The 4-DSD: A New Tool to Assess Delirium Superimposed on Moderate to Severe Dementia

Objectives: The purpose of this study was to create, standardize, and validate a new instrument, named 4DSD, and determine its diagnostic accuracy in the diagnosis of delirium in subjects with moderate to severe dementia. Design: Multicenter cross-sectional observational study. Setting and Participants: Older patients consecutively admitted to acute and rehabilitation hospital wards. Measures: The DSM-5 was used as the reference standard delirium assessment. The presence and severity of dementia was defined using the AD8 and the Global Deterioration Scale (GDS). The 4-DSD is a 4-item tool that ranges from 0 to 12. Item 1 measures alertness, item 2 altered function, item 3 attention, and item 4 acute change or fluctuation in mental status. Results: A total of 134 patients were included in the study. Most of the patients were enrolled in acute hospital wards (60%), with 40% in rehabilitation settings. A minority of the patients were categorized with moderate dementia, with a GDS score of 5 (4%). Most of the patients were in the moderate-severe stage with a GDS score <6 (77%); 19% were classed as severe, with a GDS score of 7. A 4-DSD cutoff score >5 had a sensitivity of 80% and specificity of 80% with a positive predictive value (PPV) of 67% and a negative predictive value (NPV) of 89%. In the subgroup with moderate-severe dementia (n 1/4 108), the sensitivity and the specificity were 79% and 82%, respectively, with a PPV and NPV of 62% and 92%. In the subgroup with severe dementia (n = 26) the sensitivity was 82% and the specificity 56% with a PPV of 78% and a NPV of 63%. Conclusions and Implications: The availability of a specific tool to detect delirium in patients with moderate-severe dementia has important clinical and research implications, allowing all health care providers to improve their ability to identify it. Crown Copyright (c) 2021 Published by Elsevier Inc. on behalf of AMDA -The Society for Post-Acute and Long-Term Care Medicine.

Automated summary

The study aimed to develop a new tool for diagnosing delirium in patients with moderate to severe dementia, and found that the 4-DSD had high sensitivity and specificity, which could help healthcare providers improve their ability to identify delirium symptoms.