Jackson Thomas A, MacLullich Alasdair M J, Gladman John R F, Lord Janet M, Sheehan Bart
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK Centre for Translational Inflammation Research, Queen Elizabeth Hospital Mindelsohn Way, Birmingham B15 2WD, UK.
Delirium Research Group, Geriatric Medicine, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
Age Ageing. 2016 Jul;45(4):505-11. doi: 10.1093/ageing/afw065. Epub 2016 Apr 13.
delirium and dementia co-exist commonly in hospital. Older people with delirium have high rates of undiagnosed dementia, but delirium affects the use of cognitive testing in dementia diagnosis. Novel methods to detect dementia in delirium are needed. The purpose of the study was to investigate the diagnostic test accuracy of informant tools to detect dementia in hospitalised older people with delirium.
the presence of dementia on admission was assessed using the short form of the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE-SF) and Alzheimer's Disease 8 (AD8) in people over 70 years old with delirium. Reference standard diagnosis was made using Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria at 3 months. The main outcome measures were the diagnostic test accuracy of the IQCODE-SF and the AD8 in diagnosing DSM-IV dementia.
dementia prevalence at 3 months was 61%. The area under the receiver operating characteristic curve (AUROC) was 0.93 (P < 0.0005) for admission IQCODE-SF and 0.91 (P < 0.0005) for admission AD8. An IQCODE-SF test result of >3.82 on admission had a sensitivity of 0.91 (0.79-0.97) and specificity of 0.93 (0.76-0.99) for detecting dementia. An AD8 of >6 had a sensitivity of 0.83 (0.69-0.92) and specificity of 0.90 (0.72-0.97) for detecting dementia.
the IQCODE-SF and AD8 are sensitive and specific tools to detect prior dementia in older people with delirium. The routine use of either tool in practice could have important clinical impact, by improving the recognition and hence management of those with dementia.
谵妄和痴呆在医院中常同时存在。患有谵妄的老年人未被诊断出痴呆的比例很高，但谵妄会影响痴呆诊断中认知测试的应用。需要新的方法来在谵妄患者中检测痴呆。本研究的目的是调查 informant 工具在住院的谵妄老年患者中检测痴呆的诊断测试准确性。
使用老年认知功能减退知情者问卷简表（IQCODE-SF）和阿尔茨海默病 8 项问卷（AD8）评估 70 岁以上谵妄患者入院时是否存在痴呆。采用《精神障碍诊断与统计手册》第四版（DSM-IV）标准在 3 个月时进行参考标准诊断。主要结局指标是 IQCODE-SF 和 AD8 在诊断 DSM-IV 痴呆方面的诊断测试准确性。
3 个月时痴呆患病率为 61%。入院时 IQCODE-SF 的受试者工作特征曲线下面积（AUROC）为 0.93（P < 0.0005），入院时 AD8 的 AUROC 为 0.91（P < 0.0005）。入院时 IQCODE-SF 测试结果>3.82 检测痴呆的敏感性为 0.91（0.79 - 0.97），特异性为 0.93（0.76 - 0.99）。AD8>6 检测痴呆的敏感性为 0.83（0.69 - 0.92），特异性为 0.90（0.72 - 0.97）。
IQCODE-SF 和 AD8 是检测谵妄老年患者既往痴呆的敏感且特异的工具。在实践中常规使用这两种工具中的任何一种都可能通过改善对痴呆患者的识别从而改善其管理，产生重要的临床影响。
