Outcome of delirium: part 2. Clinical features of reversible cognitive dysfunction--are they the same as accepted definitions of delirium?

OBJECTIVE

To describe the clinical features of reversible cognitive dysfunction.

DESIGN

Prospective cohort study.

SETTING

Acute geriatric inpatient units.

PATIENTS

A random sample of consecutive acute admissions of patients over the age of 65 (N = 80).

MAIN MEASUREMENTS

Serial assessments of mental state and cognitive function and observational data.

OUTCOME MEASURE

Patients with more than five points of 20% improvement in Mini Mental State Examination following the most severely impaired assessment operationally designated 'reversible cognitive dysfunction'. The clinical features of those with RCD are compared with those with non-reversible cognitive dysfunction.

MAIN RESULTS

Delusions, hallucinations, aggression, excitement, irritability and other 'active' symptoms were not commoner in RCD than in non-reversible cognitive dysfunction (non-RCD). By contrast, 'quiet' signs, such as plucking at bedclothes, poor attention, incoherent speech, abnormal associations, slow, vague thought and fluctuating mental state were more marked in RCD than in non-RCD.

CONCLUSIONS

Reversible cognitive dysfunction is a quiet and unobtrusive disorder.