Department of Psychiatry, University Hospital Limerick, Dooradoyle, Ireland.
Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Dooradoyle, Ireland.
J Geriatr Psychiatry Neurol. 2024 Mar;37(2):125-133. doi: 10.1177/08919887231195232. Epub 2023 Aug 11.
To compare the etiology, phenomenology and motor subtype of delirium in patients with and without an underlying dementia.
A combined dataset (n = 992) was collated from two databases of older adults (>65 years) from liaison psychiatry and palliative care populations in Ireland and India. Phenomenology and severity of delirium were analysed using the Delirium Symptom Rating Scale Revised (DRS-R98) and contributory etiologies for the delirium groups were ascertained using the Delirium Etiology Checklist (DEC). Delirium motor subtype was documented using the abbreviated version of the Delirium Motor Subtype Scale (DMSS4).
Delirium superimposed on dementia (DSD) showed greater impairment in short term memory, long term memory and visuospatial ability than the delirium group but showed significantly less perceptual disturbance, temporal onset and fluctuation. Systemic infection, cerebrovascular and other Central nervous system etiology were associated with DSD while metabolic disturbance, organ insufficiency and intracranial neoplasm were associated with the delirium only group.
The etiology and phenomenology of delirium differs when it occurs in the patient with an underlying dementia. We discuss the implications in terms of identification and management of this complex condition.
比较伴有和不伴有潜在痴呆的患者发生谵妄的病因、表现和运动亚型。
从爱尔兰和印度联络精神病学和姑息治疗人群中的两个老年人（>65 岁）数据库中整理了一个合并数据集（n=992）。使用修订后的谵妄症状评定量表（DRS-R98）分析谵妄的表现和严重程度，使用谵妄病因检查表（DEC）确定谵妄组的促成病因。使用简化版的谵妄运动亚型量表（DMSS4）记录谵妄的运动亚型。
在痴呆基础上发生的谵妄（DSD）在短期记忆、长期记忆和视觉空间能力方面的损害程度大于谵妄组，但在知觉障碍、时间发作和波动方面的损害程度显著较低。全身性感染、脑血管和其他中枢神经系统病因与 DSD 相关，而代谢紊乱、器官功能不全和颅内肿瘤与仅发生谵妄的组相关。
当谵妄发生在有潜在痴呆的患者中时，其病因和表现不同。我们从识别和管理这种复杂疾病的角度讨论了这些差异的意义。
