DELIRIUM IN PERSONS WITH DEMENTIA

痴呆症患者出现谵妄

基本信息

批准号：
7227749
负责人：
DONNA Marie FICK
金额：
$ 6.2万
依托单位：
PENNSYLVANIA STATE UNIVERSITY, THE
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-05-01 至 2009-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7227749
关键词：
Acute Address Admission activity Altered Level of Consciousness Apache Indians Area Attention Bed rest Blinded Caregivers Cessation of life Clinical Clinical Research Clinical Trials Clinical dementia rating scale Cognitive Cohort Studies Community Hospitals Condition Confusion DSM-III Daily Data Dehydration Delirium Dementia Development Diagnosis Diagnostic and Statistical Manual of Mental Disorders Elderly Enrollment Event Family Future Healthcare Systems High Prevalence Hospitalization Hospitals Impaired cognition Intervention Intervention Trial Interview Label Length of Stay Life Logistics Measurement Measures Medical Mental Depression Methods Modeling Morbidity - disease rate Natural History Neuraxis Numbers Nursing Homes Outcome Pain Patients Personal Satisfaction Persons Pharmaceutical Preparations Physical Function Placement Polypharmacy Population Prevention Preventive Problem behavior Prospective Studies Psyche structure Public Health Purpose Questionnaires Rate Regression Analysis Research Research Design Risk Risk Factors Severities Societies Staging Structure Syndrome Targeted Research Testing Thinking United States Urinary tract infection cohort design environmental stressor follow-up functional status improved inattention indexing instrumental activity of daily living modifiable risk neglect outcome forecast prevent prospective restraint stressor tool

项目摘要

DESCRIPTION (provided by applicant): By 2050, 14 million older persons in the United States are expected to have dementia. It is well known that persons with dementia are at increased risk of developing delirium or acute confusional state. Further, current evidence suggests that delirium may worsen the prognosis of dementia, may alter the clinical course and trajectory of cognitive decline, and may be associated with substantially worse long-term outcomes. However, the problem of delirium superimposed on dementia (DSD) remains a neglected area of clinical investigation. The proposed study is a prospective cohort study design involving 165 hospitalized subjects with dementia who are 65 and older and includes a 3-month follow-up period. Our aims for this study are: 1) to identify risk factors for DSD, and 2) to describe post-hospital outcomes and the trajectory of cognitive decline for DSD, which will justify the development of appropriate preventive and management strategies for delirium in patients with dementia. Delirium will be assessed daily from admission to discharge and then at 1 and 3 month follow-up using the Confusion Assessment Method (CAM). The potential risk factors that will be examined are divided into 3 major axes of related variables, including: 1) polypharmacy (central nervous system-active medications, number of medications, new medications added), 2) physical stressors (urinary tract infection, pain, dehydration), and 3) environmental stressors (bedrest, restraints, room changes). The primary outcomes which will be measured include: hospitalization length of stay, cognitive decline, and functional status. Outcomes will be assessed by research staff blinded to the study aims. Other baseline measurement tools will include the Folstein Mini-Mental State Examination (MMSE), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Cornell Depression Scale, Delirium Rating Scale (DRS-R-98), Katz ADL Scale, Lawton Instrumental Activities of Daily Living Scale (IADL), Charlson Co-morbidity Index, Apache II, the Clinical Dementia Rating scale (CDR), a family semi-structured interview form, and a Modified Blessed Scale. Risk factors and outcomes will be analyzed utilizing multiple logistic regression, analysis of covariance, and mixed model repeated measures analyses to examine differences between those diagnosed with DSD and those with dementia only at baseline. Our long-term objectives are to use the results from this study to design and test an intervention strategy to improve early recognition, management, prevention, and outcomes in persons with DSD. This research targets a growing public health problem of preventable problems in persons with dementia. Ultimately, the results from this and subsequent studies should improve the lives of persons with dementia and their caregivers by decreasing delirium-related complications and hospitalizations.

描述（由申请人提供）：到2050年，美国有1400万老年人有痴呆症。众所周知，患有痴呆症患者的风险增加了del妄或急性混乱状态。此外，目前的证据表明，del妄可能会恶化痴呆症的预后，可能会改变认知能力下降的临床过程和轨迹，并且可能与长期结局相关。然而，在痴呆症（DSD）上叠加的妄想问题仍然是临床研究的被忽视领域。拟议的研究是一项前瞻性队列研究设计，涉及65岁及65岁及以上的痴呆症患者，包括3个月的随访期。我们的这项研究的目的是：1）确定DSD的危险因素，以及2）描述院后结果以及DSD认知下降的轨迹，这将证明痴呆症患者的适当预防和管理策略的发展是合理的。从入院到出院，将每天评估ir妄，然后使用混乱评估方法（CAM）进行1和3个月的随访。将要检查的潜在危险因素分为3个相关变量的主要轴，包括：1）多药物（中枢神经系统活性药物，药物次数，添加的新药物），2）2）身体压力源（尿路感染，疼痛，脱水）和3）环境压力（bedrest，bedrest，bedrest，bedrest，房间，房间变化）。将测量的主要结果包括：住院时间，认知能力下降和功能状况。结果将由对研究目的看不见的研究人员进行评估。 Other baseline measurement tools will include the Folstein Mini-Mental State Examination (MMSE), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Cornell Depression Scale, Delirium Rating Scale (DRS-R-98), Katz ADL Scale, Lawton Instrumental Activities of Daily Living Scale (IADL), Charlson Co-morbidity Index, Apache II, the Clinical Dementia Rating scale （CDR），一份家庭半结构化访谈表，以及修改后的祝福规模。风险因素和结果将通过多个逻辑回归，协方差分析以及混合模型重复测量分析进行分析，以检查诊断为DSD的人与仅在基线时痴呆症患者之间的差异。我们的长期目标是利用本研究的结果来设计和测试一种干预策略，以改善DSD患者的早期认可，管理，预防和结果。这项研究针对痴呆症患者的公共卫生问题日益增长的公共卫生问题。最终，这项研究和随后的研究的结果应通过减少与ir妄相关的并发症和住院治疗来改善痴呆症及其护理人员的生活。