Tools to Detect Delirium Superimposed on Dementia: A Systematic Review

Authors

  • Alessandro Morandi MD, MPH,

    Corresponding author
    1. Geriatric Research Group, Brescia, Italy
    2. Center for Quality of Ageing, Vanderbilt University, Nashville, Tennessee
    • Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy
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  • Jessica McCurley MS,

    1. Center for Health Services Research, Vanderbilt University, Nashville, Tennessee
    2. Department of Medicine, Vanderbilt University, Nashville, Tennessee
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  • Eduard E. Vasilevskis MD,

    1. Center for Quality of Ageing, Vanderbilt University, Nashville, Tennessee
    2. Center for Health Services Research, Vanderbilt University, Nashville, Tennessee
    3. Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee
    4. Department of Medicine, Vanderbilt University, Nashville, Tennessee
    5. Clinical Research Training Center of Excellence, Tennessee Valley Healthcare System, Nashville, Tennessee
    6. Veterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee
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  • Donna M. Fick PhD,

    1. School of Nursing, Pennsylvania State University, University Park, Pennsylvania
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  • Giuseppe Bellelli MD,

    1. Geriatric Research Group, Brescia, Italy
    2. Department of Clinical and Preventive Medicine, University of Milano-Bicocca, Monza, Italy
    3. Geriatric Clinic, S. Gerardo Hospital, Monza, Italy
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  • Patricia Lee MLS,

    1. Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, Tennessee
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  • James C. Jackson PsyD,

    1. Center for Health Services Research, Vanderbilt University, Nashville, Tennessee
    2. Veterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee
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  • Susan D. Shenkin MRCP, Msc,

    1. Edinburgh Delirium Research Group, Centre for Cognitive Ageing and Cognitive Epidemiology, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, UK
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  • MarcoTrabucchi MD,

    1. Geriatric Research Group, Brescia, Italy
    2. University of Tor Vergata, Rome, Italy
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  • John Schnelle PhD,

    1. Center for Quality of Ageing, Vanderbilt University, Nashville, Tennessee
    2. Center for Health Services Research, Vanderbilt University, Nashville, Tennessee
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  • Sharon K. Inouye MD, MPH,

    1. Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
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  • Wesley E. Ely MD, MPH,

    1. Center for Quality of Ageing, Vanderbilt University, Nashville, Tennessee
    2. Center for Health Services Research, Vanderbilt University, Nashville, Tennessee
    3. Department of Medicine, Vanderbilt University, Nashville, Tennessee
    4. Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee
    5. Veterans Affairs Tennessee Valley Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee
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  • Alasdair MacLullich MRCP, PhD

    1. Edinburgh Delirium Research Group, Centre for Cognitive Ageing and Cognitive Epidemiology, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, UK
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Address correspondence to Alessandro Morandi, Via Gaspare Aselli, 14 26100 Cremona, Italy. E-mail: morandi.alessandro@gmail.com

Abstract

Objectives

To identify valid tools to diagnose delirium superimposed on dementia.

Design

Systematic review of studies of delirium tools that explicitly included individuals with dementia.

Setting

Hospital.

Participants

Studies were included if delirium assessment tools were validated against standard criteria, and the presence of dementia was assessed according to standard criteria that used validated instruments.

Measurements

PubMed, Embase, and Web of Science databases were searched for articles in English published between January 1960 and January 2012.

Results

Nine studies fulfilled the selection criteria. Of 1,569 participants, 401 had dementia, and 50 had delirium superimposed on dementia. Six delirium tools were evaluated. One study using the Confusion Assessment Method (CAM) with 85% of participants with dementia had high specificity (96–100%) and moderate sensitivity (77%). Two intensive care unit studies that used the CAM for the Intensive Care Unit (CAM-ICU) reported 100% sensitivity and specificity for delirium in 23 individuals with dementia. One study using electroencephalography reported sensitivity of 67% and specificity of 91% in a population with a 100% prevalence of dementia. No studies examined potential effects of dementia severity or subtype on diagnostic accuracy.

Conclusions

The evidence base on tools for detection of delirium superimposed on dementia is limited, although some existing tools show promise. Further studies of existing or refined tools with larger samples and more-detailed characterization of dementia are required to address the identification of delirium superimposed on dementia.

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