DELIRIUM IN PERSONS WITH DEMENTIA

描述（由申请人提供）：到2050年，预计美国将有1400万老年人患有痴呆症。众所周知，患有痴呆症的人患谵妄或急性精神错乱的风险增加。此外，目前的证据表明，谵妄可能使痴呆症的预后恶化，可能改变认知能力下降的临床过程和轨迹，并可能与较差的长期预后相关。然而，谵妄叠加痴呆（DSD）的问题仍然是一个被忽视的临床研究领域。该研究是一项前瞻性队列研究设计，涉及165名65岁及以上的住院痴呆患者，包括3个月的随访期。我们这项研究的目的是：1)确定DSD的危险因素，2)描述DSD的院后结果和认知能力下降的轨迹，这将证明痴呆患者谵妄的适当预防和管理策略的发展是合理的。谵妄将从入院到出院每天进行评估，然后在1个月和3个月的随访中使用混乱评估法（CAM）。将检查的潜在危险因素分为3个主要的相关变量轴，包括：1)多药（中枢神经系统活性药物、药物数量、新添加药物），2)物理压力因素（尿路感染、疼痛、脱水），3)环境压力因素（卧床、约束、换房）。测量的主要结局包括：住院时间、认知能力下降和功能状态。结果将由不了解研究目的的研究人员评估。其他基线测量工具包括Folstein迷你精神状态检查（MMSE）、老年人认知能力下降信息问卷（IQCODE）、Cornell抑郁量表、谵癫评定量表（DRS-R-98）、Katz ADL量表、Lawton日常生活辅助活动量表（IADL）、Charlson共发病指数、Apache II、临床痴呆评定量表（CDR）、家庭半结构化访谈表和修改的幸福量表。风险因素和结果分析将使用多重逻辑回归、协方差分析和混合模型重复测量分析来检查诊断为DSD和仅在基线时诊断为痴呆的患者之间的差异。我们的长期目标是利用这项研究的结果来设计和测试一种干预策略，以改善DSD患者的早期识别、管理、预防和预后。这项研究的目标是痴呆症患者可预防问题这一日益严重的公共卫生问题。最终，本研究和后续研究的结果应该通过减少谵妄相关并发症和住院治疗来改善痴呆症患者及其护理人员的生活。

DESCRIPTION (provided by applicant): By 2050, 14 million older persons in the United States are expected to have dementia. It is well known that persons with dementia are at increased risk of developing delirium or acute confusional state. Further, current evidence suggests that delirium may worsen the prognosis of dementia, may alter the clinical course and trajectory of cognitive decline, and may be associated with substantially worse long-term outcomes. However, the problem of delirium superimposed on dementia (DSD) remains a neglected area of clinical investigation. The proposed study is a prospective cohort study design involving 165 hospitalized subjects with dementia who are 65 and older and includes a 3-month follow-up period. Our aims for this study are: 1) to identify risk factors for DSD, and 2) to describe post-hospital outcomes and the trajectory of cognitive decline for DSD, which will justify the development of appropriate preventive and management strategies for delirium in patients with dementia. Delirium will be assessed daily from admission to discharge and then at 1 and 3 month follow-up using the Confusion Assessment Method (CAM). The potential risk factors that will be examined are divided into 3 major axes of related variables, including: 1) polypharmacy (central nervous system-active medications, number of medications, new medications added), 2) physical stressors (urinary tract infection, pain, dehydration), and 3) environmental stressors (bedrest, restraints, room changes). The primary outcomes which will be measured include: hospitalization length of stay, cognitive decline, and functional status. Outcomes will be assessed by research staff blinded to the study aims. Other baseline measurement tools will include the Folstein Mini-Mental State Examination (MMSE), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Cornell Depression Scale, Delirium Rating Scale (DRS-R-98), Katz ADL Scale, Lawton Instrumental Activities of Daily Living Scale (IADL), Charlson Co-morbidity Index, Apache II, the Clinical Dementia Rating scale (CDR), a family semi-structured interview form, and a Modified Blessed Scale. Risk factors and outcomes will be analyzed utilizing multiple logistic regression, analysis of covariance, and mixed model repeated measures analyses to examine differences between those diagnosed with DSD and those with dementia only at baseline. Our long-term objectives are to use the results from this study to design and test an intervention strategy to improve early recognition, management, prevention, and outcomes in persons with DSD. This research targets a growing public health problem of preventable problems in persons with dementia. Ultimately, the results from this and subsequent studies should improve the lives of persons with dementia and their caregivers by decreasing delirium-related complications and hospitalizations.