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Using DSM-III criteria to diagnose delirium in elderly general medical patients

Article Abstract:

Delirium is defined by criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III) and its revised version (DSM-IIIR). These criteria include: acute onset with a fluctuating or changing course; memory deficits; disorientation; clouding of consciousness indicated by inability to shift, focus, or maintain attention; and abnormalities in psychomotor activities, perceptual abilities, speech, and sleep-wake cycle. Several studies have attempted to determine the prevalence, defined as disease frequency before admission, and incidence, which is number of cases developing in the hospital, of delirium, but these studies had various shortcomings. Older studies did not use a definition of delirium that was comparable to that of DSM-III and DSM-IIIR. When the DSM-II was used, the factors comprising the diagnosis of delirium were not described in operational terms. Finally, studies that use data from medical records to diagnose delirium are necessarily affected by the bias of the persons who recorded the information. An approach was developed to make the DSM-III criteria for delirium operational, and the prevalence and incidence of delirium were determined in 235 subjects aged 70 years and older. The patients were all admitted to general medicine and were identified by screening as having psychiatric disorders. They were seen by a psychiatrist, and the DSM-III criteria for delirium were applied to determine the prevalence and incidence of this delirium. The results show that delirium is prevalent among the elderly at admission, but the incidence of delirium developing in the hospital is lower than has been reported previously. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects

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Sensitivity and specificity for dementia of population-based criteria for cognitive impairment: the MoVIES project

Article Abstract:

Poorly educated elderly populations may be misdiagnosed as suffering from dementia if the cognitive screening tests used do not allow for the effects of education on expression and cognitive capacity. When elderly residents of a rural Pennsylvania community were tested, a brief cognitive battery was found to be a more sensitive screening tool than the Mini-Mental State Exam (MMSE), global screening scale. The MMSE was more specific for individuals with higher cognitive performance levels. The results suggest that population-sensitive cutpoints should be used rather than a conventional cutoff point on the MMSE.

Social aspects, Dementia, Psychological tests

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The occurrence and duration of symptoms in elderly patients with delirium

Article Abstract:

Among a group of 168 patients admitted to the geriatric assessment unit of a teaching hospital, the prevalence of delirium was 18%, incidence was 7%. Clinical diagnosis matched predictions of DSM-III-R (Diagnostic and statistical manual, 3rd edition revised) precisely. To compare the sensitivity of DSM-III-R with that of its predecessor, duration of DSM-III and DSM-III-R symptoms were assessed. The mean duration of delirium was close to that predicted by DSM-III.

Aged patients, Elderly patients

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