Regular Research ArticlesThe Overlap of Delirium With Neuropsychiatric Symptoms Among Patients With Dementia
Section snippets
Patients
All available patients (N = 425) in seven acute geriatric wards (N = 195) and all residents of seven nursing homes (N = 230) in Helsinki, Finland during the study period (1999–2000) were screened and assessed for dementia, delirium, and various psychotic, behavioral and emotional symptoms. The only exclusion criteria were a state of coma or age less than 70 years.
Written informed consent was obtained from each patient, and in cases of moderate or severe cognitive impairment (Mini-Mental State
RESULTS
Among all 425 patients, 255 were judged to suffer from dementia according to the geriatricians' consensus; their mean age was 86.4 years, and 85% were women. Of them, 160 resided in nursing homes and 95 were in acute geriatric wards. Of those patients in acute wards, 60 had been admitted from community care and 35 from nursing homes. In geriatric wards, 43% of the patients with dementia also had delirium whereas the respective figure in nursing homes was 16%. In nursing homes, 59% of the
DISCUSSION
In our sample of patients with dementia, multiple NPS overlapped to a great degree with patients suffering from delirium. About 85% of patients with delirium suffered from multiple NPS, and nearly one in three patients with multiple NPS fulfilled the criteria for delirium. Thus, multiple NPS in dementia may mask the underlying delirium. However, and in line with previous findings,3,10, 11, 12, 13 only patients with delirium meeting DSM-IV criteria had a poor prognosis, whereas—contrary to
CONCLUSIONS
Patient groups with symptoms of delirium and with multiple NPS in dementia are highly overlapping. In this study only delirium meeting the DSM-IV criteria had significant prognostic value among these frail patients with dementia. It thus seems important to distinguish whether NPS derive from dementia alone or whether they are a sign of acute delirium, which calls for active interventions. The wide overlapping of NPS and symptoms of delirium is a challenge for professionals, and emphasizes
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