Hans-Berger-Department of Neurology, Jena University Hospital, Jena, Germany.
Center for Clinical Studies, Jena University Hospital, Jena, Germany.
J Am Geriatr Soc. 2020 Jul;68(7):1469-1475. doi: 10.1111/jgs.16422. Epub 2020 Mar 20.
Although delirium is often investigated, little is known about the outcomes of patients having acute neuropsychological changes at a single time point without fulfilling the criteria of full delirium. Our aim was to determine point prevalence, predictors, and long-term outcomes of delirium and acute neuropsychological changes in patients aged 60 years and older across different departments of a university hospital with general inpatient care.
Prospective observational study.
University hospital excluding psychiatric wards.
At baseline, 669 patients were assessed, and follow-ups occurred at months 6, 12, 18, and 36.
Measurements were obtained using the Confusion Assessment Method (CAM), comprehensive geriatric assessment, health-related quality of life, functional state (month 6), and mortality rates (months 6, 12, 18, and 36). Subjects were classified into (1) patients with delirium according to the CAM, (2) patients with only two positive CAM items (2-CAM state), and (3) patients without delirium.
Delirium was present in 10.8% and the 2-CAM state in an additional 12.7% of patients. Highest prevalence of delirium was observed in medical and surgical intensive care units and neurosurgical wards. Cognitive restrictions, restricted mobility, electrolyte imbalance, the number of medications per day, any fixations, and the presence of a urinary catheter predicted the presence of delirium and 2-CAM-state. The mean Karnofsky Performance Score and EuroQol-5D were comparable between delirium and the 2-CAM state after 6 months. The 6-, 12-, 18-, and 36-month mortality rates of patients with delirium and the 2-CAM state were comparable. The nurses' evaluation of distinct patients showed high specificity (89%) but low sensitivity (53%) for the detection of delirium in wide-awake patients.
Patients with an acute change or fluctuation in mental status or inattention with one additional CAM symptom (ie, disorganized thinking or an altered level of consciousness) have a similar risk for a lower quality of life and death as patients with delirium. J Am Geriatr Soc 68:1469-1475, 2020.
尽管谵妄经常被研究，但对于在没有完全符合谵妄标准的情况下，在单一时间点出现急性神经认知变化的患者的结局，我们知之甚少。我们的目的是确定在一所大学附属医院的不同科室中，有一般住院治疗的 60 岁及以上患者中，在特定时间点发生谵妄和急性神经认知变化的现患率、预测因素和长期结局。
前瞻性观察性研究。
大学医院，不包括精神病病房。
在基线时，评估了 669 名患者，并在第 6、12、18 和 36 个月进行随访。
使用意识模糊评估法（CAM）、全面老年评估、健康相关生活质量、功能状态（第 6 个月）和死亡率（第 6、12、18 和 36 个月）进行测量。将患者分为（1）根据 CAM 确诊为谵妄的患者，（2）仅有两项 CAM 阳性项目（2-CAM 状态）的患者，和（3）无谵妄的患者。
10.8%的患者存在谵妄，12.7%的患者存在 2-CAM 状态。在医学和外科重症监护病房和神经外科病房中，谵妄的现患率最高。认知受限、活动受限、电解质失衡、每日用药数量、任何固定物和导尿管的存在均预测了谵妄和 2-CAM 状态的发生。在第 6 个月时，谵妄和 2-CAM 状态患者的卡诺夫斯基表现评分和欧洲五维健康量表评分相当。谵妄和 2-CAM 状态患者的 6、12、18 和 36 个月死亡率相当。护士对不同患者的评估显示，在意识清醒的患者中，对谵妄的检测具有较高的特异性（89%），但敏感性较低（53%）。
有急性认知改变或波动性意识改变或注意力不集中，伴有 CAM 症状（即思维紊乱或意识水平改变）的患者，其生活质量下降和死亡风险与谵妄患者相似。美国老年医学会 68:1469-1475,2020.
