Lawson Rachael Ashleigh, Richardson Sarah Joanna, Gerakios Florence, Yarnall Alison Jane, Bate Gemma, Wright Laura, McDonald Claire, Taylor John Paul, Burn David, Stebbins Glenn, Allan Louise M
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, England, United Kingdom of Great Britain and Northern Ireland.
NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, England, United Kingdom of Great Britain and Northern Ireland.
Age Ageing. 2025 Jul 1;54(7). doi: 10.1093/ageing/afaf197.
Delirium is a serious, acute neuropsychiatric condition associated with fluctuating attention and altered arousal. Delirium in Parkinson's disease (PD) is common but often missed in hospital due to shared clinical features. This study aimed to evaluate the accuracy of current tools used to identify delirium in inpatients with PD.
People with PD admitted to all hospital wards were invited to take part. Participants completed a standardised delirium assessment based on the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) criteria, in addition to standard bedside tools including the 4 As Test (4AT), arousal and cognition. This was a secondary analysis of a prospective observational study; bedside tools were not completed independently of, or blinded to, the DSM-5 criteria. Accuracy was assessed using Receiver Operating Characteristic area under the curve (AUROC).
Participants included 115 people with PD (200 hospital admissions); 66.1% (n = 76/115) had delirium. Considering all admissions, the diagnostic accuracy of tools was good, ranging from 74% to 89% (AUROC = 0.764-0.923, P < .001 for all). The 4AT scores had the highest sensitivity (96.7%, AUROC = 0.922, P < .001). However, accuracy decreased in those with underlying cognitive impairment (AUROC = 0.499-0.886).
Current bedside tools can accurately identify delirium in PD inpatients. Although tools were comparable, the 4AT may have greater clinical utility as it had high sensitivity, is quicker to complete and already widely used clinical. However, caution is recommended as tools did not differentiate between symptoms typical in PD and acute symptoms associated with delirium; this should be a focus for future research.
谵妄是一种严重的急性神经精神疾病，与注意力波动和觉醒改变有关。帕金森病（PD）患者中的谵妄很常见，但由于临床特征相似，在医院中常被漏诊。本研究旨在评估当前用于识别PD住院患者谵妄的工具的准确性。
邀请入住所有医院病房的PD患者参与。参与者除了完成基于《精神疾病诊断与统计手册》第5版（DSM-5）标准的标准化谵妄评估外，还完成了包括4项A测试（4AT）、觉醒和认知在内的标准床边工具评估。这是一项前瞻性观察性研究的二次分析；床边工具的完成并非独立于DSM-5标准，也未对其进行盲法处理。使用曲线下面积（AUROC）评估准确性。
参与者包括115名PD患者（200次住院）；66.1%（n = 76/115）患有谵妄。考虑所有住院情况，工具的诊断准确性良好，范围为74%至89%（AUROC = 0.764 - 0.923，所有P <.001）。4AT评分具有最高的敏感性（96.7%，AUROC = 0.922，P <.001）。然而，在有潜在认知障碍的患者中准确性降低（AUROC = 0.499 - 0.886）。
当前的床边工具可以准确识别PD住院患者的谵妄。尽管工具具有可比性，但4AT可能具有更大的临床实用性，因为它具有高敏感性、完成速度更快且已在临床广泛使用。然而，由于工具无法区分PD典型症状和与谵妄相关的急性症状，建议谨慎使用；这应是未来研究的重点。
