Jackson Thomas A, MacLullich Alasdair M J, Gladman John R F, Lord Janet M, Sheehan Bart
Institute of Inflammation and Ageing, Centre for Translational Inflammation Research, Queen Elizabeth Hospital Mindelsohn Way, University of Birmingham, Birmingham B15 2WD, UK.
Geriatric Medicine, F1424, Royal Infirmary of Edinburgh 51, Little France Crescent, University of Edinburgh, Edinburgh EH16 4SA, UK.
Age Ageing. 2016 Jul;45(4):493-9. doi: 10.1093/ageing/afw064. Epub 2016 Apr 13.
delirium and dementia are common in the general hospital, being present in nearly 50% of older unselected admissions to hospital. Cognitive impairment is a risk factor for delirium, but the prevalence of previously undiagnosed cognitive impairment (dementia or mild cognitive impairment) in patients with delirium is unknown.
we performed a prospective cohort study of people over 70 years admitted to hospital with delirium to establish the prevalence of previously unrecognised prior cognitive impairment. Delirium was diagnosed at baseline using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Mild cognitive impairment and dementia were diagnosed 3 months following recruitment in survivors using the International Working Group on Mild Cognitive Impairment criteria and DSM-IV criteria, respectively.
delirium was identified in 17.9% of older patients, and 82 participants with delirium were assessed at 3 months: 5 (6%) had persistent delirium, 14 (17%) had mild cognitive impairment and 47 (57%) had dementia. In 17 participants with prior dementia and 14 with prior mild cognitive impairment, the diagnosis had been unrecognised, amounting to 31/82 (38%) of all patients with delirium having some form of previously undiagnosed cognitive impairment.
given that over 1/3 of older patients with delirium were found to have a previously undiagnosed cognitive impairment, the development and evaluation of services to follow-up and manage patients with delirium are warranted.
谵妄和痴呆在综合医院中很常见，在未经过挑选的老年住院患者中，近50%存在这些情况。认知障碍是谵妄的一个危险因素，但谵妄患者中先前未被诊断出的认知障碍（痴呆或轻度认知障碍）的患病率尚不清楚。
我们对70岁以上因谵妄入院的患者进行了一项前瞻性队列研究，以确定先前未被识别的既往认知障碍的患病率。在基线时使用《精神疾病诊断与统计手册》（DSM-IV-TR）诊断谵妄。在幸存者入组3个月后，分别使用轻度认知障碍国际工作组标准和DSM-IV标准诊断轻度认知障碍和痴呆。
在老年患者中，17.9%被诊断为谵妄，82名谵妄患者在3个月时接受了评估：5名（6%）持续存在谵妄，14名（17%）有轻度认知障碍，47名（57%）有痴呆。在17名先前患有痴呆和14名先前患有轻度认知障碍的患者中，诊断未被识别，这意味着所有谵妄患者中有31/82（38%）存在某种形式的先前未被诊断出的认知障碍。
鉴于超过1/3的老年谵妄患者被发现存在先前未被诊断出的认知障碍，因此有必要开展和评估针对谵妄患者的随访及管理服务。
