Delirium in Persons With Dementia

Study Overview
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Brief Summary
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The aims of this study were to identify risk factors associated with delirium in hospitalized persons with dementia, and to describe immediate and post-hospital (1&3 months) trajectory of cognitive decline and associated outcomes in persons with dementia who develop delirium. It was hypothesized that factors such as CNS-active medications, urinary tract infection, stage of dementia, pain, activity level, and dehydration would be associated with an increased risk of delirium and delirium severity in patients with dementia compared to dementia patients without delirium. It was also hypothesized that persons with DSD will have worse outcomes (longer hospital length of stays, decreased functional status, a steeper negative slope of cognitive decline) than dementia patients without delirium. Lastly, it was hypothesized that higher delirium severity would be associated with poorer outcomes in persons with dementia. The long-term objectives were to use the results from this study to design and test an intervention strategy to improve early recognition, management, prevention, and outcomes in persons with DSD.

Detailed Description
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It is well known that persons with dementia are at increased risk of developing delirium or acute confusional state. Further, current evidence suggests that delirium may worsen the prognosis of dementia, may alter the clinical course and trajectory of cognitive decline, and may be associated with substantially worse long-term outcomes. This study was a prospective cohort study design involving 165 hospitalized subjects with dementia who were 65 and older and included a three month follow up period. Aims for the study included: 1) to identify risk factors for DSD, and 2) to describe post-hospital outcomes and the trajectory of cognitive decline for DSD, which will justify the development of appropriate preventative and management strategies for delirium in patients with dementia. Delirium was assessed daily from admission to discharge and then at one and three month follow-ups. The potential risk factors being examined were 1) polypharmacy (central nervous system-active medications, number of medications, new medications added), 2) physical stressors (urinary tract infection, pain, dehydration), and 3) environmental stressors (bedrest, restraints, room changes). Outcomes were assessed by research study staff blinded to the study aims.

Official Title
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Delirium in Persons With Dementia

Conditions
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Delirium Superimposed on Dementia

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Persons with dementia were included if they: a) were on one of the selected medical-surgical units and age 65 years or older; b) spoke English; c) were hospitalized less than 24 hours; and d) met the criteria for dementia. This study included minorities and women. Exclusion Criteria: Persons with dementia were excluded if they: a) had any significant neurological or neurosurgical disease associated with cognitive impairment other than dementia (due to confounding with dementia or DSD), such as parkinson's disease, Huntington's disease, normal pressure hydrocephalus, seizure disorder, subdural hematoma, head trauma or any other known structural brain abnormalities; b) were nonverbal and unable to communicate due to sever dementia (MMSE=0), aphasia, intubation, or terminal illness (since interviews were required for the study); or c) had no family or caregivers to interview (since proxy interviews were required for the study). This study did not exclude persons with pre-existing delirium. In addition, subjects were not excluded on the basis of race or gender.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Persons with Dementia<br>Persons with Dementia are identified by the Modified Blessed Dementia Rating Scale and the IQCODE | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Delirium status during hospital stay | Confusion Assessment Method (CAM)and Delirium Rating Scale (DRS) were used to measure delirium. | Participants will be assessed daily until discharge (duration of hospitalization), which is expected to be about 5 days | 
| Change in Delirium status at 1 month after discharge | Confusion Assessment Method (CAM)and Delirium Rating Scale (DRS) were used to measure delirium. | Participants will be assessed 1 month after date of hospital discharge | 
| Change in Delirium status at 3 months after discharge | Confusion Assessment Method (CAM)and Delirium Rating Scale (DRS) were used to measure delirium. | Participants will be assessed 3 months after date of hospital discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospitalization Length of Stay |  | Duration of hospitalization, expected to be about 5 days | 
| Change in Functional Status during hospital stay | Measured using the KATZ ADL Scale and Lawton Index of Daily Living | Daily until discharge, expected to be about 5 days | 
| Change in Functional Status at 1 month after discharge | Measured using the KATZ ADL Scale and Lawton Index of Daily Living | Participant will be assessed 1 month after date of hospital discharge | 
| Change in Functional Status at 3 months after discharge | Measured using the KATZ ADL Scale and Lawton Index of Daily Living | Participant will be assessed 3 months after date of hospital discharge | 
| Change in Cognitive Decline during hospital stay | MMSE and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) used to measure cognition | Daily until discharge, expected to be about 5 days | 
| Change in Cognitive Decline at 1 month after discharge | MMSE and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) used to measure cognition | Participant will be assessed 1 month after date of hospital discharge | 
| Change in Cognitive Decline at 3 months after discharge | MMSE and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) used to measure cognition | Participant will be assessed 3 months after date of hospital discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Delirium, Dementia, Confusion Assessment Method, Elderly