Department of Rehabilitation and Aged Care, "Ancelle della Carità" Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy.
Department of Rehabilitation and Aged Care, "Ancelle della Carità" Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy.
J Am Med Dir Assoc. 2011 Oct;12(8):578-583. doi: 10.1016/j.jamda.2010.04.010. Epub 2010 Oct 2.
Although delirium is known as a mental disorder, recent evidence suggests that it is associated with short- and long-term impairment of functional status.
To evaluate whether a pattern of fluctuations in motor performance are a diagnostic sign of delirium.
Case-controlled study with prospective evaluations of 4 groups of patients.
Department of Rehabilitation and Aged Care.
Fifteen patients with incident delirium alone (Del group) and 15 patients with incident delirium superimposed on dementia (DSD group) were compared with 15 patients with neither delirium nor dementia (No Del-No Dem group) and 15 patients with dementia but no delirium (Dem group), respectively. Eligibility criteria were age 65 years or older, ability on admission to maintain sitting position for at least 10 minutes, and absence of visual/hearing impairment or delirium on admission. All patients underwent a multidimensional assessment on admission and serial evaluations of motor performance using Trunk Control Test (TCT) and Tinetti scale. These assessments were fixed at 5 different times, coincident with admission (T(0)), predelirium (T(1)), onset of delirium (T(2)), resolution of delirium (T(3)), and discharge (T(4)).
Patients in the Dem, DSD, and Del groups were significantly more impaired at T(0) in cognitive and functional status and motor performance compared with No Del-No Dem patients. At T(1) all groups improved, although in different ways. At T(2) only in the Del and DSD groups, but not in the others, there was a pattern of decline in TCT and Tinetti scores (P < .0005 at t test for pair comparison for both tests) and a specular pattern of improvement at T(3) (P < .0005 at t test for pair comparison for both tests). Patients in the Del and DSD groups had the poorest attentive and executive performances at T(2), which significantly improved at T(3). In No Del-No Dem and Dem groups, attentive and executive functions did not change from T(2) to T(3.)
Patients with delirium exhibit a pattern of fluctuating motor performance that is chronologically related with the onset and the end of delirium, ie, they decline when delirium develops and improve when delirium ends. This pattern seems to be typical of delirium, as it is appreciable in subjects with dementia developing delirium but not in patients with dementia alone. A fluctuation of motor performance should be considered a diagnostic sign of delirium.
谵妄被认为是一种精神障碍，但最近的证据表明，它与短期和长期的功能状态受损有关。
评估运动表现波动模式是否是谵妄的诊断标志。
病例对照研究，对 4 组患者进行前瞻性评估。
康复和老年护理科。
将 15 例单纯发生谵妄的患者（Del 组）和 15 例谵妄合并痴呆的患者（DSD 组）与 15 例既无谵妄也无痴呆的患者（No Del-No Dem 组）和 15 例有痴呆但无谵妄的患者（Dem 组）进行比较。入选标准为年龄≥65 岁，入院时能维持坐位至少 10 分钟，入院时无视觉/听觉障碍或谵妄。所有患者入院时进行多维评估，并使用躯干控制测试（TCT）和 Tinetti 量表对运动表现进行连续评估。这些评估在 5 个不同的时间点固定，与入院时（T(0)）、谵妄前（T(1)）、谵妄发作时（T(2)）、谵妄缓解时（T(3)）和出院时（T(4)）一致。
与 No Del-No Dem 组患者相比，Dem、DSD 和 Del 组患者在认知和功能状态以及运动表现方面，在 T(0)时明显受损。在 T(1)时，所有组均有所改善，尽管方式不同。在 T(2)时，只有 Del 和 DSD 组而不是其他组，TCT 和 Tinetti 评分出现下降模式（t 检验，两组测试的配对比较均为 P <.0005），T(3)时出现相似的改善模式（t 检验，两组测试的配对比较均为 P <.0005）。Del 和 DSD 组患者在 T(2)时注意力和执行功能最差，在 T(3)时明显改善。在 No Del-No Dem 和 Dem 组中，注意力和执行功能从 T(2)到 T(3)没有变化。
谵妄患者表现出波动的运动表现模式，与谵妄的发生和结束在时间上相关，即当谵妄发生时下降，当谵妄结束时改善。这种模式似乎是谵妄的典型特征，因为它在发生谵妄的痴呆患者中是明显的，但在单纯痴呆患者中则不然。运动表现的波动应被视为谵妄的诊断标志。
