Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia

Erika Steensma, Wenxiao Zhou, Long Ngo, Jacqueline Gallagher, Sharon Inouye, Douglas Leslie, Marie Boltz, Ann Kolanowski, Lorraine Mion, Edward R. Marcantonio, Donna Fick

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objective: Delirium superimposed on dementia (DSD) is common, morbid, and costly, yet frequently undiagnosed. Our study aimed to develop a brief screening test to improve health care worker recognition of DSD. Design/Setting/Participants: Older hospitalized adults with dementia were prospectively enrolled from medical and surgical inpatient units of 3 hospitals (2 in Pennsylvania, 1 in Tennessee). Measures: The reference standard delirium assessment used Confusion Assessment Method (CAM) criteria and was based on a structured interview including the Mini-Mental State Examination, interviewer observations, and medical record review. To develop the screening test, 1-, 2-, and 3-item combinations from the reference standard assessment were analyzed to determine their sensitivity and specificity in diagnosing delirium presence in a dementia population compared to the reference standard. For multiple-item screeners, error on 1 or more items was considered a positive screen. Results: Overall, 391 older adults with dementia were enrolled (mean age: 83.9 years, 71.1% female), and 95 (24.4%) developed DSD during their hospitalization, based on the reference standard. The best single-item screen for DSD was “What day of the week is it?” with 84% sensitivity [95% confidence interval (CI): 0.75, 0.91] and 41% specificity (CI: 0.35, 0.47). The best 2-item screen was “list the days of the week backwards” and “What day of the week is it?” with 93% sensitivity (CI: 0.85, 0.97) and 30% specificity (CI: 0.25, 0.36). The best 3-item screen was “list the days of the week backwards,” “What type of place is this? [hospital]” and “Does the patient appear sleepy?” with 94% sensitivity (CI: 0.87, 0.98) and 42% specificity (CI: 0.36, 0.48). Conclusions/Implications: We identified a 3-item DSD screener with excellent sensitivity but limited specificity. This screener can be used to quickly rule out DSD in populations with a high prevalence of dementia and is a promising step toward developing efficient tools for DSD recognition among care providers.

Original languageEnglish (US)
Pages (from-to)1391-1396.e1
JournalJournal of the American Medical Directors Association
Issue number11
StatePublished - Nov 2019

All Science Journal Classification (ASJC) codes

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology


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