Sharon K. Inouye, MD, MPH, Hebrew SeniorLife / Havard Medical School, Boston, MA, discusses the challenges surrounding the diagnosis of delirium in persons with moderate-severe dementia. Delirium remains underrecognized but has serious consequences on function and quality of life. It is diagnosed using cognitive screening and careful clinical observation, based on the presence of an acute change in mental status, inattention, impaired consciousness, and cognitive disturbances. Acute onset and fluctuating course of symptoms is a key feature. Some changes associated with delirium may mimic those seen in dementia, so knowledge of the patient’s baseline is essential for differential diagnosis. The CAM (Confusion Assessment Method) is the most widely used delirium instrument and has high sensitivity and specificity. Several teams are working to develop brief screening tools to rapidly test for delirium, such as the ultra-brief CAM. The ability to rate delirium severity is also key for patient care, to give a better idea of prognosis, treatment response, and care needs. The DEL-S was developed as a novel rating tool for clinical and research use. Building on this, the DEL-S-AD is a new delirium severity instrument being developed for use specifically in individuals with mild to moderate Alzheimer’s disease. Domains in the original DEL-S were adjusted to account for the fact that these patients may already have cognitive, functional, and emotional changes at baseline. This interview took place at the Alzheimer’s Association International Conference (AAIC) 2022 in San Diego, CA.
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