Delirium during the course of clinically diagnosed Alzheimer's disease

Abstract

SUMMARYA retrospective chart review was completed on the 122 cases of CDAD for the period of 1965-1970 identified from a longitudinal study of dementia a t the Mayo Clinic. A psychiatrist assigned DSM-111-R diagnoses based upon the longitudinal description of symptoms detailed in the medical records of the Mayo Clinic hospitals, nursing home visit records and state hospital records.Thirty patients (25%) were found to have an episode of delirium (EOD) during their course of CDAD which occurred during inpatient admissions. Single EODs were found to occur within 2 years of the onset of CDAD, and multiple EODs within 3 years of the onset of CDAD. A psychiatric consultation was requested in only 14% of the sample ( N = 17); 88% of these patients received diagnoses involving primary degenerative dementia of the Alzheimer's type, late onset. Psychopharmacology was the major management strategy (82Y~ of patients with an EOD received medication) with the resolution of symptoms within 48 hours. At discharge, only two patients (7%)) failed to completely clear the increased degree of confusion. Implications of these findings for the management of patients with CDAD and the management of EOD with the knowledge of the 1990s are discussed.KEY WORDS-Delirium, dementia, management. Delirium is an acute confusional state characterized by a global disturbance in cognitive function. Thinking, perception and awareness are all impaired (Blass et al., 1991). The causes of delirium are protean and include metabolic derangement due to electrolyte imbalance or hepatorenal failure,

Delirium accelerates cognitive decline in Alzheimer disease

“…Prior studies have shown that patients with dementia who develop delirium have increased rates of hospitalization, institutionalization, and mortality. 6,[13][14][15] In this sample, after adjusting for baseline differences, the change in score on the Blessed IMC prior to an episode of delirium was 2.5 points per year, consistent with prior reported increases in patients with AD of about 3 points per year. [16][17][18] In the delirium group, the relative change in IMC score doubled from 2.5 points per year at baseline to a postdelirium rate of 4.9 points per year.…”

The interface between delirium and dementia in elderly adults

“…57-61 In one study of 771 community-dwelling patients with Alzheimer’s disease (AD), after adjustment for confounders, delirium was associated with a greatly increased adjusted risk of death, relative risk of 5.4 (95% CI 2.3-12.5) or institutionalisation, relative risk of 9.3 (95% CI 5.5-15.7). At one year, 21% of those with cognitive decline, 15% of institutionalisations and 6% of deaths were attributable to delirium.…”

Delirium in elderly adults: diagnosis, prevention and treatment

“…Outcomes for patients with dementia who develop delirium are worse than for those who do not develop this condition 88,89. In addition to showing worse cognitive function, patients with dementia who experience delirium have higher rates of hospitalization, institutionalization and death 101–103…”