Morandi Alessandro, Davis Daniel, Bellelli Giuseppe, Arora Rakesh C, Caplan Gideon A, Kamholz Barbara, Kolanowski Ann, Fick Donna Marie, Kreisel Stefan, MacLullich Alasdair, Meagher David, Neufeld Karen, Pandharipande Pratik P, Richardson Sarah, Slooter Arjen J C, Taylor John P, Thomas Christine, Tieges Zoë, Teodorczuk Andrew, Voyer Philippe, Rudolph James L
Department of Rehabilitation and Aged Care of the Fondazione Camplani, Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy.
University College London, London, United Kingdom.
J Am Med Dir Assoc. 2017 Jan;18(1):12-18. doi: 10.1016/j.jamda.2016.07.014. Epub 2016 Sep 16.
Delirium occurring in patients with dementia is referred to as delirium superimposed on dementia (DSD). People who are older with dementia and who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision are considered the standard reference for the diagnosis of delirium and include criteria of impairments in cognitive processes such as attention, additional cognitive disturbances, or altered level of arousal. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision does not provide guidance regarding specific tests for assessment of the cognitive process impaired in delirium. Importantly, the assessment or inclusion of preexisting cognitive impairment is also not addressed by these standards. The challenge of DSD gets more complex as types of dementia, particularly dementia with Lewy bodies, which has features of both delirium and dementia, are considered. The objective of this article is to critically review key elements for the diagnosis of DSD, including the challenge of neuropsychological assessment in patients with dementia and the influence of particular tests used to diagnose DSD. To address the challenges of DSD diagnosis, we present a framework for guiding the focus of future research efforts to develop a reliable reference standard to diagnose DSD. A key feature of a reliable reference standard will improve the ability to clinically diagnose DSD in facility-based patients and research studies.
痴呆患者中发生的谵妄被称为痴呆叠加谵妄（DSD）。患有痴呆症的老年人以及住在养老院的人在住院时发生谵妄的风险会增加。此外，他们先前存在的认知障碍使得检测他们的谵妄成为一项挑战。《精神疾病诊断与统计手册》第五版和《国际疾病及相关健康问题统计分类》第十版被视为谵妄诊断的标准参考文献，其中包括认知过程受损的标准，如注意力、其他认知障碍或觉醒水平改变。《精神疾病诊断与统计手册》第五版和《国际疾病及相关健康问题统计分类》第十版并未提供关于评估谵妄中受损认知过程的具体测试的指导。重要的是，这些标准也未涉及对先前存在的认知障碍的评估或纳入。随着痴呆类型的考虑，尤其是路易体痴呆，其具有谵妄和痴呆的特征，DSD的挑战变得更加复杂。本文的目的是批判性地回顾DSD诊断的关键要素，包括痴呆患者神经心理学评估的挑战以及用于诊断DSD的特定测试的影响。为应对DSD诊断的挑战，我们提出一个框架，以指导未来研究工作的重点，即开发一种可靠的参考标准来诊断DSD。可靠参考标准的一个关键特征将提高在机构患者和研究中临床诊断DSD的能力。
