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Treatment characteristics of delirium superimposed on dementia

Published online by Cambridge University Press:  28 June 2011

Soenke Boettger ,
Steven Passik  and
William Breitbart
Soenke Boettger*
Affiliation:
Department of Consultation – Liaison and Medical Psychiatry, Bellevue Hospital Center, New York University Langone Medical Center, New York, USA
Steven Passik
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
William Breitbart
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
*
Correspondence should be addressed to: Soenke Boettger, MD, Bellevue Hospital Center, New York University Langone Medical Center, Department of Consultation – Liaison and Medical Psychiatry, 462 First Avenue, New York, NY 10016, USA. Phone: +1 212 562 3536; Fax: +1 212 562 8985. Email: soenkeboettger@yahoo.com.
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Abstract

Background: The course of delirium in patients with dementia who are undergoing management of delirium with antipsychotics has not previously been studied. In order to investigate the treatment characteristics of patients with delirium superimposed on dementia in contrast to delirium in the absence of dementia we performed a secondary analysis of our delirium database.

Methods: We collected sociodemographic data and medical variables in addition to using the systematic rating scales of the Memorial Delirium Assessment Scale (MDAS) and Karnofsky Scale of Performance Status (KPS). These data were recorded in the delirium database. For this analysis we extracted all data pertaining to patients with delirium and dementia (DD) and compared them to those with delirium without dementia (i.e. non-demented with delirium; NDD).

Results: Out of 111 cases with a diagnosis of delirium we acquired 22 cases with a diagnosis of DD and 89 cases with NDD. The mean age was significantly different with 77.1 years for DD and 62.7 years for NDD. The MDAS scores at baseline were significantly higher in DD (21.1) compared to NDD (17.6). Over the course of treatment, MDAS scores were significantly higher in DD with 11.7 at T3 compared with 7.0 in NDD. After three days of management, delirium resolution rates were significantly lower in DD with 18.2% compared to 53.9% in NDD, and at seven days delirium resolution rates were 50% and 83% respectively. At the endpoint of the observation period, DD had a significantly more pronounced disturbance of consciousness and impairment in the cognitive domain. KPS scores were not significantly different between DD and NDD.

Conclusion: In our sample of patients with delirium superimposed on dementia the delirium resolution rates were lower than in patients without dementia at one week of treatment. The data suggest that when delirium is superimposed on dementia the delirium may resolve at a slower rate.

Keywords

deliriumdementiadelirium superimposed on dementiacognitive disordertreatment characteristics
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 10 , December 2011 , pp. 1671 - 1676
Copyright
Copyright © International Psychogeriatric Association 2011

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