BASILÃÂÃÂÃÂÃÂ Better Assessment of Illness: Delirium Severity Measures for Persons with and without Dementia

精神错乱是一种常见的、严重的、往往是致命的疾病，影响多达60%的住院老年人，以及 每年花费超过1640亿美元。精神错乱在阿尔茨海默病及其相关疾病中的重要性增强 痴呆(ADRD)，与那些人相比，它的发生频率(风险4-5倍)和严重性都有所增加 没有阿德勒。妄想的严重程度与不良的临床结果直接相关，其测量方法是 对风险分层、靶向治疗和作为病理生理研究和临床结果的监测至关重要 审判。在我们成功的第一个周期中，我们开发了一种新的17项用于检测精神错乱严重程度的仪器--Del-S。 有了这个提议，我们将用测量精神错乱严重程度的新概念来扩展这项工作 在患有和不患有ADRD的人之间应该有所区别。众所周知，现有的ADRD会导致 严重高估了精神错乱的严重程度，而目前的40种精神错乱严重程度测试仪器中没有一种是 专门为ADRD患者开发或验证的使用。因此，我们的具体目标是：(1)确定 评估ADRD患者中精神障碍严重程度的重要领域的关键项目，并制定 新工具，Del-S-AD(ADR)；(2)进行多点前瞻性队列研究 对500名老年人(225名CDR为0，50名CDR为0.5,225名CDR为1-2)进行的研究，以验证两者的有效性 同时具有参考标准评级的德尔-S和德尔-S-AD；以及(3)比较表现 德-S和德-S-AD在不同认知功能水平上的比较 中度ADRD。我们还将协调德尔-S和德尔-S-AD的分数，提供一个比较的框架 在统一度量上的结果。为了达到这些目标，我们将重点澄清精神错乱严重程度的概念。 ADRD使用了我们之前的数据和一个专家小组。其次，我们将验证不同的精神错乱严重程度仪器 对于从3个独特但互补的地点抽取的多地点队列中患有和不患有ADRD的患者(BASIL II) 与500名老年人(225名患有ADRD)一起，他们将从内科和外科人群中登记，并长期- 定期护理。所有参与者还将由熟练的临床医生同时进行评估，以确定参考标准 所有的最终诊断都将由一个经验丰富的跨学科评审小组做出。 将评估每个工具的内部可靠性、表面和内容效度、收敛 有效性(相对于传统工具)、标准有效性(相对于参考标准)和预测有效性 相关的临床结果。最后，我们对德尔-S和德尔-S-AD的成绩进行比较和协调，以进行测试 德尔S在认知正常或非常轻微的认知障碍者中是否会有更好的表现 认知障碍，以及Del-S-AD是否在轻中度ADRD患者中表现最好。 这一应用将催生一种范式转变，即如何测量患有和 没有阿德勒。这项工作将产生第一个专门针对ADRD的妄想严重程度的验证仪器，以及 最终将有助于促进我们对有效新治疗方法的病理生理学理解和测试。

Delirium is a common, serious, and often fatal disorder, affecting up to 60% of hospitalized seniors, and costing over $164 billion per year. The significance of delirium is heightened in Alzheimer’s disease and related dementias (ADRD), where it occurs with increased frequency (4-5 fold risk) and severity, compared to those without ADRD. Delirium severity is directly correlated with poor clinical outcomes, and its measurement is essential to stratify risk, target treatments, and monitor as an outcome for pathophysiologic studies and clinical trials. In our successful first cycle, we developed a new 17-item instrument for DELirium Severity, the DEL-S. With this proposal, we will extend this work with the novel concept that measurement of delirium severity should be distinct among persons with and without ADRD. Preexisting ADRD is well-known to lead to substantial over-estimation of delirium severity, and none of the >40 current delirium severity instruments were specifically developed or validated for use in persons with ADRD. Thus, our specific aims are: (1) to identify key items that assess the important domains of delirium severity among persons with ADRD, and to develop a new instrument, the DEL-S-AD (DELirium Severity in ADRD); (2) to conduct a multi-site prospective cohort study of 500 older adults (225 with CDR of 0, 50 with CDR of 0.5, and 225 with CDR 1-2) for validation of both the DEL-S and DEL-S-AD with a simultaneous reference standard rating; and (3) to compare the performance of the DEL-S and DEL-S-AD across different levels cognitive function, ranging from normal cognition to moderate ADRD. We will also harmonize DEL-S and DEL-S-AD scores, providing a framework to compare results on a unified metric. For these aims, we will focus on clarifying the construct of delirium severity in ADRD using our prior data and an expert panel. Second, we will validate distinct delirium severity instruments for those with and without ADRD in a multi-site cohort drawn from 3 unique yet complementary sites (BASIL II) with 500 older adults (225 with ADRD), who will be enrolled from medical and surgical populations, and long- term care. All participants will also have concurrent evaluation by skilled clinicians for a reference standard assessment, and all final diagnoses will be made by an experienced, interdisciplinary Adjudication Team. Performance of each instrument will be assessed for internal reliability, face and content validity, convergent validity (against legacy instruments), criterion validity (against reference standard) and predictive validity for relevant clinical outcomes. Finally, we will compare and harmonize the DEL-S and DEL-S-AD scores, to test whether the DEL-S will have superior performance in those with normal cognition or very mild degrees of cognitive impairment, and whether the DEL-S-AD will perform best in those with mild to moderate ADRD. This application will catalyze a paradigm shift in how delirium severity is measured in persons with and without ADRD. This work will yield the first validated instrument specifically for delirium severity in ADRD, and ultimately will help to advance our pathophysiologic understanding and testing of effective new treatments.