OBJECTIVE Delirium superimposed on dementia (DSD) is common, morbid, and costly, yet frequently undiagnosed. Our study aimed to develop a brief screening test to improve health care worker recognition of DSD. DESIGN/SETTING/PARTICIPANTS Older hospitalized adults with dementia were prospectively enrolled from medical and surgical inpatient units of 3 hospitals (2 in Pennsylvania, 1 in Tennessee). MEASURES The reference standard delirium assessment used Confusion Assessment Method (CAM) criteria and was based on a structured interview including the Mini-Mental State Examination, interviewer observations, and medical record review. To develop the screening test, 1-, 2-, and 3-item combinations from the reference standard assessment were analyzed to determine their sensitivity and specificity in diagnosing delirium presence in a dementia population compared to the reference standard. For multiple-item screeners, error on 1 or more items was considered a positive screen. RESULTS Overall, 391 older adults with dementia were enrolled (mean age: 83.9 years, 71.1% female), and 95 (24.4%) developed DSD during their hospitalization, based on the reference standard. The best single-item screen for DSD was "What day of the week is it?" with 84% sensitivity [95% confidence interval (CI): 0.75, 0.91] and 41% specificity (CI: 0.35, 0.47). The best 2-item screen was "list the days of the week backwards" and "What day of the week is it?" with 93% sensitivity (CI: 0.85, 0.97) and 30% specificity (CI: 0.25, 0.36). The best 3-item screen was "list the days of the week backwards," "What type of place is this? [hospital]" and "Does the patient appear sleepy?" with 94% sensitivity (CI: 0.87, 0.98) and 42% specificity (CI: 0.36, 0.48). CONCLUSIONS/IMPLICATIONS We identified a 3-item DSD screener with excellent sensitivity but limited specificity. This screener can be used to quickly rule out DSD in populations with a high prevalence of dementia and is a promising step toward developing efficient tools for DSD recognition among care providers.

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用于检测叠加在痴呆症上的谵妄的超简短筛选器

目的 叠加在痴呆 (DSD) 上的谵妄是常见的、病态的、昂贵的，但经常未被诊断出来。我们的研究旨在开发一种简短的筛查测试，以提高卫生保健工作者对 DSD 的认识。设计/设置/参与者 从 3 家医院（宾夕法尼亚州 2 家，田纳西州 1 家）的内科和外科住院部前瞻性招募老年痴呆症住院患者。测量 参考标准谵妄评估使用混淆评估方法 (CAM) 标准，并基于结构化访谈，包括简易精神状态检查、访谈者观察和医疗记录审查。为了开发筛选测试，1-、2-、分析了参考标准评估中的 3 个项目组合，以确定与参考标准相比，它们在诊断痴呆人群谵妄方面的敏感性和特异性。对于多项目筛选器，1 个或多个项目的错误被视为阳性筛选。结果 总体而言，根据参考标准，共有 391 名老年痴呆症患者入组（平均年龄：83.9 岁，71.1% 为女性），95 名（24.4%）在住院期间出现 DSD。DSD 最好的单项屏幕是“星期几？” 具有 84% 的敏感性 [95% 置信区间 (CI)：0.75, 0.91] 和 41% 的特异性 (CI: 0.35, 0.47)。最好的 2 项屏幕是“向后列出星期几”和“星期几？” 93% 的灵敏度 (CI: 0.85, 0. 97) 和 30% 的特异性 (CI: 0.25, 0.36)。最好的 3 项屏幕是“向后列出一周中的天数”、“这是什么类型的地方？[医院]”和“病人看起来困倦了吗？” 具有 94% 的灵敏度 (CI: 0.87, 0.98) 和 42% 的特异性 (CI: 0.36, 0.48)。结论/意义 我们确定了一个 3 项 DSD 筛选器，具有出色的灵敏度但特异性有限。该筛查器可用于在痴呆症高发人群中快速排除 DSD，并且是朝着在护理提供者中开发 DSD 识别的有效工具迈出的有希望的一步。36, 0.48)。结论/意义 我们确定了一个 3 项 DSD 筛选器，具有出色的灵敏度但特异性有限。该筛查器可用于在痴呆症高发人群中快速排除 DSD，并且是朝着在护理提供者中开发 DSD 识别的有效工具迈出的有希望的一步。36, 0.48)。结论/意义 我们确定了一个 3 项 DSD 筛选器，具有出色的灵敏度但特异性有限。该筛查器可用于在痴呆症高发人群中快速排除 DSD，并且是朝着在护理提供者中开发 DSD 识别的有效工具迈出的有希望的一步。