The project is funded by a Joint Age UK-Research into Ageing Fund and BGS Clinical Fellowship
Our research project
Why study this problem/subject?
Dementia is a progressive disease of the brain affecting over 800,000 people in the UK today. This number will rise steadily in future years. It is devastating both to the sufferer and their family as it involves memory loss, confusion, problems with speech and understanding and functional decline. At present it is diagnosed by tests of memory and thinking as well as charting functional decline. Dementia is in fact present in at least 40% of older people in hospital yet less than half of these patients to date have a diagnosis either before or during their time in hospital. This is highly detrimental both to their immediate care in hospital and any after care programme.
Delirium is a serious and distressing condition in which a person suffers a severe and acute decline in memory, thinking and other mental functioning. It is often caused by infections, acute illnesses or side-effects of prescription drugs. People with dementia are highly prone to delirium. Indeed, two-thirds of hospital patients with delirium also have dementia.
Appropriate testing therefore needs to be constructed if these patients are to receive the best care for their condition. In our investigation we will for the first time use valid methods to measure the presence of delirium as a marker to prompt further investigation of dementia. Results of our study should therefore secure improved care for all dementia sufferers.
Current understanding of the problem/subject
However, there is little research on how best to detect dementia in patients with delirium:
Tests of memory and thinking are not possible in this context.
History from a known individual is more useful but very time consuming. Moreover they are usually conducted by psychiatrists due to the level of skill involved and few are available for this work.
Use of short, standardised questionnaires instead is highly promising, but studies evaluating their use in this group of patients are lacking.
Purpose of this project
This project will evaluate and validate existing simple informant questionnaire-based methods of detecting dementia in older hospital patients with delirium. We are focusing on patients with delirium, because screening tools for patients with dementia but with no delirium are already available.
What the project will investigate
The main questions are:
Are simple informant-based rating scales valid for detection of dementia in patients with delirium?
Is it feasible to select patients with possible dementia as detected by our protocol for follow-up in outpatient clinics?
We will also use the opportunity afforded by the study to analyse which blood tests predict worse outcomes for patients with delirium superimposed on dementia. This offers considerable added value (at very little extra financial cost) because studies like this are rare.
What will the research achieve?
Validation of simple and rapid methods of detection of dementia in older hospital patients with delirium would have the potential to have a large clinical impact. It would open up a new major route to improve dementia diagnosis rates in general. Equally importantly, people with dementia would have better care while they were in hospital.