The project is funded by a Joint Age UK-Research into Ageing Fund and BGS Clinical Fellowship
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.
However, there is little research on how best to detect dementia in patients with delirium:
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.
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 because studies like this are rare.
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.
Maclullich AM, Anand A, Davis DH, Jackson T, Barugh AJ, Hall RJ, et al. New horizons in the pathogenesis, assessment and management of delirium. Age Ageing. 2013 Nov;42(6):667-74
Jackson TA, Naqvi SH, Sheehan B. Screening for dementia in general hospital inpatients: a systematic review and meta-analysis of available instruments. Age Ageing. 2013 November 1, 2013;42(6):689-95.
British Geriatrics Society Spring Meeting 17th-19th April 2013 Belfast: Is delirium a marker for undetected chronic cognitive impairment?
T. A. Jackson, P. Nicolson, B. Sheehan. Is delirium a marker for undetected chronic cognitive impairment? Age Ageing (2013) 42 (suppl 3): iii27-iii28 doi:10.1093/ageing/aft108
Delirium as a risk factor for dementia: Invited talk at Alzheimer Scotland Dementia Research Centre, 17/5/13
NIHR specialty group newsletter “Study of the month”.
Managing Delirium Out of Hours – A short teaching video for junior doctors, invited to produce by AEME (Academy of Elderly Medical Education).
Is the Abbreviated Mental Test Score the best we’ve got? Blog post on BGS blog discussing recently published systematic review.
Dementia is common in older inpatients but only half will have a previous diagnosis of dementia. Delirium is a common, severe, inpatient acute neuropsychiatric syndrome. Two-thirds of cases of delirium occur in patients with dementia. Delirium, therefore, provides an opportunity to identify undiagnosed dementia.
However, because delirium affects cognition, detecting dementia is problematic.
To determine if, in older hospital inpatients with delirium:
- There is dementia
- Simple informant questionnaires can identify dementia
To determine if key clinical factors, routine blood tests or putative endocrine or immune biomarkers predict poorer outcomes in patients with delirium.
230 patients aged over 70 years with delirium will be assessed through detailed carer interview for the presence pre-existing DSM-IV dementia (gold standard). This will be compared with (blinded) assessments of dementia using simple, clinically pragmatic informant questionnaires. Key clinical variables and putative prognostic endocrine and immune indicators of prognosis will be measured. Participants will undergo a home visit at 3 months to confirm presence/absence of dementia.
Validation of informant questionnaires for detection of dementia in delirium will provide a pragmatic method of detecting undiagnosed dementia in general hospitals, potentially benefiting tens of thousands of patients in the UK per year.