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Delirium among patients with and without dementia: does the diagnosis according to the DSM‐IV differ from the previous classifications?
Author(s) -
Laurila Jouko V.,
Pitkala Kaisu H.,
Strandberg Timo E.,
Tilvis Reijo S.
Publication year - 2004
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.1079
Subject(s) - delirium , dementia , psychology , operationalization , psychiatry , medical diagnosis , rating scale , clinical psychology , logistic regression , medicine , developmental psychology , pathology , disease , epistemology , philosophy
Abstract Background Different diagnostic criteria differ in their capacity to identify subjects as delirious. It is not known how DSM‐IV classification, compared with the DSM‐III, DSM‐III‐R, and ICD‐10, identifies delirium among individuals with and without dementia and whether the symptom profiles differ between these two subgroups. Methods A cross‐sectional study was performed on patients (age ≥ 70 years) in seven acute geriatric wards ( n = 230) and in seven nursing‐homes ( n = 195) in Helsinki, Finland. Delirium was diagnosed according to the operationalized criteria according to the DSM‐III, DSM‐III‐R, DSM‐IV, and clinical criteria of ICD‐10. Dementia was defined according to consensus judgment among three geriatricians with concise information including: prior dementia diagnoses, Clinical Dementia Rating Scale, operationalized criteria according to the DSM‐IV, nurses and/or caregivers interviews, and the results of the brain CT/MRI and prior Mini‐Mental State Examination scores, when available. Results According to the DSM‐III, DSM‐IIIR, DSM‐IV and ICD‐10 criteria of delirium 22.7, 23.5, 25.9 and 14.9% of the demented, and 12.9, 13.5, 23.5 and 2.9% of the non‐demented, respectively, were diagnosed as delirious. In stepwise logistic regression analysis clouding of consciousness, perceptual disturbances, and disorganized thinking were the most significant contributors to delirium diagnosis according to the DSM‐IV among individuals with dementia, whereas perceptual disturbances, motor disturbances, and disorientation were the most significant contributors among those without dementia. Conclusions DSM‐IV criteria of delirium identify new, often non‐demented, subjects as being delirious, while ICD‐10 is overly restrictive. The symptom profile of delirium was slightly different among individuals with and without dementia. Copyright © 2004 John Wiley & Sons, Ltd.