Search Results (7)

Background: Delirium and dementia are highly interrelated. Delirium superimposed on dementia can alter the course of an underlying cognitive impairment, with dramatic worsening of the trajectory of cognitive decline, resulting in more rapid progression of functional losses. This review seeks to identify challenges in the recognition and management of delirium superimposed on dementia and highlight strategies to improve patient care. It also aims to examine its pathophysiology, risk factors, diagnosis and clinical outcomes. Methods: This narrative review discusses the current knowledge on close interaction between delirium and dementia. We searched the following databases: PubMed, Google Scholar, Web of Science, and AgeLine. A comprehensive literature search was conducted for studies published between 1970 and 2026. Results: Dementia is a known risk factor for delirium. The literature suggests that cerebral vulnerability in patients with dementia may predispose them to the development of delirium. This review gives a general overview of delirium superimposed on dementia. It starts with a general discussion of the nature of the interrelationship between delirium and dementia. This is followed by research studies in this field, including pathophysiological relations between delirium and dementia, and the effects of delirium on dementia progression. Finally, we show different methods to manage delirium in patients with dementia. The review identifies the following key findings: (1) the coexistence of dementia and delirium presents significant diagnostic challenge because of overlapping symptoms; (2) delirium superimposed on dementia is associated with poorer clinical outcomes than either condition alone, including accelerated cognitive and functional decline; (3) prevention remains the most effective management strategy; and (4) multicomponent non-pharmacological interventions, carried out by a multidisciplinary team, have demonstrated benefits in reducing delirium incidence. Conclusions: Delirium superimposed on dementia is frequently under-recognized. Early diagnosis and management of delirium superimposed on dementia can be challenging. More effort is needed to better standardize and optimize symptom assessment. Multicomponent preventive measures should be applied to decrease the risk of this condition. The aim of the treatment is to identify and treat the underlying cause. It is essential to improve caregivers’ knowledge about this syndrome to improve healthcare quality. Full article

Delirium, an acute neuropsychiatric disorder characterized by a disturbance of attention and awareness, is often superimposed on dementia with its progressive cognitive decline. Despite the high frequency and clinical relevance of this condition, often called delirium-superimposed dementia (DSD), little is known about possible triggers. In this study using the GePsy-B databank, we investigated the impact of the underlying brain disorder and multimorbidity (MM) on DSD. MM was measured by CIRS and the number of ICD-10 diagnoses. Dementia was diagnosed by CDR, and delirium by DSM IV TR criteria. A total of 218 patients were diagnosed with DSD and these were compared to 105 patients with only dementia, 46 with only delirium, and 197 patients suffering from other psychiatric diseases, mainly depression. No significant differences between groups were found concerning CIRS scores. Based on CT scans, DSD cases were grouped into those with cerebral atrophy only (probably pure neurodegenerative), with brain infarction, or with white matter hyperintensities (WMH), but no between-group differences regarding the MM indices could be found. Regression analysis only revealed age and dementia stage as influencing factors. Conclusion: Our results suggest that neither MM nor morphologic changes in the brain are predisposing factors for DSD. Full article

This article considers current contemporaneous practical issues of delirium care in nursing homes with reference to a hypothetical case study B.M. I introduce the diagnosis and management of delirium-superimposed-on-dementia (DSD), being relatively common in patients in advanced phases of illness of many nursing home residents. General principles are discussed, although this article applies mainly to higher income countries. There is inevitably much palliative and end-of-life care in nursing homes, necessitating rigorous advance care planning. Nursing home residents are especially prone to acquiring infections. Urinary tract infections (UTIs) are traditionally the most commonly treated infection among nursing home residents and, indeed, the accurate diagnosis of a UTI poses significant and distinctive challenges in the nursing home setting. There is no denying, however, that recently the global coronavirus (SARS-CoV-2) pandemic has posed an existential threat to both staff and residents of nursing homes. Resident-focused factors are striking. Psychotropic drugs are the most frequently prescribed medications in European nursing homes, but medication errors in nursing homes in general are relatively prevalent. Contributing factors to a high burden from pain for residents include residents belief set that age-related pain is inevitable, as well as under-recognition of pain and inappropriate pain assessment by clinicians. Dehydration is associated with frailty, poor cognition, falls, delirium, disability, and mortality. Issues relating to the environment also matter. It is also impossible to ignore the organisational constraints on the provision of high quality care. Faced with widespread staffing shortages, and many economies in financial distress, one partial solution is to retain current staff longer in nursing homes. Research on nursing home staffing has expanded beyond just staffing levels to include multiple other staffing issues of concern. Full article

