The online version of this article (doi:10.1186/1471-2318-14-87) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
DD and JC devised the algorithm. DD undertook the statistical analysis with assistance from BS and FM. LB conducted and co-ordinated the fieldwork for CFAS. AM and DM provided expertise on syndromal and subsyndromal delirium phenomenology. CB contributed to the conception and design of the study, and is a principal investigator on CFAS, along with FM. All authors read and approved the final manuscript.
In the general population, the epidemiological relationships between delirium and adverse outcomes are not well defined. The aims of this study were to: (1) construct an algorithm for the diagnosis of delirium using the Geriatric Mental State (GMS) examination; (2) test the criterion validity of this algorithm against mortality and dementia risk; (3) report the age-specific prevalence of delirium as determined by this algorithm.
Participant and informant data in a randomly weighted subsample of the Cognitive Function and Ageing Study were taken from a standardized assessment battery. The algorithmic definition of delirium was based on the DSM-IV classification. Outcomes were: proportional hazard ratios for death; odds ratios of dementia at 2-year follow-up.
Data from 2197 persons (representative of 13,004) were used, median age 77 years, 64% women. Study-defined delirium was associated with a new dementia diagnosis at two years (OR 8.82, 95% CI 2.76 to 28.2) and death (HR 1.28, 95% CI 1.03 to 1.60), even after adjustment for acute illness severity. Similar associations were seen for study-defined subsyndromal delirium. Age-specific prevalence as determined by the algorithm increased with age from 1.8% in the 65-69 year age group to 10.1% in the ≥85 age group (p < 0.01 for trend). For study-defined subsyndromal delirium, age-specific period prevalence ranged from 8.2% (65-69 years) to 36.1% (≥85 years).
These results demonstrate the possibility of constructing an algorithmic diagnosis for study-defined delirium using data from the GMS schedule, with predictive criterion validity for mortality and dementia risk. These are the first population-based analyses able to account prospectively for both illness severity and an earlier study diagnosis of dementia.
Khan BA, Zawahiri M, Campbell NL, Fox GC, Weinstein EJ, Nazir A, Farber MO, Buckley JD, Maclullich A, Boustani MA: Delirium in hospitalized patients: implications of current evidence on clinical practice and future avenues for research-A systematic evidence review. J Hosp Med. 2012, 7 (7): 580-589. CrossRefPubMedPubMedCentral
Kay DW, Dewey ME, McKeith IG, O'Cuill M, McCracken C, Fairbairn AF, Harrison R, Illing JC, Hrisos S: Do experienced diagnosticians agree about the diagnosis of dementia from survey data? The effects of informants’ reports and interviewers’ vignettes. Int J Geriatr Psychiatry. 1998, 13 (12): 852-862. CrossRefPubMed
Matthews FE, Arthur A, Barnes LE, Bond J, Jagger C, Robinson L, Brayne C: A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet. 2013, 382 (9902): 1405-1412. CrossRefPubMedPubMedCentral
- The descriptive epidemiology of delirium symptoms in a large population-based cohort study: results from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS)
Daniel HJ Davis
Linda E Barnes
Blossom CM Stephan
Alasdair MJ MacLullich
Fiona E Matthews
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II