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A comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium-dementia and cognitively intact controls
  1. David J Meagher1,2,
  2. Maeve Leonard1,
  3. Sinead Donnelly3,
  4. Marion Conroy3,
  5. Jean Saunders4,
  6. Paula T Trzepacz5
  1. 1Department of Adult Psychiatry, Midwestern Regional Hospital, and University of Limerick Medical School, Limerick, Ireland
  2. 2Health Systems Research Centre, University of Limerick, Limerick, Ireland
  3. 3Milford Hospice Palliative Care Centre, Limerick, Ireland
  4. 4Statistical Consulting Unit, University of Limerick, Limerick, Ireland
  5. 5Lilly Research Laboratories, Indianapolis, Indiana, USA
  1. Correspondence to Professor David Meagher, University of Limerick Medical School, Limerick, Ireland; david.meagher{at}ul.ie

Abstract

Purpose Delirium and dementia have overlapping features that complicate differential diagnosis. Delirium symptoms overshadow dementia symptoms when they co-occur, but delirium phenomenology in comorbid cases has not been compared to both conditions alone.

Methods Consecutive adults with DSM-IV delirium, dementia, comorbid delirium-dementia and cognitively intact controls were assessed using the Revised Delirium Rating Scale (DRS-R98) and Cognitive Test for Delirium (CTD).

Results Delirium and comorbid delirium-dementia groups had comparable DRS-R98 and CTD total scores, which were greater than in dementia or control groups. On the DRS-R98, multiple non-cognitive symptoms, inattention and disorientation were more severe in delirium groups compared with dementia-alone. Patients with dementia differed from both delirium groups on the CTD test of attention. Spatial span backwards was significantly lower in all patients with cognitive impairment (delirium, comorbid delirium-dementia, dementia alone) compared to controls, whereas spatial span forwards distinguished delirium groups from dementia.

Conclusions Delirium phenomenology is similar with or without comorbid dementia. A wide range of neuropsychiatric symptoms distinguish delirium from dementia. Spatial span forward is disproportionately diminished in delirium suggesting usefulness as a differentiating screening test.

  • Delirium
  • dementia
  • phenomenology
  • assessment
  • diagnosis
  • cognition

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Footnotes

  • Funding This study was supported through departmental funds at Limerick Mental Health Services.

  • Competing interests Unrelated to this research, DJ Meagher has received research grant funding from Astra-Zeneca and has acted as an advisory consultant for Pfizer, Eli-Lilly, Bristol-Meyers and Janssen Pharmaceuticals, as well as receiving travel support from Smith-Kline Beecham, Eli-Lilly, Astra-Zeneca, Novartis, Wyeth and Bristol-Meyers Pharmaceuticals Ltd. T Trzepacz is a full-time salaried employee of Eli Lilly and Company and shareholder of Lilly. Lilly does not have a product with an indication for delirium. P Trzepacz owns the copyright for the Delirium Rating Scale-Revised-98 but does not charge a fee for its use except in for-profit situations.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Midwestern Regional Hospital Ethics Committee, Dooradoyle, Limerick, Ireland.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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