TY - JOUR
T1 - Tools to detect delirium superimposed on dementia
T2 - A systematic review
AU - Morandi, Alessandro
AU - McCurley, Jessica
AU - Vasilevskis, Eduard E.
AU - Fick, Donna M.
AU - Bellelli, Giuseppe
AU - Lee, Patricia
AU - Jackson, James C.
AU - Shenkin, Susan D.
AU - Marcotrabucchi,
AU - Schnelle, John
AU - Inouye, Sharon K.
AU - Ely, Wesley E.
AU - MacLullich, Alasdair
PY - 2012/11
Y1 - 2012/11
N2 - Objectives To identify valid tools to diagnose delirium superimposed on dementia. Design Systematic review of studies of delirium tools that explicitly included individuals with dementia. Setting Hospital. Participants Studies were included if delirium assessment tools were validated against standard criteria, and the presence of dementia was assessed according to standard criteria that used validated instruments. Measurements PubMed, Embase, and Web of Science databases were searched for articles in English published between January 1960 and January 2012. Results Nine studies fulfilled the selection criteria. Of 1,569 participants, 401 had dementia, and 50 had delirium superimposed on dementia. Six delirium tools were evaluated. One study using the Confusion Assessment Method (CAM) with 85% of participants with dementia had high specificity (96-100%) and moderate sensitivity (77%). Two intensive care unit studies that used the CAM for the Intensive Care Unit (CAM-ICU) reported 100% sensitivity and specificity for delirium in 23 individuals with dementia. One study using electroencephalography reported sensitivity of 67% and specificity of 91% in a population with a 100% prevalence of dementia. No studies examined potential effects of dementia severity or subtype on diagnostic accuracy. Conclusions The evidence base on tools for detection of delirium superimposed on dementia is limited, although some existing tools show promise. Further studies of existing or refined tools with larger samples and more-detailed characterization of dementia are required to address the identification of delirium superimposed on dementia.
AB - Objectives To identify valid tools to diagnose delirium superimposed on dementia. Design Systematic review of studies of delirium tools that explicitly included individuals with dementia. Setting Hospital. Participants Studies were included if delirium assessment tools were validated against standard criteria, and the presence of dementia was assessed according to standard criteria that used validated instruments. Measurements PubMed, Embase, and Web of Science databases were searched for articles in English published between January 1960 and January 2012. Results Nine studies fulfilled the selection criteria. Of 1,569 participants, 401 had dementia, and 50 had delirium superimposed on dementia. Six delirium tools were evaluated. One study using the Confusion Assessment Method (CAM) with 85% of participants with dementia had high specificity (96-100%) and moderate sensitivity (77%). Two intensive care unit studies that used the CAM for the Intensive Care Unit (CAM-ICU) reported 100% sensitivity and specificity for delirium in 23 individuals with dementia. One study using electroencephalography reported sensitivity of 67% and specificity of 91% in a population with a 100% prevalence of dementia. No studies examined potential effects of dementia severity or subtype on diagnostic accuracy. Conclusions The evidence base on tools for detection of delirium superimposed on dementia is limited, although some existing tools show promise. Further studies of existing or refined tools with larger samples and more-detailed characterization of dementia are required to address the identification of delirium superimposed on dementia.
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U2 - 10.1111/j.1532-5415.2012.04199.x
DO - 10.1111/j.1532-5415.2012.04199.x
M3 - Review article
C2 - 23039270
AN - SCOPUS:84869147311
SN - 0002-8614
VL - 60
SP - 2005
EP - 2013
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 11
ER -