Neuropsychiatric and cognitive profile of patients with DSM-IV delirium referred to an old age psychiatry consultation-liaison service.
BACKGROUND
The phenomenology of delirium is understudied, including how the symptom profile varies across populations. The aim of this study was to explore phenomenology occurring in patients with delirium referred to an old age psychiatry consultation-liaison setting and compare with delirium occurring in palliative care patients.


METHODS
Consecutive cases of DSM-IV delirium were assessed with the Delirium Rating scale Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD).


RESULTS
Eighty patients (mean age 79.3 ± 7.7 years; mean DRS-R98 total score 21.7 ± 4.9 and total CTD score 10.2 ± 6.3) were included. Forty patients (50%) with comorbid dementia were older, had a longer duration of symptoms at referral, and more severe delirium due to greater cognitive impairments. Inattention (100%) was the most prominent cognitive disturbance, while sleep-wake cycle disturbance (98%), altered motor activity (97%), and thought process abnormality (96%) were the most frequent DRS-R98 non-cognitive features. Inattention was associated with severity of other cognitive disturbances on both the DRS-R98 and CTD, but not with DRS-R98 non-cognitive items. The phenomenological profile was similar to palliative care but with more severe delirium due to greater cognitive and non-cognitive disturbance.


CONCLUSIONS
Delirium is a complex neuropsychiatric syndrome with generalized cognitive impairment and disproportionate inattention. Sleep-wake cycle and motor-activity disturbances are also common. Comorbid dementia results in a similar phenomenological pattern but with greater cognitive impairment and later referral.
Psychiatry for Later Life Service, University College Hospital, Galway, Ireland.
Faiza
F
Jabbar
Maeve
M
Leonard
Karena
K
Meehan
Margaret
M
O'Connor
Con
C
Cronin
Paul
P
Reynolds
Anna Maria
AM
Meaney
David
D
Meagher
D000328:Adult; D000368:Aged; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000209:etiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000517:prevention & control*; D003693:Delirium / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006948:Hyperkinesis / Q000175:diagnosis / Q000209:etiology; D007361:Intelligence Tests; D008297:Male; D016743:Mental Competency; D009483:Neuropsychological Tests; D012017:Referral and Consultation; D012720:Severity of Illness Index; D020178:Sleep Disorders, Circadian Rhythm / Q000175:diagnosis / Q000209:etiology