Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
Charité - Universitätsmedizin Berlin, CVK: Campus Virchow-Klinikum, Institute of Tropical Medicine and International Health, Berlin, Germany.
J Neurol Sci. 2018 Feb 15;385:156-163. doi: 10.1016/j.jns.2017.12.006. Epub 2017 Dec 6.
In sub-Saharan Africa, there are no validated screening tools for delirium in older adults. This study assesses clinical utility of two instruments, the IDEA cognitive screen and the Confusion Assessment Method (CAM) for identification of delirium in older adults admitted to medical wards of a tertiary referral hospital in Tanzania.
The IDEA cognitive screen and CAM were administered to a consecutive cohort of older individuals on admission to Kilimanjaro Christian Medical Centre using a blinded protocol. Consensus diagnosis for delirium was established against DSM-5 criteria and dementia by DSM-IV criteria.
Of 507 admission assessments, 95 (18.7%) had DSM-5 delirium and 95 (18.7%) had DSM-IV dementia (33 (6.5%) delirium superimposed on dementia). The CAM and IDEA cognitive screen had very good diagnostic accuracy for delirium (AUROC curve 0.94 and 0.87 respectively). However, a number of participants (10.5% and 16.4% respectively) were unable to complete these screening assessments due to reduced consciousness, or other causes of reduced verbal response and were excluded from this analysis; many of whom met DSM-5 criteria for delirium. Secondary analysis suggests that selected cognitive and observational items from the CAM and IDEA cognitive screen may be as effective as the full screening tools in identifying delirium even in unresponsive patients.
Both instruments appeared useful for delirium screening in this inpatient setting, but had significant limitations. The combination of assessment items identified may form the basis of a brief, simple delirium screening tool suitable for use by non-specialist clinicians. Further development work is needed.
在撒哈拉以南非洲地区，目前尚无针对老年人谵妄的经验证的筛查工具。本研究评估了两种工具，即 IDEA 认知筛查和混乱评估方法（CAM）在坦桑尼亚一家三级转诊医院内科病房识别老年人谵妄的临床效用。
使用盲法方案，对基利马尼基督教医学中心的连续入院老年个体进行 IDEA 认知筛查和 CAM 评估。根据 DSM-5 标准和 DSM-IV 标准，建立谵妄和痴呆的共识诊断。
在 507 次入院评估中，95 例（18.7%）存在 DSM-5 谵妄，95 例（18.7%）存在 DSM-IV 痴呆（33 例（6.5%）谵妄叠加痴呆）。CAM 和 IDEA 认知筛查对谵妄均具有很好的诊断准确性（AUROC 曲线分别为 0.94 和 0.87）。然而，由于意识降低或其他导致语言反应能力降低的原因，一些参与者（分别为 10.5%和 16.4%）无法完成这些筛查评估，其中许多人符合 DSM-5 谵妄标准。次要分析表明，CAM 和 IDEA 认知筛查的一些选定认知和观察项目可能与完整的筛查工具一样有效，即使在无反应的患者中也可以识别谵妄。
这两种工具在这种住院环境中似乎都可用于谵妄筛查，但具有明显的局限性。识别出的评估项目组合可能构成一种简短、简单的谵妄筛查工具的基础，适合非专科临床医生使用。还需要进一步的开发工作。
