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Impairments in balance and mobility identify delirium in patients with comorbid dementia

Published online by Cambridge University Press:  15 October 2018

Neus Gual Open the ORCID record for Neus Gual [Opens in a new window] ,
Sarah J. Richardson ,
Daniel H. J. Davis ,
Giuseppe Bellelli ,
Wolfgang Hasemann ,
David Meagher ,
Stefan H. Kreisel ,
Alasdair M. J. MacLullich ,
Joaquim Cerejeira  and
Marco Inzitari
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Neus Gual*
Affiliation:
Parc Sanitari Pere Virgili, Barcelona, Spain
Sarah J. Richardson
Affiliation:
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
Daniel H. J. Davis
Affiliation:
MRC Unit for Lifelong Health and Ageing, UCL, London, UK
Giuseppe Bellelli
Affiliation:
School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
Wolfgang Hasemann
Affiliation:
Universitatsspital Basel, Basel, Switzerland
David Meagher
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland
Stefan H. Kreisel
Affiliation:
Department of Psychiatry and Psychotherapy Bethel, Division of Geriatric Psychiatry, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany
Alasdair M. J. MacLullich
Affiliation:
Edinburgh Delirium Research Group, Geriatric Medicine, University of Edinburgh, Edinburgh, UK
Joaquim Cerejeira
Affiliation:
Department of Psychiatry, Hospitais da Universidade de Coimbra, Coimbra, Portugal
Marco Inzitari
Affiliation:
Parc Sanitari Pere Virgili, Barcelona, Spain
Alessandro Morandi
Affiliation:
Ancelle Hospital, Cremona, Italy
*
Correspondence should be addressed to: Neus Gual, Parc Sanitari Pere Virgili, Avinguda Vallcarca 169-205, 08023 Barcelona, Spain. Phone (+34) 932594000. Email: ngual@perevirgili.cat.
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Abstract

Diagnosing delirium superimposed on dementia (DSD) remains challenging because of a lack of specific tools, though motor dysfunction in delirium has been relatively under-explored. This study aimed to use dysfunction in balance and mobility (with the Hierarchical Assessment of Balance And Mobility: HABAM) to identify DSD. This is a cross-sectional multicenter study, recruiting consecutive patients ≥70 years admitted to five acute or rehabilitation hospitals in Ireland, Italy, Portugal, and Switzerland. Delirium was diagnosed using DSM-5 criteria; dementia was determined by the Mini-Mental State Examination and the Questionnaire of Cognitive Decline in the Elderly. HABAM score was recorded at admission. Out of 114 patients (mean age ± SD = 82 ± 7; 54% female), dementia alone was present in 24.6% (n = 28), delirium alone in 18.4% (n = 21) and DSD in 27.2% (n = 31). Patients with DSD had a mean HABAM score 7 points greater than those with dementia alone (19.8 ± 8.7 vs 12.5 ± 9.5; p < 0.001); 70% of participants with DSD were correctly identified using the HABAM at a cut off of 22 (sensitivity 61%, specificity 79%, AUC = 0.76). Individuals with delirium have worse motor function than those without delirium, even in the context of comorbid dementia. Measuring motor function using the HABAM in older people at admission may help to diagnose DSD.

Keywords

DeliriumDementiaMotor DisordersDiagnosis and Classification
Type
Brief Report
Information
International Psychogeriatrics , Volume 31 , Issue 5: Issue Theme: Well-Being in Dementia , May 2019 , pp. 749 - 753
Copyright
© International Psychogeriatric Association 2018 

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