Delirium among patients with and without dementia: does the diagnosis according to the DSM-IV differ from the previous classifications?
✍ Scribed by Jouko V. Laurila; Kaisu H. Pitkala; Timo E. Strandberg; Reijo S. Tilvis
- Book ID
- 102224368
- Publisher
- John Wiley and Sons
- Year
- 2004
- Tongue
- English
- Weight
- 79 KB
- Volume
- 19
- Category
- Article
- ISSN
- 0885-6230
- DOI
- 10.1002/gps.1079
No coin nor oath required. For personal study only.
✦ Synopsis
Abstract
Background
Different diagnostic criteria differ in their capacity to identify subjects as delirious. It is not known how DSM‐IV classification, compared with the DSM‐III, DSM‐III‐R, and ICD‐10, identifies delirium among individuals with and without dementia and whether the symptom profiles differ between these two subgroups.
Methods
A cross‐sectional study was performed on patients (age ≥ 70 years) in seven acute geriatric wards (n = 230) and in seven nursing‐homes (n = 195) in Helsinki, Finland. Delirium was diagnosed according to the operationalized criteria according to the DSM‐III, DSM‐III‐R, DSM‐IV, and clinical criteria of ICD‐10. Dementia was defined according to consensus judgment among three geriatricians with concise information including: prior dementia diagnoses, Clinical Dementia Rating Scale, operationalized criteria according to the DSM‐IV, nurses and/or caregivers interviews, and the results of the brain CT/MRI and prior Mini‐Mental State Examination scores, when available.
Results
According to the DSM‐III, DSM‐IIIR, DSM‐IV and ICD‐10 criteria of delirium 22.7, 23.5, 25.9 and 14.9% of the demented, and 12.9, 13.5, 23.5 and 2.9% of the non‐demented, respectively, were diagnosed as delirious. In stepwise logistic regression analysis clouding of consciousness, perceptual disturbances, and disorganized thinking were the most significant contributors to delirium diagnosis according to the DSM‐IV among individuals with dementia, whereas perceptual disturbances, motor disturbances, and disorientation were the most significant contributors among those without dementia.
Conclusions
DSM‐IV criteria of delirium identify new, often non‐demented, subjects as being delirious, while ICD‐10 is overly restrictive. The symptom profile of delirium was slightly different among individuals with and without dementia. Copyright © 2004 John Wiley & Sons, Ltd.