Leonard Maeve M, Agar Meera, Spiller Juliet A, Davis Brid, Mohamad Mas M, Meagher David J, Lawlor Peter G
Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
Discipline, Palliative & Supportive Services, Flinders University, Adelaide, South Australia, Australia; South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia; Department of Palliative Care, Braeside Hospital, HammondCare, Sydney, New South Wales, Australia.
J Pain Symptom Manage. 2014 Aug;48(2):199-214. doi: 10.1016/j.jpainsymman.2014.03.012. Epub 2014 May 28.
Delirium often presents difficult diagnostic and classification challenges in palliative care settings.
To review three major areas that create diagnostic and classification challenges in relation to delirium in palliative care: subsyndromal delirium (SSD), delirium in the context of comorbid dementia, and classification of psychomotor subtypes, and to identify knowledge gaps and research priorities in relation to these three areas of focus.
We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant PubMed literature searches as the knowledge synthesis strategy in this review.
We identified six (SSD), 33 (dementia), and 44 (psychomotor subtypes) articles of relevance in relation to the focus of our review. Recent literature data highlight the frequency and impact of SSD, the relevance of comorbid dementia, and the propensity for a hypoactive presentation of delirium in the palliative population. The differential diagnoses to consider are wide and include pain, fatigue, mood disturbance, psychoactive medication effects, and other causes for altered consciousness.
Challenges in the diagnosis and classification of delirium in people with advanced disease are compounded by the generalized disturbance of central nervous system function that occurs in the seriously ill, often with comorbid illness, including dementia. Further research is needed to delineate the pathophysiological and clinical associations of these presentations and thus inform therapeutic strategies. The expanding aged population and growing focus on dementia care in palliative care highlight the need to conduct this research.
在姑息治疗环境中，谵妄常常带来诊断和分类方面的难题。
回顾在姑息治疗中与谵妄相关的、造成诊断和分类挑战的三个主要领域：亚综合征性谵妄（SSD）、共病痴呆情况下的谵妄以及精神运动亚型的分类，并确定与这三个重点领域相关的知识空白和研究重点。
在一次国际谵妄研究规划会议上，我们结合了谵妄研究人员和知识使用者的多学科意见，并进行了相关的PubMed文献检索，以此作为本综述中的知识综合策略。
我们确定了与综述重点相关的6篇（SSD）、33篇（痴呆）和44篇（精神运动亚型）文章。近期文献数据突出了SSD的频率和影响、共病痴呆的相关性以及姑息治疗人群中谵妄表现为活动减退的倾向。需要考虑的鉴别诊断范围广泛，包括疼痛、疲劳、情绪障碍、精神活性药物作用以及意识改变的其他原因。
晚期疾病患者谵妄的诊断和分类挑战因重症患者常伴有包括痴呆在内的共病而导致的中枢神经系统功能普遍紊乱而更加复杂。需要进一步研究来阐明这些表现的病理生理和临床关联，从而为治疗策略提供依据。不断增长的老年人口以及姑息治疗中对痴呆护理的日益关注凸显了开展这项研究的必要性。
