Delirium Diagnostic and Classification Challenges in Palliative Care: Subsyndromal Delirium, Comorbid Delirium-Dementia, and Psychomotor Subtypes
Delirium often presents difficult diagnostic and classification challenges in palliative care settings. To review three major areas that create diagnostic and classification challenges in relation to delirium in palliative care: subsyndromal delirium (SSD), delirium in the context of comorbid dement...
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| Published in | Journal of pain and symptom management Vol. 48; no. 2; pp. 199 - 214 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article Conference Proceeding |
| Language | English |
| Published |
New York, NY
Elsevier Inc
01.08.2014
Elsevier |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0885-3924 1873-6513 1873-6513 |
| DOI | 10.1016/j.jpainsymman.2014.03.012 |
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| Abstract | Delirium often presents difficult diagnostic and classification challenges in palliative care settings.
To review three major areas that create diagnostic and classification challenges in relation to delirium in palliative care: subsyndromal delirium (SSD), delirium in the context of comorbid dementia, and classification of psychomotor subtypes, and to identify knowledge gaps and research priorities in relation to these three areas of focus.
We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant PubMed literature searches as the knowledge synthesis strategy in this review.
We identified six (SSD), 33 (dementia), and 44 (psychomotor subtypes) articles of relevance in relation to the focus of our review. Recent literature data highlight the frequency and impact of SSD, the relevance of comorbid dementia, and the propensity for a hypoactive presentation of delirium in the palliative population. The differential diagnoses to consider are wide and include pain, fatigue, mood disturbance, psychoactive medication effects, and other causes for altered consciousness.
Challenges in the diagnosis and classification of delirium in people with advanced disease are compounded by the generalized disturbance of central nervous system function that occurs in the seriously ill, often with comorbid illness, including dementia. Further research is needed to delineate the pathophysiological and clinical associations of these presentations and thus inform therapeutic strategies. The expanding aged population and growing focus on dementia care in palliative care highlight the need to conduct this research. |
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| AbstractList | Delirium often presents difficult diagnostic and classification challenges in palliative care settings.CONTEXTDelirium often presents difficult diagnostic and classification challenges in palliative care settings.To review three major areas that create diagnostic and classification challenges in relation to delirium in palliative care: subsyndromal delirium (SSD), delirium in the context of comorbid dementia, and classification of psychomotor subtypes, and to identify knowledge gaps and research priorities in relation to these three areas of focus.OBJECTIVESTo review three major areas that create diagnostic and classification challenges in relation to delirium in palliative care: subsyndromal delirium (SSD), delirium in the context of comorbid dementia, and classification of psychomotor subtypes, and to identify knowledge gaps and research priorities in relation to these three areas of focus.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant PubMed literature searches as the knowledge synthesis strategy in this review.METHODSWe combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant PubMed literature searches as the knowledge synthesis strategy in this review.We identified six (SSD), 33 (dementia), and 44 (psychomotor subtypes) articles of relevance in relation to the focus of our review. Recent literature data highlight the frequency and impact of SSD, the relevance of comorbid dementia, and the propensity for a hypoactive presentation of delirium in the palliative population. The differential diagnoses to consider are wide and include pain, fatigue, mood disturbance, psychoactive medication effects, and other causes for altered consciousness.RESULTSWe identified six (SSD), 33 (dementia), and 44 (psychomotor subtypes) articles of relevance in relation to the focus of our review. Recent literature data highlight the frequency and impact of SSD, the relevance of comorbid dementia, and the propensity for a hypoactive presentation of delirium in the palliative population. The differential diagnoses to consider are wide and include pain, fatigue, mood disturbance, psychoactive medication effects, and other causes for altered consciousness.Challenges in the diagnosis and classification of delirium in people with advanced disease are compounded by the generalized disturbance of central nervous system function that occurs in the seriously ill, often with comorbid illness, including dementia. Further research is needed to delineate the pathophysiological and clinical associations of these presentations and thus inform therapeutic strategies. The expanding aged population and growing focus on dementia care in palliative care highlight the need to conduct this research.CONCLUSIONChallenges in the diagnosis and classification of delirium in people with advanced disease are compounded by the generalized disturbance of central nervous system function that occurs in the seriously ill, often with comorbid illness, including dementia. Further research is needed to delineate the pathophysiological and clinical associations of these presentations and thus inform therapeutic strategies. The expanding aged population and growing focus on dementia care in palliative care highlight the need to conduct this research. AbstractContextDelirium often presents difficult diagnostic and classification challenges in palliative care settings. ObjectivesTo review three major areas that create diagnostic and classification challenges in relation to delirium in palliative care: subsyndromal delirium (SSD), delirium in the context of comorbid dementia, and classification of psychomotor subtypes, and to identify knowledge gaps