Institute of Neuroscience,3rd floor Biomedical Research Building,Campus for Ageing and Vitality,Newcastle University,Newcastle upon Tyne,NE4 5PL,UK.
University College London,MRC Unit for Lifelong Health and Ageing at UCL,London,UK.
Int Psychogeriatr. 2017 Oct;29(10):1585-1593. doi: 10.1017/S1041610217000916. Epub 2017 May 31.
Detecting delirium superimposed on dementia (DSD) can be challenging because assessment partly relies on cognitive tests that may be abnormal in both conditions. We hypothesized that a combined arousal and attention testing procedure would accurately detect DSD.
Patients aged ≥70 years were recruited from five hospitals across Europe. Delirium was diagnosed by physicians using DSM-5 criteria using information from nurses, carers, and medical records. Dementia was ascertained by the Informant Questionnaire on Cognitive Decline in the Elderly. Arousal was measured using the Observational Scale of Level of Arousal (OSLA), which assesses eye opening, eye contact, posture, movement, and communication. Attention was measured by participants signaling each time an "A" was heard when "S-A-V-E-A-H-A-A-R-T" was read out.
The sample included 114 persons (mean age 82 years (SD 7); 54% women). Dementia alone was present in 25% (n = 28), delirium alone in 18% (n = 21), DSD in 27% (n = 31), and neither in 30% (n = 34). Arousal and attention was assessed in n = 109 (96%). Using OSLA, 83% participants were correctly identified as having delirium (sensitivity 85%, specificity 82%, AUROC 0.92). The attention task correctly classified 76% of participants with delirium (sensitivity 90%, specificity 64%, AUROC 0.80). Combining scores correctly classified 91% of participants with delirium (sensitivity 84%, specificity 92%, AUROC 0.94). Diagnostic accuracy remained high in the subgroup with dementia (93% correctly classified, sensitivity 94%, specificity 92%, AUROC 0.98).
This combined arousal-attention assessment to detect DSD was brief yet had high diagnostic accuracy. Such an approach could have clinical utility for diagnosing DSD.
识别痴呆合并谵妄（DSD）具有挑战性，因为评估部分依赖于认知测试，而这些测试在两种情况下可能都是异常的。我们假设，联合觉醒和注意力测试程序将能够准确地检测 DSD。
这项研究在欧洲的五家医院招募了年龄≥70 岁的患者。使用护士、护理人员和病历中的信息，根据 DSM-5 标准，由医生诊断谵妄。痴呆通过老年认知障碍 informant 问卷来确定。使用观察性觉醒量表（OSLA）来测量觉醒，该量表评估睁眼、眼神接触、姿势、运动和交流。注意力通过参与者在听到“当读出“S-A-V-E-A-H-A-A-R-T”时每次听到“A”时进行信号来测量。
该样本包括 114 人（平均年龄 82 岁（标准差 7）；54%为女性）。25%（n=28）存在单纯痴呆，18%（n=21）存在单纯谵妄，27%（n=31）存在 DSD，30%（n=34）两者均不存在。n=109（96%）进行了觉醒和注意力评估。使用 OSLA，83%的参与者被正确识别为患有谵妄（敏感性 85%，特异性 82%，AUROC 0.92）。注意力任务正确分类了 76%的谵妄患者（敏感性 90%，特异性 64%，AUROC 0.80）。联合评分正确分类了 91%的谵妄患者（敏感性 84%，特异性 92%，AUROC 0.94）。在合并痴呆的亚组中，诊断准确性仍然很高（93%正确分类，敏感性 94%，特异性 92%，AUROC 0.98）。
这种联合觉醒-注意力评估方法用于检测 DSD 既简单又具有较高的诊断准确性。这种方法可能对诊断 DSD 具有临床实用价值。
