Delirium that occurs in patients with dementia is referred to as delirium superimposed on dementia (DSD).1 The prevalence of DSD has been reported in acute hospitals, nursing homes, and community populations, but there are few studies in rehabilitation facilities. In the only systematic selleck chemical review investigating its prevalence in various care settings, of 15 studies identified, none were in postacute care rehabilitation
settings.1 However, a high proportion of patients in acute hospitals have dementia or cognitive impairment,2 and a significant proportion is discharged to postacute facilities with delirium still present.3, 4, 5, 6 and 7 Both delirium and dementia affect functional recovery, and especially affect the ability to recover walking after an acute illness.8, 9, 10, 11, 12, 13, 14, 15, 16, 17 and 18 This also has been demonstrated in community populations.19 and 20 Little attention has been given to the impact of delirium, and specifically of DSD, on functional outcomes in rehabilitation settings, despite the need to predict functional improvement as a part of the rehabilitation process. The occurrence of delirium alone has been shown in rehabilitation hospitals to be linked to worse functional outcomes4 and 21 while the effect of dementia alone
is still controversial.22 One might expect that the overlap between delirium and dementia as the overlap of delirium with depressive symptoms23 might indeed expose the patient learn more to a greater risk of adverse outcomes after a rehabilitation treatment. Only one study,3 to our knowledge, has provided preliminary information on the association between DSD and functional status. This study found that patients with DSD were significantly more functionally impaired on admission in comparison with those with dementia alone, delirium alone, or neither of these conditions, and that DSD was a predictor of the risk of institutionalization at discharge. However, the authors did not assess the role of DSD in
predicting functional recovery at discharge and did not evaluate the effect of confounding factors. next Delirium also has been shown to predict institutionalization and mortality in different clinical settings24 but few studies have been conducted to understand the association between DSD and these outcomes in older adults admitted to acute hospitals and rehabilitation settings.3, 17, 18 and 25 DSD predicted worse functional outcomes and institutionalization in elderly patients at 1-month and up to 1-year discharge from an acute hospital, although the definition of dementia in these 2 studies17 and 18 was carried out differently. One study used the IQCODE18 and the second one used a more rigorous approach.