The course of delirium in older medical inpatients -: A prospective study
The course of delirium in older medical inpatients -: A prospective study
复制标题
DOI：
10.1046/j.1525-1497.2003.20602.x
复制
发表时间：
2003-09-01
影响因子：
5.7
通讯作者：
Belzile, É
中科院分区：
文献类型：
--
作者：
McCusker, J;Cole, M;Belzile, É
目的：描述诊断后12个月内谵妄的临床病程和预后，住院临床病程和出院后预后之间的关系，以及痴呆在谵妄临床病程和预后中的作用。设计：前瞻性队列研究。队列的193名年龄在65岁及以上的内科住院患者在入院时或在住院的第一周内诊断为谵妄，他们从医院活着出院。研究结果包括认知障碍和日常生活活动（标准化，面对面的临床仪器在1个月，2个月，6个月和12个月的随访），和死亡率。在诊断时测量痴呆、疾病严重程度、合并症和社会人口学变量。构建了谵妄住院过程的几种测量方法。在诊断和12个月随访时，痴呆患者亚组的平均谵妄症状数分别为4.5和3.5，而非痴呆患者亚组的平均谵妄症状数分别为3.4和2.2。注意力不集中、定向障碍和记忆力受损是两个亚组中最持久的症状。在多变量分析中，发病前和入院时的功能水平，疗养院居住，以及最初住院期间恢复较慢与认知和功能结局较差相关，但与死亡率无关。
OBJECTIVES: To describe the clinical course and outcomes of delirium up to 12 months after diagnosis, the relationship between the in-hospital clinical course and post-discharge outcomes, and the role of dementia in both the clinical course and outcomes of delirium.DESIGN: Prospective cohort study.SETTING: Medical wards of a 400-bed, university-affiliated, primary acute care hospital in Montreal.PATIENTS: Cohort of 193 medical inpatients aged 65 and over with delirium diagnosed at admission or during the first week in hospital, who were discharged alive from hospital.MEASUREMENTS AND MAIN RESULTS: Study outcomes included cognitive impairment and activities of daily living (standardized, face-to-face clinical instruments at 1-, 2-, 6-, and 12-month follow-up), and mortality. Dementia, severity of illness, comorbidity, and sociodemographic variables were measured at time of diagnosis. Several measures of the in-hospital course of delirium were constructed. The mean numbers of symptoms of delirium at diagnosis and 12-month follow-up, respectively, were 4.5 and 3.5 in the subgroup of patients with dementia and 3.4 and 2.2 among those without dementia. Inattention, disorientation, and impaired memory were the most persistent symptoms in both subgroups. In multivariate analyses, pre-morbid and admission level of function, nursing home residence, and slower recovery during the initial hospitalization were associated with worse cognitive and functional outcomes but not mortality.