Background: Delirium and dementia are two of the most common geriatric syndromes, which requires innovative rehabilitation approaches. Aim: We aimed at determining which occupational therapy and physiotherapy interventions are applied with older people with delirium and dementia in different care settings. We also identified the assessment tools that were used. Materials and methods: We conducted a literature search for scientific articles published from 2012 to 2022 (PubMed, MEDLINE, AMED and CINAHL) with adults aged >65 years including experimental study designs with randomized or non-randomized intervention, exploratory studies, pilot studies, quasi-experimental studies, case series and/or clinical cases. Studies that did not use interventions that could be classified as occupational therapy or physiotherapy were excluded. Results: After applying the exclusion criteria, 9 articles were selected. The most widely used assessment to define dementia was the MMSE (N = 5; 55.5%), whereas the CAM (N = 2; 22.2%), CAM-ICU (N = 2; 22.2%) and RASS (N = 3; 33.3%) were the most widely used to define delirium. The rehabilitation interventions that were most frequently performed were early mobilization, inclusion of the caregiver during treatment, modification of the environment to encourage orientation and autonomy, the interprofessional systemic approach and engaging persons in meaningful activities. Conclusions: Despite the growing evidence on its effectiveness, the role of physiotherapy and occupational therapy interventions in the prevention and treatment of people with dementia and delirium is still emerging. More research is needed to investigate if effective occupational therapy programs known to reduce the behavioral and psychological symptoms in people with dementia are also useful for treating delirium and specifically delirium superimposed on dementia. Regarding physiotherapy, it is crucial to know about the amount and timing of intervention required. Further studies are needed including older adults with delirium superimposed on dementia to define the role of the interprofessional geriatric rehabilitation team. Full article

Delirium in persons with dementia (DSD) is a common occurrence. Over the past three decades, several tools have been developed and validated to diagnose delirium, yet there is still a shortage of tools recommended in persons with dementia and there is a lack of sufficient research on the accuracy of performance of such tools in this growing population. The purpose of this article is to (1) conduct a clinical review of the detection of DSD across settings of care by formal health care professionals and informal family members and care partners; (2) identify barriers and facilitators to detection and highlight delirium tools that have been tested in person with dementia; and (3) make recommendations for future research, practice, and policy. Given this review, an “ideal” tool for DSD would point to tools being brief, easy to integrate into the EMR, and accurate with at least 90% accuracy given the poor outcomes associated with delirium and DSD. Knowing the baseline and communication between family members and healthcare professionals should be a top priority for education, research, and health systems policy. More work is needed in better understanding DSD and optimizing and standardizing feature assessment, especially the acute change feature at the bedside for DSD. Full article

People with dementia are more likely to develop delirium. We conducted a brief literature search and give a pragmatic overview of the key issues. Making rational and safe prescribing decisions is highly influenced by organisational culture and embedded staff practices. Comprehensive assessment for unmet physical, psychological, and social needs is an important intervention in itself. Taking a broad overview of possible pharmacological interventions should include stopping inappropriate medications and prescribing for key drivers of the underlying causes of delirium. Prescribing psychotropic medications may be indicated where there is significant distress or risk to the person with dementia and risk to those around them. It is vital to consider the dementia subtype and, where possible, involve family and friend carers in the decision-making process. Medications should be prescribed at the lowest possible dose for the least amount of time after carefully weighing risks versus benefits and documenting these. While these cases are challenging for staff and families, it can be rewarding to improve the quality of life and lessen distress for the person with dementia. There are also opportunities for informing family and friend carers, educating the wider multidisciplinary team, and promoting organisational change. Full article

Delirium is a life-threatening condition, the causes of which are still not fully understood. It may develop in patients with pre-existing dementia. Delirium superimposed on dementia (DSD) can go completely unnoticed with routine examination. It may happen in the perioperative period and in the critical care setting, especially in the ageing population. Difficulties in diagnosing and lack of specific pharmacological and non-pharmacological treatment make DSD a seriously growing problem. Patient-oriented, multidirectional preventive measures should be applied to reduce the risk of DSD. For this reason, anesthesiologists and intensive care specialists should be aware of this interesting condition in their everyday clinical practice. Full article