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J Am Med Dir Assoc. 2009 Mar;10(3):181-8. doi: 10.1016/j.jamda.2008.09.006. Epub 2009 Jan 8.

Detecting delirium and subsyndromal delirium using different diagnostic criteria among demented long-term care residents.

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Faculty of Nursing, Laval University, Laval University Geriatric Research Unit of St-Sacrement Hospital Centre, Quebec City, Canada.



To evaluate the impact of using different diagnostic criteria on prevalence rates of delirium and subsyndromal delirium (SSD) among demented long-term care (LTC) residents.


Descriptive study.


LTC settings in Quebec City, Canada.


Participants were 155 individuals aged 65 and older, with dementia.


(1) Prevalence rates of delirium according to: (a) the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, DSM-III-R, and DSM-IV) and (b) the Confusion Assessment Method (CAM) algorithms for definite and probable delirium; and (2) prevalence rates of SSD employing 2 definitions described in previous studies.


Prevalence rates of delirium according to each set of criteria were 26.5% for DSM-III; 29% for DSM-IV-TR; 41.3% for DSM-III-R; 45.8% for CAM algorithm for definite delirium; and 70.3% for CAM algorithm for probable delirium. A total of 109 subjects (70.3%) were identified as delirious consistent with at least one classification and 37 (23.9%) met all the sets of criteria considered. Prevalence rates for SSD were 75 (48.4%) and 78 (50.3%) depending on the definition employed.


Prevalence rates for delirium are much affected by the diagnostic formulations used. The use of DSM-IV-TR among this population could result in fewer cases being identified as delirious and thus compromise proper care for those individuals. Considering that SSD was prevalent among this population, a systematic implementation of protocols targeting risk factors of delirium might be beneficial among demented LTC residents.

[Indexed for MEDLINE]

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