Hostname: page-component-cd4964975-598jt Total loading time: 0 Render date: 2023-03-28T04:02:41.292Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Detecting delirium in elderly outpatients with cognitive impairment

Published online by Cambridge University Press:  15 April 2016

Anne J. M. Stroomer-van Wijk
Department of Old Age Psychiatry, Parnassia, The Hague, the Netherlands
Barbara W. Jonker
Department of Old Age Psychiatry, Parnassia, The Hague, the Netherlands
Rob M. Kok
Department of Old Age Psychiatry, Parnassia, The Hague, the Netherlands
Roos C. van der Mast
Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
Hendrika J. Luijendijk*
Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands Department of Geriatric Psychiatry, BAVO Europoort, Rotterdam, the Netherlands
Correspondence should be addressed to: H.J. Luijendijk, University of Groningen, University Medical Centre Groningen, Department of General Practice, Postbus 196, 9700 AD Groningen, the Netherlands. Phone: +31-50-363-2731; Fax: +31-50-363-2964. Email:



Delirium may be more prevalent in elderly outpatients than has long been assumed. However, it may be easily missed due to overlap with dementia. Our aim was to study delirium symptoms and underlying somatic disorders in psycho-geriatric outpatients.


We performed a case-control study among outpatients that were referred to a psychiatric institution between January 1st and July 1st 2010 for cognitive evaluation. We compared 44 cases with DSM-IV delirium (24 with and 20 without dementia) to 44 controls with dementia only. All participants were aged 70 years or older. We extracted from the medical files (1) referral characteristics including demographics, medical history, medication use, and referral reasons, (2) delirium symptoms, scored with the Delirium Rating Scale-Revised-98, and (3) underlying disorders categorized as: drugs/intoxication, infection, metabolic/endocrine disturbances, cardiovascular disorders, central nervous system disorders, and other health problems.


At referral, delirium patients had significantly higher numbers of chronic diseases and medications, and more often a history of delirium and a recent hospital admission than controls. Most study participants, including those with delirium, were referred for evaluation of (suspected) dementia. The symptoms that occurred more frequently in cases were: sleep disturbances, perceptual abnormalities, delusions, affect lability, agitation, attention deficits, acute onset, and fluctuations. Drug related (68%), infectious (61%), and metabolic-endocrine (50%) disturbances were often involved.


Detection of delirium and distinction from dementia in older outpatients was feasible but required detailed caregiver information about the presence, onset, and course of symptoms. Most underlying disorders could be managed at home.

