Cole Martin G, McCusker Jane, Voyer Philippe, Monette Johanne, Champoux Nathalie, Ciampi Antonio, Belzile Eric, Vu Minh
Department of Psychiatry,St. Mary's Hospital Center & McGill University,Montreal,Quebec,Canada.
St. Mary's Research Centre,St Mary's Hospital Center,Montreal,Quebec,Canada.
Int Psychogeriatr. 2014 Jul;26(7):1181-9. doi: 10.1017/S1041610214000313. Epub 2014 Mar 13.
The immediate clinical significance of Confusion Assessment Method (CAM)-defined core symptoms of delirium not meeting criteria for delirium is unclear. This study proposed to determine if such symptoms are associated with cognitive and functional impairment, mood and behavior problems and increased Burden of Care (BOC) in older long-term care (LTC) residents.
The study was a secondary analysis of data collected for a prospective cohort study of delirium. Two hundred and fifty-eight LTC residents aged 65 years and older in seven LTC facilities had monthly assessments (for up to six months) of CAM - defined core symptoms of delirium (fluctuation, inattention, disorganized thinking, and altered level of consciousness) and five outcome measures: Mini-Mental State Exam, Barthel Index, Cornell Scale for Depression, Nursing Home Behavioral Problems Scale, and Burden of Care. Associations between core symptoms and the five outcome measures were analyzed using generalized estimating equations.
Core symptoms of delirium not meeting criteria for delirium among residents with and without dementia were associated with cognitive and functional impairment and mood and behavior problems but not increased BOC. The associations appear to be intermediate between those of full delirium and no core symptoms and were greater for residents with than without dementia.
CAM-defined core symptoms of delirium not meeting criteria for delirium appear to be associated with cognitive and functional impairment and mood and behavior problems in LTC residents with or without dementia. These findings may have implications for the prevention and management of such impairments and problems in LTC settings.
由混乱评估方法（CAM）定义的、未达到谵妄标准的谵妄核心症状的直接临床意义尚不清楚。本研究旨在确定这些症状是否与老年长期护理（LTC）机构居民的认知和功能损害、情绪和行为问题以及护理负担（BOC）增加有关。
本研究是对一项谵妄前瞻性队列研究收集的数据进行的二次分析。七个LTC机构中258名65岁及以上的LTC居民每月接受一次评估（最长6个月），评估内容包括CAM定义的谵妄核心症状（波动、注意力不集中、思维紊乱和意识水平改变）以及五项结局指标：简易精神状态检查表、巴氏指数、康奈尔抑郁量表、养老院行为问题量表和护理负担。使用广义估计方程分析核心症状与五项结局指标之间的关联。
患有和未患有痴呆症的居民中，未达到谵妄标准的谵妄核心症状与认知和功能损害以及情绪和行为问题相关，但与护理负担增加无关。这些关联似乎介于完全谵妄和无核心症状之间，且在患有痴呆症的居民中比未患有痴呆症的居民更为明显。
由CAM定义的、未达到谵妄标准的谵妄核心症状似乎与患有或未患有痴呆症的LTC居民的认知和功能损害以及情绪和行为问题相关。这些发现可能对LTC机构中此类损害和问题的预防及管理具有启示意义。
