DELIRIUM IN PERSONS WITH DEMENTIA

描述(由申请人提供)：到2050年，美国预计将有1400万老年人患有痴呆症。众所周知，痴呆症患者发展为精神错乱或急性精神错乱状态的风险更高。此外，目前的证据表明，精神错乱可能会恶化痴呆症的预后，可能会改变认知能力下降的临床过程和轨迹，并可能与更糟糕的长期结果有关。然而，痴呆症(DSD)叠加妄想的问题仍然是临床研究中一个被忽视的领域。这项拟议的研究是一项前瞻性队列研究设计，涉及165名65岁及以上的痴呆症住院患者，包括3个月的随访期。本研究的目的是：1)确定DSD的危险因素；2)描述DSD患者住院后的结局和认知功能衰退的轨迹，从而为痴呆患者制定适当的预防和管理策略提供依据。从入院到出院，然后在1个月和3个月的随访中，使用迷惑评估法(CAM)对精神错乱进行每日评估。将被检查的潜在危险因素被分为三个相关变量的主要轴，包括：1)多药(中枢神经系统活性药物、药物数量、新增加的药物)，2)身体应激源(尿路感染、疼痛、脱水)，以及3)环境应激源(卧床休息、约束、房间改变)。将测量的主要结果包括：住院时间、认知能力下降和功能状态。结果将由研究人员对研究目标视而不见进行评估。其他基线测量工具将包括Folstein简易精神状态检查(MMSE)、关于老年人认知下降的告密者问卷(IQCODE)、康奈尔抑郁量表、妄想症评定量表(DRS-R-98)、Katz ADL量表、Lawton日常生活能力量表(IADL)、Charlson共病指数、APACHE II、临床痴呆症评定量表(CDR)、家庭半结构访谈表和修订的幸福度量表。风险因素和结果将使用多元Logistic回归、协方差分析和混合模型重复测量分析来检查被诊断为DSD的人和仅在基线时患有痴呆症的人之间的差异。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的问题，这是一个日益严重的公共卫生问题。最终，这项研究和后续研究的结果应该会通过减少与精神错乱相关的并发症和住院治疗来改善痴呆症患者及其照顾者的生活。

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.