Delirium during the course of clinically diagnosed Alzheimer's disease

A retrospective chart review was completed on the 122 cases of CDAD for the period of 1965–1970 identified from a longitudinal study of dementia at the Mayo Clinic. A psychiatrist assigned DSM-III-R diagnoses based upon the longitudinal description of symptoms detailed in the medical records of the Mayo Clinic hospitals, nursing home visit records and state hospital records. Thirty patients (25%) were found to have an episode of delirium (EOD) during their course of CDAD which occurred during inpatient admissions. Single EODs were found to occur within 2 years of the onset of CDAD, and multiple EODs within 3 years of the onset of CDAD. A psychiatric consultation was requested in only 14% of the sample (N = 17); 88% of these patients received diagnoses involving primary degenerative dementia of the Alzheimer's type, late onset. Psychopharmacology was the major management strategy (82% of patients with an EOD received medication) with the resolution of symptoms within 48 hours. At discharge, only two patients (7%) failed to completely clear the increased degree of confusion. Implications of these findings for the management of patients with CDAD and the management of EOD with the knowledge of the 1990s are discussed.