Lerner A J, Hedera P, Koss E, Stuckey J, Friedland R P
Alzheimer Center, Department of Neurology, University Hospitals of Cleveland, Ohio, USA.
Alzheimer Dis Assoc Disord. 1997 Mar;11(1):16-20. doi: 10.1097/00002093-199703000-00004.
Advanced age and dementia are well-known risk factors for delirium, and most studies of delirium have concentrated on hospitalized populations. We reviewed the records of 199 community-dwelling Alzheimer disease (AD) patients and identified 43 (22%) who had had episodes of delirium during their dementing illness. These patients were matched for age, gender, and disease duration to AD patients without previous episodes of delirium. Variables examined included causes of delirium, Mini-Mental State Examination scores, Clinical Dementia Rating scores. Blessed Activities of Daily Living (ADL) scores, years of education, neuropsychological performance, and incidence of behavioral symptoms on the Brief Psychiatric Rating Scale. In six of 198 (3%) patients delirium was an initial symptom of AD. Conditions associated with onset of delirium were urinary tract infections, stressful events, surgery, medical illnesses, and medications. No significant differences were found between groups on neuropsychological testing. Patients with previous episodes of delirium had worse ADL scores and higher disease-course incidences of hallucinations and paranoid delusions, mostly occurring during the delirious episode. We conclude that delirium is common in AD, but it is an unusual initial symptom and it occurs in diverse clinical settings. Measures of behavioral symptoms and ADLs are more likely to reflect the impact of delirium on clinical status than measures of cognition or stage of dementia.
高龄和痴呆是公认的谵妄危险因素，大多数关于谵妄的研究都集中在住院人群。我们回顾了199例社区居住的阿尔茨海默病（AD）患者的记录，确定了43例（22%）在痴呆病程中曾有谵妄发作的患者。这些患者在年龄、性别和病程方面与既往无谵妄发作的AD患者相匹配。所检查的变量包括谵妄的病因、简易精神状态检查表评分、临床痴呆评定量表评分、Blessed日常生活活动（ADL）评分、受教育年限、神经心理学表现以及简明精神病评定量表上的行为症状发生率。在198例患者中有6例（3%）谵妄是AD的首发症状。与谵妄发作相关的情况有尿路感染、应激事件、手术、内科疾病和药物。两组在神经心理学测试方面未发现显著差异。既往有谵妄发作的患者ADL评分更差，幻觉和偏执妄想的病程发生率更高，大多发生在谵妄发作期间。我们得出结论，谵妄在AD中很常见，但它是一种不常见的首发症状，且发生在多种临床环境中。行为症状和ADL的测量指标比认知或痴呆阶段的测量指标更有可能反映谵妄对临床状态的影响。
