REVIEW OF: Schnorr T et al, Front Psychiatry 2024;15:1407213

STUDY TYPE: Cross-sectional observational study

Delirium superimposed on dementia (DSD) is underrecognized in hospitalized older adults. Given that more than half of hospitalized dementia patients develop delirium, leading to worse outcomes and increased mortality, distinguishing DSD from dementia only (DO) is critical. But many symptoms overlap, and standard diagnostic tools fall short. This study aims to pinpoint which signs and symptoms may help differentiate the two.

Researchers at a German geriatric psychiatry hospital conducted a cross-sectional study of patients over 60, including 43 with DSD and 51 with DO. The team assessed patients within 48 hours of admission using the Delirium Motor Subtyping Scale, the Mini-Mental State Examination (MMSE), the Clock Drawing Test (CDT), DemTect, and the Neuropsychiatric Inventory. Diagnoses were made using ICD-10 criteria and the Confusion Assessment Method. Researchers then compared motor, cognitive, and behavioral markers that could help separate DSD from DO. 

Compared to the DO group, patients with DSD had significantly higher anxiety scores, more severe sleep/nighttime behavior disturbances, and lower CDT scores. MMSE and DemTect scores did not differ significantly. Motor disturbances (hyperactive and hypoactive) were more common in DSD. Sleep disturbances and motor abnormalities emerged as the strongest differentiators. 

CARLAT TAKE

Monitor patients with dementia for new or worsening sleep/nighttime behavior disturbances, which can signal DSD. Watch for motor change, hypo/hyperactivity, and increased anxiety, restlessness, or agitation. Bedside observation remains the gold standard, but wearable tech may soon help track motor fluctuations and identify DSD earlier, especially for subtle or intermittent changes.