Research Article
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn., Washington, DC: American Psychiatric Association.Google ScholarPubMed
Clegg, A., Westby, M. and Young, J. B. (2011). Under-reporting of delirium in the NHS. Age and Ageing, 40, 283286. DOI: 10.1093/ageing/afq157.CrossRefGoogle ScholarPubMed
de Lange, E., Verhaak, P. F. M. and van der Meer, K. (2013). Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review. International Journal of Geriatric Psychiatry, 28, 127134. DOI: 10.1002/gps.3814.CrossRefGoogle ScholarPubMed
de Rooij, S. E. et al. (2006). Delirium subtype identification and the validation of the delirium rating scale-revised-98 (Dutch version) in hospitalized elderly patients. International Journal of Geriatric Psychiatry, 21, 876882. DOI: 10.1002/gps.1577.CrossRefGoogle Scholar
Edlund, A., Lundström, M., Sandberg, O., Bucht, G., Brännström, B. and Gustafson, Y. (2007). Symptom profile of delirium in older people with and without dementia. Journal of Geriatric Psychiatry and Neurology, 20, 166171. DOI: 10.1177/0891988707303338.CrossRefGoogle ScholarPubMed
Eriksson, I., Gustafson, Y., Fagerström, L. and Olofsson, B. (2011). Urinary tract infection in very old women is associated with delirium. International Psychogeriatrics, 23, 496502. DOI: 10.1017/S1041610210001456.CrossRefGoogle ScholarPubMed
Fick, D. M., Kolanowski, A. M., Waller, J. L. and Inouye, S. K. (2005). Delirium superimposed on dementia in a community-dwelling managed care population: a 3-year retrospective study of occurrence, costs, and utilization. Journal of Gerontology: Medical Sciences, 60, 748753. DOI: 10.1093/gerona/60.6.748.Google Scholar
Folstein, M. F., Bassett, S. S., Romanowski, A. J. and Nestadt, G. (1991). The epidemiology of delirium in the community: the Eastern Baltimore mental health survey. International Psychogeriatrics, 3, 169176.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental-state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Fong, T. G. et al. (2009). Delirium accelerates cognitive decline in Alzheimer disease. Neurology, 72, 15701575. DOI: 10.1212/WNL.0b013e3181a4129a.CrossRefGoogle ScholarPubMed
Gupta, N., de Jonghe, J., Schieveld, J., Leonard, M. and Meagher, D. (2008). Delirium phenomenology: what can we learn from the symptoms of delirium?. Journal of Psychosomatic Research, 65, 215222. DOI: 10.1016/j.jpsychores.2008.05.020.CrossRefGoogle ScholarPubMed
Han, J. H. et al. (2009). Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Academic Emergency Medicine, 16, 193200. DOI: 10.1111/j.1553-2712.2008.00339.x.CrossRefGoogle ScholarPubMed
Hasegawa, N. et al. (2013). Prevalence of delirium among outpatients with dementia. International Psychogeriatrics, 25, 18771883. DOI:10.1017/S1041610213001191.CrossRefGoogle ScholarPubMed
Hölttä, E. et al. (2011). The overlap of delirium with neuropsychiatric symptoms among patients with dementia. American Journal of Geriatric Psychiatry, 19, 10341041. DOI: ScholarPubMed
Inouye, S. K. and Charpentier, P. A. (1996). Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA, 275, 852857. DOI: 10.1001/jama.1996.03530350034031.CrossRefGoogle ScholarPubMed
Inouye, S. K., Westendorp, R. G. J. and Saczynski, J. S. (2014). Delirium in elderly people. Lancet, 383, 911922. DOI: 10.1016/S0140-6736(13)60688-1.CrossRefGoogle ScholarPubMed
Lerner, A. J., Hedera, P., Koss, E., Stuckey, J. and Friedland, R. P. (1997). Delirium in Alzheimer disease. Alzheimer Disease and Associated Disorders, 11, 1620.CrossRefGoogle ScholarPubMed
Lipowski, Z. (1990). Acute Confusional States. New York: Oxford University Press.Google ScholarPubMed
Mattoo, S. K., Grover, S., Chakravarti, K., Trzepacz, P. T., Meagher, D. J. and Gupta, N. (2012). Symptom profile and etiology of delirium in a referral population in Northern India: factor analysis of the DRS–R98. Journal of Neuropsychiatry and Clinical Neurosciences, 24, 95101. DOI: Scholar
Meagher, D. J., Leonard, M., Donelly, S., Conroy, M., Saunders, J. and Trzepacz, P. T. (2010). A comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium-dementia and cognitively intact controls. Journal of Neurology, Neurosurgery, and Psychiatry, 81, 876881. DOI: 10.1136/jnnp.2009.200956.CrossRefGoogle ScholarPubMed
Meagher, D. J., Moran, M., Raju, B., Gibbons, D., Donelly, S. and Saunders, J. (2007). Phenomenology of delirium: assessment of 100 adult cases using standardised measures. British Journal of Psychiatry, 190, 135141. DOI: 10.1192/bjp.bp.106.023911.CrossRefGoogle ScholarPubMed
Meagher, D., Adamis, D., Trzepacz, P. and Leonard, M. (2012). Features of subsyndromal and persistent delirium. British Journal of Psychiatry, 200, 3744. DOI: 10.1192/bjp.bp.111.095273.CrossRefGoogle Scholar
Pitkala, K. H., Laurila, J. V., Strandberg, T. E. and Tilvis, R. S. (2005). Prognostic significance of delirium in frail older people. Dementia and Geriatric Cognitive Disorders, 19, 158163. DOI: 10.1159/000082888.CrossRefGoogle Scholar
Sandberg, O., Gustafson, Y., Brännström, B. and Bucht, G. (1998). Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly. Scandinavian Journal of Social Medicine, 26, 5662. DOI: 10.1177/14034948980260011201.CrossRefGoogle ScholarPubMed
Sandberg, O., Gustafson, Y., Brännström, B. and Bucht, G. (1999). Clinical profile of delirium in older patients. Journal of the American Geriatrics Society, 47, 13001306. DOI: 10.1111/j.1532-5415.1999. tb07429.x CrossRefGoogle ScholarPubMed
Stroomer-van Wijk, A. J. M. and Luijendijk, H. J. (2011). Het mobiele delierteam voor tijdige detectie en behandeling van delier bij ouderen verwezen voor ambulante geestelijke gezondheidszorg. Tijdschrift voor Ouderengeneeskunde, 4, 127133.Google Scholar
Trzepacz, P. T., Mittal, D., Torres, R., Kanary, K., Norton, J. and Jimerson, N. (2001). Validation of the delirium rating scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. Journal of Neuropsychiatry and Clinical Neurosciences, 13, 229242. DOI: ScholarPubMed
Voyer, P., Richard, S., Doucet, L. and Carmichael, P. (2009). Detecting delirium and subsyndromal delirium using different diagnostic criteria among demented long-term care residents. Journal of the American Medical Directors Association, 10, 181188. DOI: 10.1016/j.jamda.2008.09.006.CrossRefGoogle ScholarPubMed
Witlox, J., Eurelings, L. S. M., de Jonghe, J. F. M., Kalisvaart, K. J., Eikelenboom, P. and van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA, 304, 443451. DOI: 10.1001/jama.2010.1013.CrossRefGoogle ScholarPubMed