Stroomer-van Wijk Anne J M, Jonker Barbara W, Kok Rob M, van der Mast Roos C, Luijendijk Hendrika J
Department of Old Age Psychiatry,Parnassia,The Hague,the Netherlands.
Department of Psychiatry,Leiden University Medical Center,Leiden,the Netherlands.
Int Psychogeriatr. 2016 Aug;28(8):1303-11. doi: 10.1017/S1041610216000600. Epub 2016 Apr 15.
Delirium may be more prevalent in elderly outpatients than has long been assumed. However, it may be easily missed due to overlap with dementia. Our aim was to study delirium symptoms and underlying somatic disorders in psycho-geriatric outpatients.
We performed a case-control study among outpatients that were referred to a psychiatric institution between January 1st and July 1st 2010 for cognitive evaluation. We compared 44 cases with DSM-IV delirium (24 with and 20 without dementia) to 44 controls with dementia only. All participants were aged 70 years or older. We extracted from the medical files (1) referral characteristics including demographics, medical history, medication use, and referral reasons, (2) delirium symptoms, scored with the Delirium Rating Scale-Revised-98, and (3) underlying disorders categorized as: drugs/intoxication, infection, metabolic/endocrine disturbances, cardiovascular disorders, central nervous system disorders, and other health problems.
At referral, delirium patients had significantly higher numbers of chronic diseases and medications, and more often a history of delirium and a recent hospital admission than controls. Most study participants, including those with delirium, were referred for evaluation of (suspected) dementia. The symptoms that occurred more frequently in cases were: sleep disturbances, perceptual abnormalities, delusions, affect lability, agitation, attention deficits, acute onset, and fluctuations. Drug related (68%), infectious (61%), and metabolic-endocrine (50%) disturbances were often involved.
Detection of delirium and distinction from dementia in older outpatients was feasible but required detailed caregiver information about the presence, onset, and course of symptoms. Most underlying disorders could be managed at home.
谵妄在老年门诊患者中的患病率可能比长期以来所认为的更高。然而，由于与痴呆症症状重叠，谵妄可能很容易被漏诊。我们的目的是研究老年精神科门诊患者的谵妄症状及潜在躯体疾病。
我们对2010年1月1日至7月1日期间因认知评估被转诊至一家精神病机构的门诊患者进行了一项病例对照研究。我们将44例符合《精神疾病诊断与统计手册》第四版（DSM-IV）谵妄诊断标准的患者（其中24例伴有痴呆症，20例不伴有痴呆症）与44例仅患有痴呆症的对照患者进行了比较。所有参与者年龄均在70岁及以上。我们从医疗档案中提取了以下信息：（1）转诊特征，包括人口统计学信息、病史、用药情况及转诊原因；（2）使用谵妄评定量表修订版98对谵妄症状进行评分；（3）潜在疾病分类为：药物/中毒、感染、代谢/内分泌紊乱、心血管疾病、中枢神经系统疾病及其他健康问题。
在转诊时，谵妄患者的慢性病和用药数量显著多于对照组，且谵妄病史和近期住院史也更为常见。包括谵妄患者在内的大多数研究参与者因（疑似）痴呆症接受评估。病例组中更频繁出现的症状有：睡眠障碍、感知异常、妄想、情感不稳定、激越、注意力缺陷、急性起病及症状波动。药物相关（68%）、感染性（61%）及代谢 - 内分泌（50%）紊乱常与之相关。
在老年门诊患者中检测谵妄并与痴呆症相区分是可行的，但需要护理人员提供有关症状的存在、起病及病程的详细信息。大多数潜在疾病可在家中处理。
