McCusker Jane, Cole Martin, Dendukuri Nandini, Han Ling, Belzile Eric
Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, McGill University, 3830 Lacombe Avenue, Montreal, Quebec H3T 1M5, Canada.
J Gen Intern Med. 2003 Sep;18(9):696-704. doi: 10.1046/j.1525-1497.2003.20602.x.
To describe the clinical course and outcomes of delirium up to 12 months after diagnosis, the relationship between the in-hospital clinical course and post-discharge outcomes, and the role of dementia in both the clinical course and outcomes of delirium.
Prospective cohort study.
Medical wards of a 400-bed, university-affiliated, primary acute care hospital in Montreal.
Cohort of 193 medical inpatients aged 65 and over with delirium diagnosed at admission or during the first week in hospital, who were discharged alive from hospital.
Study outcomes included cognitive impairment and activities of daily living (standardized, face-to-face clinical instruments at 1-, 2-, 6-, and 12-month follow-up), and mortality. Dementia, severity of illness, comorbidity, and sociodemographic variables were measured at time of diagnosis. Several measures of the in-hospital course of delirium were constructed. The mean numbers of symptoms of delirium at diagnosis and 12-month follow-up, respectively, were 4.5 and 3.5 in the subgroup of patients with dementia and 3.4 and 2.2 among those without dementia. Inattention, disorientation, and impaired memory were the most persistent symptoms in both subgroups. In multivariate analyses, pre-morbid and admission level of function, nursing home residence, and slower recovery during the initial hospitalization were associated with worse cognitive and functional outcomes but not mortality.
Among patients with and without dementia, symptoms of delirium persist up to 12 months after diagnosis. Quicker in-hospital recovery is associated with better outcomes.
描述谵妄诊断后长达12个月的临床病程及转归、住院临床病程与出院后转归之间的关系，以及痴呆在谵妄临床病程和转归中的作用。
前瞻性队列研究。
蒙特利尔一所拥有400张床位、隶属于大学的初级急症护理医院的内科病房。
193名65岁及以上的内科住院患者组成的队列，这些患者在入院时或住院第一周被诊断为谵妄，且出院时存活。
研究转归包括认知障碍和日常生活活动能力（在1、2、6和12个月随访时采用标准化的面对面临床工具进行评估）以及死亡率。在诊断时测量痴呆、疾病严重程度、合并症和社会人口统计学变量。构建了几种谵妄住院病程的测量指标。在痴呆患者亚组中，诊断时和12个月随访时谵妄症状的平均数量分别为4.5和3.5，在无痴呆患者中分别为3.4和2.2。注意力不集中、定向障碍和记忆受损是两个亚组中最持续存在的症状。在多变量分析中，病前和入院时的功能水平、入住养老院以及住院初期恢复较慢与较差的认知和功能转归相关，但与死亡率无关。
在有痴呆和无痴呆的患者中，谵妄症状在诊断后可持续长达12个月。住院恢复较快与较好的转归相关。
