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Outcome of delirium: part 2. Clinical features of reversible cognitive dysfunction--are they the same as accepted
1Section of Old Age Psychiatry, UMDS (Guy's) Bexley, UK.
Objective:
To describe the clinical features of reversible cognitive dysfunction.
Design:
Prospective cohort study.
Setting:
Acute geriatric inpatient units.
Patients:
A random sample of consecutive acute admissions of patients over the age of 65 (N = 80).
Main Measurements:
Serial assessments of mental state and cognitive function and observational data.
Outcome Measure:
Patients with more than five points of 20% improvement in Mini Mental State Examination following the most severely impaired assessment operationally designated 'reversible cognitive dysfunction'. The clinical features of those with RCD are compared with those with non-reversible cognitive dysfunction.
Main Results:
Delusions, hallucinations, aggression, excitement, irritability and other 'active' symptoms were not commoner in RCD than in non-reversible cognitive dysfunction (non-RCD). By contrast, 'quiet' signs, such as plucking at bedclothes, poor attention, incoherent speech, abnormal associations, slow, vague thought and fluctuating mental state were more marked in RCD than in non-RCD.
Conclusions:
Reversible cognitive dysfunction is a quiet and unobtrusive disorder.