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谵妄:我们完全认识它吗
原作者: Danya Khoujah,陈都译,肖锋 发布日期:2015-03-02
关键词:谵妄;精神症状;痴呆;神经认知检测;筛查

Title: Delirium - are we really looking for it?
题目:谵妄:我们完全认识它吗?
Author 作者: Danya Khoujah
翻译:陈都 校对:肖锋

Delirium has long been recognized as a common disorder of the geriatric ED population (seen in up to 20% of patients above the age of 65 years), but how good are we at detecting it?
谵妄长期以来被看作是老年急诊患者的常见症状(65岁以上的患者中比例高达20%以上)。但是我们在发现这类患者的过程中做的如何呢?

Studies show that the diagnosis of delirium is made in the ED in only 11-46% of patients, which means that more than half go undiagnosed. The problem is, the risk of death at 3 months increases by 11% for every 48 hours of delirium the patient experiences, and so does their length of stay and functional decline. It is mostly missed in patients who have a baseline cognitive dysfunction, such as dementia.
研究显示在急诊诊断谵妄的人群仅占到患者比例的11%-46%,这意味着超过半数的被漏诊。问题是患者每次谵妄发作48小时其三个月死亡风险增加11%,他们的住院时间及认知功能下降亦是如此。对于合并基础认知功能不全的患者如痴呆患者,更容易漏诊。

So what can we do about that?
那么,我们应该如何做哪?

Treat delirium as a neurolgical emergency; be vigilant about diagnosing it and treating it. There are a lot of neurocognitive tests that can be used for diagnosis (such as the mini-mental status exam), but they are usually too cumbersome to use in an ED setting. The CAM (Confusion Assessment Method) has been extensively studied and has a sensitivity and specifity of about 95% to diagnose delirium. It includes the acuity of onset, fluctuant course, inattention (the hallmark), disorganized thinking and/or altered level of consciousness.
把谵妄作为神经急症来处理,对其诊断和治疗我们应该保持警惕。有很多的神经认知检测可用于其诊断(如快速精神状态测试),但是他们用在急诊显得过于繁琐。CAM(精神混乱评估法)历经了广泛的研究,诊断谵妄具有约95%的灵敏度和特异度。包括发作的剧烈程度,波动过程,注意力不集中(标志),思维紊乱、意识水平的改变。

Bottom Line? Don't forget to screen your elderly patients for delirium and treat them accordingly!
要点:对于老年患者不要忘了做谵妄筛查并采取相应的治疗。

References 参考文献
1. Wilber ST, Han JH. Altered Mental Status in the Elderly. Geriatric Emergency Medicine Principles and Practice. Edited by Kahn JH, Maguaran Jr BG, Olshaker JS. New York: Cambridge University Press; 2014: 102-113
2. Barron EA, Holmes J. Delirium within the emergency Care setting, occurence and detection: a systematic review. EMJ 2013; 30(4) 263-268
3. Wei LA, BA, Fearing MA et al. The Confusion Assessment Method: A Systematic Review of Current Usage J Am Geriatr Soc 56:823–830, 2008