Screening time for delirium in dementia patients matters: Validation of the Spanish version of the RADAR

Sepúlveda, Esteban; Bermúdez, Ester; Vallinoto, Lourdes; Sánchez, Julia; Saura, Paola; Piany, Pau; Viñuelas, Eva; Ciutat, Marta; Palma, José; Grau, Imma; Vilella, Elisabet; Voyer, Philippe; Franco, José G.

doi:10.1016/j.ejpsy.2024.100272

ISSN: 0213-6163

The European Journal of Psychiatry is a quarterly publication founded in 1986 and directed by Professor A. Seva until his death in 2004. The journal is indexed in different bibliographic data bases, including the Social Sciences Citation Index. It is supported by the Spanish Society of Psychiatry and Mental Health, has been open to contributions from all over the world, and also has North American and Asian-Pacific co- editors.

A new stage of development of the journal has started in 2017. A new Editorial Board has been appointed and an advanced on-line editorial system has been implemented. Our new publishing partners will help to assure that our valuable research gets broadly disseminated, providing a more accessible entry into our contribution.

The overriding criteria for publication are originality, a high scientific quality and interest to a wide audience of those concerned with all aspects of mental illness. The scope is broad and the journal is committed to present new developments in the full spectrum of issues related to psychiatry and mental health, in areas linked to biological, psychological and social sciences. It will include basic studies and the growing application of clinical laboratory techniques in psychiatry. The European Journal of Psychiatry is determined to place particular emphasis on clinical issues related to a personalised medicine, including prevention and early intervention. All original papers will be refereed by independent experts in the field. Review articles and monographs designed to bring the reader up to date with research in the area will be a feature of the journal. There is a Book Review section and correspondence to the editor will be considered for publication.

The journal will be of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in mental health professions, together with basic neurobiological researchers.

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Scopus, Social Sciences Citation Index (SSCI)

Table 1. Clinical and demographic variables of the 34 patients with dementia, differentiated by the presence or absence of delirium according to a cut-off score ≤6 on the DDT-Pro. The results are reported as frequencies (percentages) for discrete variables and means ± standard deviations for continuous variables.

Table 2. The frequency of positivity or moderate to severe impairment for each item of the DDT-Pro in 34 patients according to the diagnosis of delirium.

Table 3. Validity of the RADAR for the diagnosis of delirium according to the DDT-Pro. Data are reported for each of the two assessments and for both (Total). Values are shown with 95 % confidence intervals in parentheses for the DDT-Pro cut-off scores ≤6 (delirium) and ≤7 (SSD and delirium).

Table 4. Correspondence analysis of the RADAR and its items with the delirium diagnosis according to the reference standard, DDT-Pro ≤6 cutoff. Analyses correspond to both the midday and morning RADAR assessments and all their dimensional solutions were one dimensional. Since the midday performance was the best, it is reported first. The model for item 1 (drowsiness) had the lower inertia and was not significant. The models for the other items and for the whole RADAR were significant, with item 2 (following instructions) and the whole RADAR models having the higher inertias. Positive rather than negative response to any item or for the RADAR explained most of the dimension inertia, with item positivity for item having the highest explained inertia among the midday significant models.

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Abstract

Background and objectives

Delirium is frequently underdiagnosed in patients with dementia. The Repérage Actif du Delirium Adapté à la Routine (RADAR) can be adapted to nursing routines for delirium screening. We validated the Spanish RADAR version and determined the best time of day for its administration.

Methods

All dementia patients admitted to a postacute care centre on one day were independently assessed by nurses using the RADAR at the morning and midday and by geriatricians with the Delirium Diagnostic Tool-Provisional (DDT-Pro) reference standard for delirium and subsyndromal delirium (SSD). We evaluated the test–retest temporal stability of the morning and midday RADAR assessments, the RADAR validity considering these two time points and then, the suitability of the DDT-Pro for diagnostic confirmation.

Results

Of 34 dementia patients included, 47.1 % had delirium, and 83.3 % had behavioural, mental or neurological disturbances that made diagnostic assessment difficult. The test–retest temporal stability of the RADAR was moderate, which is consistent with the fact that the diagnostic accuracy of the midday assessment for delirium (79.4 %) was better than that of the morning (73.5 %). The screening accuracy when also considering SSD, accounting for either assessment time, was 79.4 %. Several correspondence and correlation analyses support the use of DDT-Pro for confirmation and assessment of delirium severity after RADAR screening.

Conclusion

The RADAR is useful for the screening of delirium and SSD by nurses in dementia patients and midday assessments have greater diagnostic validity than morning assessments. Screened patients need subsequent diagnosis confirmation before starting therapeutic measures.

Keywords:

Delirium

Dementia

Diagnosis

Postacute care

Elderly

Nursing

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