Sarah Richardson1, Andrew Teodorczuk2, Giuseppe Bellelli3, Daniel H J Davis4, Karin J Neufeld5, Barbara A Kamholz6, Marco Trabucchi7, Alasdair M J MacLullich8, Alessandro Morandi9. 1. Institute of Neuroscience,Newcastle University,Newcastle-upon-Tyne,UK. 2. School of Medical Education,Newcastle University,Newcastle upon Tyne,UK. 3. Department of Medicine and Surgery,University of Milano-Bicocca;Geriatric Unit,S. Gerardo Hospital,Monza,Italy; andGeriatric Research Group,Brescia,Italy. 4. University College London,London,UK. 5. Department of Psychiatry and Behavioral Sciences,Johns Hopkins University School of Medicine,Baltimore,MD,USA. 6. Department of Psychiatry,University of California at San Francisco,San Francisco,CA,USA. 7. Department of Neuropharmacology,Università Tor Vergata,Rome,Italy; andGeriatric Research Group,Brescia,Italy. 8. University of Edinburgh,Edinburgh,UK. 9. Department of Rehabilitation and Aged Care "Fondazione Camplani" Hospital,Cremona,Italy; andGeriatric Research Group,Brescia,Italy.
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.
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.
Entities:
Keywords:
European delirium association; clinical practice; delirium; delirium superimposed on dementia; dementia; knowledge; survey
Authors: Alessandro Morandi; Daniel Davis; Giuseppe Bellelli; Rakesh C Arora; Gideon A Caplan; Barbara Kamholz; Ann Kolanowski; Donna Marie Fick; Stefan Kreisel; Alasdair MacLullich; David Meagher; Karen Neufeld; Pratik P Pandharipande; Sarah Richardson; Arjen J C Slooter; John P Taylor; Christine Thomas; Zoë Tieges; Andrew Teodorczuk; Philippe Voyer; James L Rudolph Journal: J Am Med Dir Assoc Date: 2016-09-16 Impact factor: 4.669
Authors: Letty Oudewortel; Karlijn J Joling; Cees M P M Hertogh; Viona J M Wijnen; Anne A M van der Brug; Willem A van Gool Journal: Int Psychogeriatr Date: 2018-07-23 Impact factor: 3.878
Authors: Alessandro Morandi; Jin H Han; David Meagher; Eduard Vasilevskis; Joaquim Cerejeira; Wolfgang Hasemann; Alasdair M J MacLullich; Giorgio Annoni; Marco Trabucchi; Giuseppe Bellelli Journal: J Am Med Dir Assoc Date: 2016-06-23 Impact factor: 4.669