguez-Pascual, C. (2007). Acurate diagnosis of delirium in elderly patients. Current Opinions in Psychiatry, 20, 262–267.CrossRefGoogle ScholarPubMed
Rahkonen, T., Makela, H., Paanila, S., et al. (2000). Delirium in elderly people without severe predisposing disorders: Etiology and 1-year prognosis after discharge. International Psychogeriatrics, 12, 473–481.CrossRefGoogle ScholarPubMed
Trzepacz, P.T., Breitbart, W., Franklin, J., et al. (1999). Practice guideline for the treatment of patients with delirium. American Journal of Psychiatry, 156, 1–20.Google Scholar
Trzepacz, P.T., Mulsant, B.H., Amanda, D.M., et al. (1998). Is delirium different when it occurs in dementia? A study using the delirium rating scale. Journal of Neuropsychiatry and Clinical Neuroscience, 10, 199–204.CrossRefGoogle ScholarPubMed
Voyer, P., Cole, M.G., McCusker, J., et al. (2006 a). Prevalence and symptoms of delirium superimposed on dementia. Clinical Nursing Research, 15, 46–66.CrossRefGoogle ScholarPubMed
Voyer, P., McCusker, J., Cole, M.G., et al. (2006 b). Influence of prior cognitive impairment on the severity of delirium symptoms among older patients. Journal of Neuroscience Nursing, 38, 90–101.CrossRefGoogle ScholarPubMed