Esteban Sepulveda1, José G Franco2, Paula T Trzepacz3, Ana M Gaviria1, Eva Viñuelas1, José Palma1, Gisela Ferré1, Imma Grau1, Elisabet Vilella1. 1. Hospital Psiquiatric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Reus, Tarragona, Spain. 2. Hospital Psiquiatric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Reus, Tarragona, Spain; Faculty of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia. Electronic address: josefranco11@hotmail.com. 3. Tufts University School of Medicine, Boston, MA; Indiana University School of Medicine, Indianapolis, IN.
Abstract
BACKGROUND: Delirium diagnosis in elderly is often complicated by underlying dementia. OBJECTIVE: We evaluated performance of the Delirium Rating Scale-Revised-98 (DRS-R98) in patients with high dementia prevalence and also assessed concordance among past and current diagnostic criteria for delirium. METHODS: Cross-sectional analysis of newly admitted patients to a skilled nursing facility over 6 months, who were rated within 24-48 hours after admission. Interview for Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-R (DSM)-III-R, DSM-IV, DSM-5, and International Classification of Diseases 10th edition delirium ratings, administration of the DRS-R98, and assessment of dementia using the Informant Questionnaire on Cognitive Decline in the Elderly were independently performed by 3 researchers. Discriminant analyses (receiver operating characteristics curves) were used to study DRS-R98 accuracy against different diagnostic criteria. Hanley and McNeil test compared the area under the curve for DRS-R98's discriminant performance for all diagnostic criteria. RESULTS: Dementia was present in 85/125 (68.0%) subjects, and 36/125 (28.8%) met criteria for delirium by at least 1 classification system, whereas only 19/36 (52.8%) did by all. DSM-III-R diagnosed the most as delirious (27.2%), followed by DSM-5 (24.8%), DSM-IV-TR (22.4%), and International Classification of Diseases 10th edition (16%). DRS-R98 had the highest AUC when discriminating DSM-III-R delirium (92.9%), followed by DSM-IV (92.4%), DSM-5 (91%), and International Classification of Diseases 10th edition (90.5%), without statistical differences among them. The best DRS-R98 cutoff score was ≥14.5 for all diagnostic systems except International Classification of Diseases 10th edition (≥15.5). CONCLUSIONS: There is a low concordance across diagnostic systems for identification of delirium. The DRS-R98 performs well despite differences across classification systems perhaps because it broadly assesses phenomenology, even in this population with a high prevalence of dementia.
BACKGROUND:Delirium diagnosis in elderly is often complicated by underlying dementia. OBJECTIVE: We evaluated performance of the Delirium Rating Scale-Revised-98 (DRS-R98) in patients with high dementia prevalence and also assessed concordance among past and current diagnostic criteria for delirium. METHODS: Cross-sectional analysis of newly admitted patients to a skilled nursing facility over 6 months, who were rated within 24-48 hours after admission. Interview for Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-R (DSM)-III-R, DSM-IV, DSM-5, and International Classification of Diseases 10th edition delirium ratings, administration of the DRS-R98, and assessment of dementia using the Informant Questionnaire on Cognitive Decline in the Elderly were independently performed by 3 researchers. Discriminant analyses (receiver operating characteristics curves) were used to study DRS-R98 accuracy against different diagnostic criteria. Hanley and McNeil test compared the area under the curve for DRS-R98's discriminant performance for all diagnostic criteria. RESULTS:Dementia was present in 85/125 (68.0%) subjects, and 36/125 (28.8%) met criteria for delirium by at least 1 classification system, whereas only 19/36 (52.8%) did by all. DSM-III-R diagnosed the most as delirious (27.2%), followed by DSM-5 (24.8%), DSM-IV-TR (22.4%), and International Classification of Diseases 10th edition (16%). DRS-R98 had the highest AUC when discriminating DSM-III-R delirium (92.9%), followed by DSM-IV (92.4%), DSM-5 (91%), and International Classification of Diseases 10th edition (90.5%), without statistical differences among them. The best DRS-R98 cutoff score was ≥14.5 for all diagnostic systems except International Classification of Diseases 10th edition (≥15.5). CONCLUSIONS: There is a low concordance across diagnostic systems for identification of delirium. The DRS-R98 performs well despite differences across classification systems perhaps because it broadly assesses phenomenology, even in this population with a high prevalence of dementia.
Authors: Ann Kolanowski; Donna Fick; Mark Litaker; Paula Mulhall; Linda Clare; Nikki Hill; Jacqueline Mogle; Malaz Boustani; David Gill; Andrea Yevchak-Sillner Journal: J Am Geriatr Soc Date: 2016-11-12 Impact factor: 5.562
Authors: Esteban Sepulveda; Maeve Leonard; Jose G Franco; Dimitrios Adamis; Geraldine McCarthy; Colum Dunne; Paula T Trzepacz; Ana M Gaviria; Joan de Pablo; Elisabet Vilella; David J Meagher Journal: Alzheimers Dement (Amst) Date: 2016-12-01
Authors: Annmarie Hosie; Jane Phillips; Lawrence Lam; Slavica Kochovska; Beverly Noble; Meg Brassil; Susan E Kurrle; Anne Cumming; Gideon A Caplan; Richard Chye; Brian Le; E Wesley Ely; Peter G Lawlor; Shirley H Bush; Jan Maree Davis; Melanie Lovell; Linda Brown; Belinda Fazekas; Seong Leang Cheah; Layla Edwards; Meera Agar Journal: BMJ Open Date: 2019-01-28 Impact factor: 3.006
Authors: Esteban Sepulveda; José G Franco; Paula T Trzepacz; Ana M Gaviria; David J Meagher; José Palma; Eva Viñuelas; Imma Grau; Elisabet Vilella; Joan de Pablo Journal: BMC Psychiatry Date: 2016-05-26 Impact factor: 3.630
Authors: Kate Gibb; Anna Seeley; Terry Quinn; Najma Siddiqi; Susan Shenkin; Kenneth Rockwood; Daniel Davis Journal: Age Ageing Date: 2020-04-27 Impact factor: 10.668