and research priorities in relation to these three areas of focus. MethodsWe combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant PubMed literature searches as the knowledge synthesis strategy in this review. ResultsWe identified six (SSD), 33 (dementia), and 44 (psychomotor subtypes) articles of relevance in relation to the focus of our review. Recent literature data highlight the frequency and impact of SSD, the relevance of comorbid dementia, and the propensity for a hypoactive presentation of delirium in the palliative population. The differential diagnoses to consider are wide and include pain, fatigue, mood disturbance, psychoactive medication effects, and other causes for altered consciousness. ConclusionChallenges in the diagnosis and classification of delirium in people with advanced disease are compounded by the generalized disturbance of central nervous system function that occurs in the seriously ill, often with comorbid illness, including dementia. Further research is needed to delineate the pathophysiological and clinical associations of these presentations and thus inform therapeutic strategies. The expanding aged population and growing focus on dementia care in palliative care highlight the need to conduct this research. Delirium often presents difficult diagnostic and classification challenges in palliative care settings. To review three major areas that create diagnostic and classification challenges in relation to delirium in palliative care: subsyndromal delirium (SSD), delirium in the context of comorbid dementia, and classification of psychomotor subtypes, and to identify knowledge gaps and research priorities in relation to these three areas of focus. We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant PubMed literature searches as the knowledge synthesis strategy in this review. We identified six (SSD), 33 (dementia), and 44 (psychomotor subtypes) articles of relevance in relation to the focus of our review. Recent literature data highlight the frequency and impact of SSD, the relevance of comorbid dementia, and the propensity for a hypoactive presentation of delirium in the palliative population. The differential diagnoses to consider are wide and include pain, fatigue, mood disturbance, psychoactive medication effects, and other causes for altered consciousness. Challenges in the diagnosis and classification of delirium in people with advanced disease are compounded by the generalized disturbance of central nervous system function that occurs in the seriously ill, often with comorbid illness, including dementia. Further research is needed to delineate the pathophysiological and clinical associations of these presentations and thus inform therapeutic strategies. The expanding aged population and growing focus on dementia care in palliative care highlight the need to conduct this research. |
| Author | Mohamad, Mas M. Spiller, Juliet A. Lawlor, Peter G. Agar, Meera Leonard, Maeve M. Davis, Brid Meagher, David J. |
| Author_xml | – sequence: 1 givenname: Maeve M. surname: Leonard fullname: Leonard, Maeve M. organization: Graduate Entry Medical School, University of Limerick, Limerick, Ireland – sequence: 2 givenname: Meera surname: Agar fullname: Agar, Meera organization: Discipline, Palliative & Supportive Services, Flinders University, Adelaide, South Australia, Australia – sequence: 3 givenname: Juliet A. surname: Spiller fullname: Spiller, Juliet A. organization: Palliative Medicine, Marie Curie Hospice, Edinburgh and West Lothian Palliative Care Service, Edinburgh, United Kingdom – sequence: 4 givenname: Brid surname: Davis fullname: Davis, Brid organization: Milford Care Centre, University of Limerick, Limerick, Ireland – sequence: 5 givenname: Mas M. orcidid: 0000-0002-0060-9727 surname: Mohamad fullname: Mohamad, Mas M. organization: Milford Care Centre, University of Limerick, Limerick, Ireland – sequence: 6 givenname: David J. surname: Meagher fullname: Meagher, David J. organization: Graduate Entry Medical School, University of Limerick, Limerick, Ireland – sequence: 7 givenname: Peter G. surname: Lawlor fullname: Lawlor, Peter G. email: plawlor@bruyere.org organization: Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada |
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| Copyright | 2014 American Academy of Hospice and Palliative Medicine American Academy of Hospice and Palliative Medicine 2015 INIST-CNRS Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. |
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| Keywords | Delirium classification and hospice assessment subsyndromal diagnosis dementia palliative care psychomotor Evaluation Organic mental disorder Classification Palliative care Palliative care unit Degenerative disease Diagnosis Subtype Mental confusion Dementia |
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| Snippet | Delirium often presents difficult diagnostic and classification challenges in palliative care settings.
To review three major areas that create diagnostic and... AbstractContextDelirium often presents difficult diagnostic and classification challenges in palliative care settings. ObjectivesTo review three major areas... Delirium often presents difficult diagnostic and classification challenges in palliative care settings.CONTEXTDelirium often presents difficult diagnostic and... |
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| SubjectTerms | Adult and adolescent clinical studies Anesthesia assessment Biological and medical sciences classification and hospice Comorbidity Delirium Delirium - classification Delirium - diagnosis Delirium - epidemiology dementia Dementia - classification Dementia - diagnosis Dementia - epidemiology diagnosis Diagnosis, Differential Humans Medical sciences Organic mental disorders. Neuropsychology Pain Medicine palliative care Palliative Care - methods Pharmacology. Drug treatments Psychology. Psychoanalysis. Psychiatry psychomotor Psychomotor Disorders - classification Psychomotor Disorders - diagnosis Psychopathology. Psychiatry subsyndromal |
| Title | Delirium Diagnostic and Classification Challenges in Palliative Care: Subsyndromal Delirium, Comorbid Delirium-Dementia, and Psychomotor Subtypes |
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