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An Empirical Study of Different Diagnostic Criteria for Delirium Among Elderly Medical Inpatients

From the Department of Psychiatry, St. Mary's Hospital and McGill University (m.g.c.), and the Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital and Department of Epidemiology and Biostatistics, McGill University (N.D., J.M., L.H.), Montreal, Quebec. Address correspondence to Dr. Cole, Department of Psychiatry, St. Mary's Hospital Center, 3830 Lacombe Avenue, Room 2508, Montreal, Quebec H3T 1M5. E-mail: martin.cole{at}ssss.gouv.qc.ca

This study compared the sensitivity and specificity of DSM-IV criteria for delirium with the sensitivity and specificity of DSM-III and ICD-10 criteria among elderly medical inpatients with or without dementia. Secondary objectives were to examine the effect of changing the definition of criterion A on sensitivity and specificity and to compare the sensitivity and specificity of different numbers of symptoms of delirium. A total of 322 elderly patients who had been admitted from the emergency department to the medical services were classified into one of four groups using DSM-III-R criteria: delirium and dementia (n = 128), delirium only (n = 40), dementia only (n = 94), and neither (n = 60). The sensitivity and specificity of DSM-IV, DSM-III, and ICD-10 criteria were determined against DSM-III-R criteria using three definitions of criterion A (clouding of consciousness only, clouding of consciousness and inattention, clouding of consciousness or inattention). When criterion A was defined as clouding of consciousness or inattention, the sensitivity and specificity of DSM-IV, DSM-III, and ICD-10 criteria were 100% and 71%, 96% and 91%, and 61% and 91%, respectively. The results were similar among patients with or without dementia. The lower specificity of DSM-IV was accounted for by its inclusion of patients who did not show disorganized thinking. DSM-IV criteria for delirium are the most inclusive criteria to date for elderly medical patients with or without dementia.

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