Delirium episodes during the course of clinically diagnosed Alzheimer's disease

A retrospective review was conducted of 122 charts of patients with clinica lly diagnosed Alzheimer's disease (CDAD) who had participatd in a longitudi nal dementia study at the Mayo Clinic from 1965 to 1970. DSM-III-R diagnose s were assigned based on the longitudinal description of symptoms detailed in the Mayo Clinic medical records of the hospitalizations; clinic, home, a nd nursing home visits; and state hospital admissions. Thirty patients (25% ) were found to have a delirium episode during their course of CDAD that oc curred. during inpatient admissions; 50% (15 of 30) of the delirium episode occurred in patients ages 80 to 89. Among patients with a delirium episode , 50% died within one year of the delirium episode and 64% died within two years. Of 13 patients, 10 (77%) had multiple delirium episodes within two y ears. Admitting diagnoses were mainly primary degenerative dementia of the Alzheimer's type (PDDAT) or PDDAT with delirium. Only 3 (10%) demented pati ents experienced delirium episodes during a medical admission. No deaths oc curred during hospitalization for the years covered by this study. A psychi atric consultation was requested in only 17(14%) patients; 88% of these pat ients received diagnoses involving PDDAT, late onset. An additional diagnos is included depressive disorders. Psychopharmacology was the major manageme nt strategy (82% of patients with a delirium episode received medication) w ith a resolution of symptoms within 48 hours. At discharge, only 2 (7%) pat ients failed to clear the increased degree of confusion.