The Diagnosis of Delirium Superimposed on Dementia: An Emerging Challenge.
Alessandro Morandi, Daniel Davis, Giuseppe Bellelli and 18 others
PMID 27650668WHAT IT FOUND
When a patient with dementia suddenly becomes drowsy, unable to sit up, or less mobile, think delirium.
Attention tests may fail in advanced dementia. Confirm baseline with family, check infection, pain, and medicines, and be cautious with antipsychotics if Lewy body dementia is possible.
Key findings
01In severe dementia, standard attention tests may be unusable, so arousal and basic movement can be more practical clues to delirium.
02Acute changes in patients with dementia or Lewy body dementia need collateral history and review for reversible causes, because misdiagnosis can miss infection, pain, or medicines and lead to antipsychotic harm.
03There is no agreed way to assess attention for delirium, and current diagnostic tools are described as insufficient.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It is a narrative review and consensus framework, not a systematic review or original diagnostic accuracy study. No patients were recruited, and no new test results are reported. The review says current tools are insufficient, but it does not provide a validated protocol for diagnosing delirium in dementia. Suggestions such as using arousal or motor observation are hypotheses or indirect observations, not tested interventions.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not read the suggested bedside observations as a validated delirium test. The paper is a narrative review and says current diagnostic tools are insufficient, so it does not prove that arousal, movement, or mobility signs reliably diagnose delirium in dementia.