title: Core symptoms not meeting criteria for delirium are associated with cognitive and functional impairment and mood and behavior problems in older long-term care residents.
abstract: BACKGROUND
  The immediate clinical significance of Confusion Assessment Method (CAM)-defined core symptoms of delirium not meeting criteria for delirium is unclear. This study proposed to determine if such symptoms are associated with cognitive and functional impairment, mood and behavior problems and increased Burden of Care (BOC) in older long-term care (LTC) residents.
  
  
  METHODS
  The study was a secondary analysis of data collected for a prospective cohort study of delirium. Two hundred and fifty-eight LTC residents aged 65 years and older in seven LTC facilities had monthly assessments (for up to six months) of CAM - defined core symptoms of delirium (fluctuation, inattention, disorganized thinking, and altered level of consciousness) and five outcome measures: Mini-Mental State Exam, Barthel Index, Cornell Scale for Depression, Nursing Home Behavioral Problems Scale, and Burden of Care. Associations between core symptoms and the five outcome measures were analyzed using generalized estimating equations.
  
  
  RESULTS
  Core symptoms of delirium not meeting criteria for delirium among residents with and without dementia were associated with cognitive and functional impairment and mood and behavior problems but not increased BOC. The associations appear to be intermediate between those of full delirium and no core symptoms and were greater for residents with than without dementia.
  
  
  CONCLUSIONS
  CAM-defined core symptoms of delirium not meeting criteria for delirium appear to be associated with cognitive and functional impairment and mood and behavior problems in LTC residents with or without dementia. These findings may have implications for the prevention and management of such impairments and problems in LTC settings.
authors.affiliation: Department of Psychiatry,St. Mary's Hospital Center & McGill University,Montreal,Quebec,Canada.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Cole
authors.affiliation: St. Mary's Research Centre,St Mary's Hospital Center,Montreal,Quebec,Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: McCusker
authors.affiliation: Faculty of Nursing Sciences,Laval University,Quebec,Quebec,Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Voyer
authors.affiliation: Division of Geriatric Medicine,Sir Mortimer B Davis Jewish General Hospital,Montreal,Quebec,Canada.
authors.forename: Johanne
authors.initials: J
authors.lastname: Monette
authors.affiliation: Institut Universitaire de Gériatrie de Montréal; Département de médecine familiale,Université de Montréal,Montreal,Quebec,Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Champoux
authors.affiliation: St. Mary's Research Centre,St Mary's Hospital Center,Montreal,Quebec,Canada.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciampi
authors.affiliation: St. Mary's Research Centre,St Mary's Hospital Center,Montreal,Quebec,Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Belzile
authors.affiliation: Division of Geriatric Medicine,Centre Hospitalier de l'Université de Montréal,Montreal,Quebec,Canada.
authors.forename: Minh
authors.initials: M
authors.lastname: Vu
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology*; D003693:Delirium / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis* / Q000523:psychology; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales