title: The Diagnosis of Delirium Superimposed on Dementia: An Emerging Challenge.
abstract: Delirium occurring in patients with dementia is referred to as delirium superimposed on dementia (DSD). People who are older with dementia and who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision are considered the standard reference for the diagnosis of delirium and include criteria of impairments in cognitive processes such as attention, additional cognitive disturbances, or altered level of arousal. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision does not provide guidance regarding specific tests for assessment of the cognitive process impaired in delirium. Importantly, the assessment or inclusion of preexisting cognitive impairment is also not addressed by these standards. The challenge of DSD gets more complex as types of dementia, particularly dementia with Lewy bodies, which has features of both delirium and dementia, are considered. The objective of this article is to critically review key elements for the diagnosis of DSD, including the challenge of neuropsychological assessment in patients with dementia and the influence of particular tests used to diagnose DSD. To address the challenges of DSD diagnosis, we present a framework for guiding the focus of future research efforts to develop a reliable reference standard to diagnose DSD. A key feature of a reliable reference standard will improve the ability to clinically diagnose DSD in facility-based patients and research studies.
authors.affiliation: Department of Rehabilitation and Aged Care of the Fondazione Camplani, Ancelle Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: morandi.alessandro@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morandi
authors.affiliation: University College London, London, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Davis
authors.affiliation: Geriatric Research Group, Brescia, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, and Geriatric Unit, San Gerardo hospital, Monza, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellelli
authors.affiliation: Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Rakesh C
authors.initials: RC
authors.lastname: Arora
authors.affiliation: Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, Australia Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Gideon A
authors.initials: GA
authors.lastname: Caplan
authors.affiliation: Department of Psychiatry, University of California at San Francisco, San Francisco, CA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kamholz
authors.affiliation: College of Nursing and College of Medicine, The Pennsylvania State University, University Park, PA.
authors.forename: Ann
authors.initials: A
authors.lastname: Kolanowski
authors.affiliation: Penn State College of Nursing, The Pennsylvania State University, University Park, PA.
authors.forename: Donna Marie
authors.initials: DM
authors.lastname: Fick
authors.affiliation: Department of Psychiatry and Psychotherapy, Bethel EvangelischesKrankenhaus, Bielefeld, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kreisel
authors.affiliation: Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Alasdair
authors.initials: A
authors.lastname: MacLullich
authors.affiliation: Graduate-entry Medical School, Cognitive Impairment Research Group, Center for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Meagher
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD.
authors.forename: Karen
authors.initials: K
authors.lastname: Neufeld
authors.affiliation: Department of Anesthesiology, Division of Critical Care, Vanderbilt University School of Medicine, and the Anesthesia Service, Department of Veterans Affairs, Tennessee Valley Healthcare System.
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Pandharipande
authors.affiliation: Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Richardson
authors.affiliation: Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Arjen J C
authors.initials: AJ
authors.lastname: Slooter
authors.affiliation: Campus for Ageing and Vitality, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
authors.forename: John P
authors.initials: JP
authors.lastname: Taylor
authors.affiliation: Department of Psychiatry and Psychotherapy of the Aged, Center of Mental Health, Klinikum Stuttgart, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Zoë
authors.initials: Z
authors.lastname: Tieges
authors.affiliation: School of Medicine and Health Institute for the Development of Education and Scholarship (HEALTH IDEAS), Griffith University, Queensland, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Teodorczuk
authors.affiliation: Laval University, Quebec City, Canada Center for Excellence in Aging-Research Unit, Quebec City, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Voyer
authors.affiliation: Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI; Warren Alpert School of Medicine at Brown University, Providence, RI.
authors.forename: James L
authors.initials: JL
authors.lastname: Rudolph
mesh_terms: D015897:Comorbidity; D003693:Delirium / Q000175:diagnosis*; D003704:Dementia; D006801:Humans; D009483:Neuropsychological Tests
keywords: Alzheimer disease; Delirium; Lewy Body dementia; delirium superimposed on dementia; dementia; diagnosis