Hospital Psiquiatric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Reus, Spain.
Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia.
Int J Geriatr Psychiatry. 2019 Aug;34(8):1217-1225. doi: 10.1002/gps.5120. Epub 2019 May 3.
Mild cognitive impairment (MCI) and dementia (DEM) are prevalent in skilled nursing facilities (SNFs), confounding delirium detection. We report characteristics of delirium in an SNF to ascertain distinguishing features for delirium diagnosis, despite challenges of comorbidity with MCI and DEM.
Cross-sectional study of 200 consecutive patients from an SNF in Catalunya, Spain, assessed within the first 24 to 48 admission hours by independent experts with Spanish-Informant Questionnaire on Cognitive Decline in the Elderly (for MCI-DEM), Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) delirium criteria, and Delirium Rating Scale Revised-98 (DRS-R98) for delirium phenomenology. Delirium characteristics were modeled in successive steps, according to the presence of delirium and MCI-DEM, with analysis of variance (ANOVA), receiver operator characteristic analyses, and conditional logistic regression.
The final model produced symptoms that represented each of the three delirium core domains (ie, cognitive, higher order thinking, and circadian). The DRS-R98 items rated these symptoms as moderate-severe attention/vigilance, mild-severe language, and moderate-severe sleep-wake cycle alterations. The delirium discriminant accuracy of the three symptoms together was high: 84.6% in the MCI-DEM group to 92.8% in the No MCI-DEM group.
Impairments of attention, language, and sleep-wake cycle indicate delirium in SNF patients regardless of the underlying MCI-DEM status. Because delirium is underdetected in SNFs, where nursing staff/patient ratios are low, brief simple tools that measure these symptoms could potentially enhance delirium detection.
轻度认知障碍（MCI）和痴呆（DEM）在熟练护理机构（SNF）中很常见，这给谵妄的检测带来了困难。我们报告了 SNF 中谵妄的特征，以确定谵妄诊断的鉴别特征，尽管存在与 MCI 和 DEM 的共病性挑战。
对西班牙加泰罗尼亚的一家 SNF 中的 200 名连续患者进行了横断面研究，在入院后 24 至 48 小时内由独立专家使用西班牙认知下降老年人口 informant 问卷（用于 MCI-DEM）、精神障碍诊断与统计手册第五版（DSM-5）谵妄标准和修订后的 98 项谵妄评定量表（DRS-R98）进行评估。根据谵妄和 MCI-DEM 的存在情况，对谵妄特征进行了逐步建模，采用方差分析（ANOVA）、受试者工作特征分析和条件逻辑回归进行分析。
最终模型产生了代表谵妄三个核心领域（即认知、高级思维和昼夜节律）的症状。DRS-R98 项目评估这些症状为中度至重度注意/警觉、轻度至重度语言和中度至重度睡眠-觉醒周期改变。这三个症状一起的谵妄判别准确性很高：在 MCI-DEM 组中为 84.6%，在无 MCI-DEM 组中为 92.8%。
在 SNF 患者中，注意力、语言和睡眠-觉醒周期的损害表明存在谵妄，无论潜在的 MCI-DEM 状态如何。由于在护理人员/患者比例较低的 SNF 中，谵妄的检测率较低，因此，使用简单的简短工具来测量这些症状可能会提高谵妄的检测率。
