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Detecting delirium superimposed on dementia: evaluation of the diagnostic performance of the Richmond agitation and sedation scale

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dc.contributor.author Morandi, Alessandro
dc.contributor.author Han, Jin H.
dc.contributor.author Meagher, David
dc.contributor.author Vasilevskis, Eduard
dc.contributor.author Cerejeira, Joaquim
dc.contributor.author Hasemann, Wolfgang
dc.contributor.author MacLullich, Alasdair M.
dc.contributor.author Annoni, Giorgio
dc.contributor.author Trabucchi, Marco T.
dc.contributor.author Bellelli, Giuseppe
dc.date.accessioned 2018-11-12T12:30:03Z
dc.date.available 2018-11-12T12:30:03Z
dc.date.issued 2016
dc.identifier.uri http://hdl.handle.net/10344/7298
dc.description peer-reviewed en_US
dc.description.abstract Objectives—Delirium disproportionately affects patients with dementia and is associated with adverse outcomes. The diagnosis of delirium superimposed on dementia (DSD), however, can be challenging due to several factors including the absence of caregivers or the severity of pre-existing cognitive impairment. Altered level of consciousness has been advocated as a possible useful indicator of delirium in this population. Here we evaluated the performance of the Richmond Agitation and Sedation Scale (RASS) and the modified-RASS (m-RASS) – an ultra-brief measure of the level of consciousness – in the diagnosis of DSD. Design—Multicenter prospective observational study. RASS and m-RASS results were analysed together, labelled RASS/m-RASS). Setting—Acute geriatric wards, inhospital rehabilitation, emergency department. Participants—Patients 65 years and older with dementia. Measurements—Delirium was diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) or with the DRS-R-98 or with the 4AT. Dementia was detected with the Clinical Dementia Rating (CDR) Scale, the Short Form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) or via the clinical records. Results—Of the 645 patients included, 376 (58%) had delirium. According to the instrument used to evaluate delirium the prevalence was 66% with the 4AT, 23% with the DSM and 100% with the DRS-R-98. Overall a RASS/m-RASS score other than 0 was 70.5% sensitive (95% CI: 65.9% – 75.1%) and 84.8% (CI: 80.5% – 89.1%) specific for DSD. Using a RASS/m-RASS value >+1 or <−1 as a cut-off, the sensitivity was 30.6% (CI: 25.9% – 35.2%) and the specificity was 95.5% (CI: 93.1% – 98.0%). The sensitivity and the specificity did not greatly vary according to the method of delirium diagnosis and the dementia ascertainment, though the specificity was slightly higher when the DSM and the IQCODE were used. Conclusion—In older patients admitted to different clinical settings the RASS and m-RASS analyzed as a single group had moderate sensitivity and very high specificity for the detection of DSD. Level of consciousness is therefore a valuable clinical indicator that should form part of delirium screening strategies, though for higher sensitivity other methods of assessment should be used. en_US
dc.language.iso eng en_US
dc.publisher Elsevier en_US
dc.relation.ispartofseries Journal of the American Directors Association;17 (9), pp. 828-833
dc.relation.uri https://doi.org/10.1016/j.jamda.2016.05.010
dc.subject delirium en_US
dc.subject dementia en_US
dc.subject diagnosis en_US
dc.subject RASS en_US
dc.subject m-RASS en_US
dc.title Detecting delirium superimposed on dementia: evaluation of the diagnostic performance of the Richmond agitation and sedation scale en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.1016/j.jamda.2016.05.010
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US


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