Classification

The ICD-10 and DSM-IV diagnostic criteria for delirium are described in C..h.a,P.te.r 4,.,1,,.2. They are not entirely concordant; ICD-10 is more restrictive, and results in the diagnosis of fewer cases.(3) However, the two systems agree on four essential features: disturbance of consciousness, disturbance of cognition, rapid onset/fluctuating course, and evidence of an external cause. Unfortunately, none of these features is specific for delirium as opposed to dementia (see below), and the current diagnostic criteria are poor predictors of outcome, defined in terms of improvement in cognitive function. Reversibility of cognitive impairment may be the most discriminating feature of delirium,(2) but this is problematic as a diagnostic criterion since outcome is unknown at the outset.

Another shortcoming of the current classifications of delirium is that they do not recognize the partial and transitory disturbances that are commonly observed in elderly patients. Subsyndromal delirium is common, and is part of a continuum between normality and the full syndrome. Subsyndromal cases are clinically significant, since they have the same risk factors and the same increased mortality as syndromal cases.(4)

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