Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I was interested to read about subjective memory problems and their
association with dementia, mild cognitive impairment and depression. I
also feel that useful advice is given to general practitioners when
approaching patients with subjective memory impairment. However, I feel
that no approach to assessing patients with cognitive impairment is
complete without emphasising the importance of excluding medical
conditions that can cause or contribute to cognitive impairment.
In the elderly delirium can be missed in up to 70% of cases with
subsequent mortality, morbidity, delayed admissions and inappropriate
referrals to secondary psychiatric causing significant costs. Apart from
the important aspects mentioned in this review, assessment of any patient
with cognitive impairment in primary care should also include a review of
their diet, medications, relevant blood tests, urinalysis, and a thorough
physical examination.
The cognitive function tests mentioned in this review (GPCog and
MMSE) will help identify most cases of cognitive impairment, however, the
use of a more specific validated delirium diagnostic tool such as the
shortened version of the Confusion Assessment Method (CAM) will reduce
unrecognised cases of delirium. The shortened version of the Confusion
Assessment Method will only take a few minutes and can be completed by
general practitioners.
Having worked on elderly psychiatric inpatient units, I have seen
several cases of unrecognised delirium referred to secondary care and feel
that assessment of these patients in primary care should be more robust
especially in view of elderly population growth.
References:
1. Inouye SK. Delirium in hospitalized older patients: recognition
and risk factors. J Geriatr Psychiatry Neurol 1998; 11:118-125
2. Wei LA, Fearing MA, Sternberg EJ, Inouye SK The Confusion
Assessment Method: a systematic review of current usage, Journal of the
American Geriatrics Society 2008; 56:823-830
3. Reeves RR, Parker JD, Burke RS, Hart RH, Inappropriate psychiatric
admission of elderly patients with unrecognized delirium, Southern Medical
Journal 2010; 103: 111-115
4. Moraga, Arturo Vilches; Rodriguez-Pascual, Carlos, Acurate
diagnosis of delirium in elderly patients, Current Opinion in Psychiatry
2007; 20: 262–267
Competing interests:
None declared
Competing interests:
No competing interests
03 April 2010
Martin van Zyl
CT3 Psychiatry
Tees, Esk and Wear Valleys NHS Foundation Trust, Durham University
Subjective memory problems: always consider delirium
I was interested to read about subjective memory problems and their
association with dementia, mild cognitive impairment and depression. I
also feel that useful advice is given to general practitioners when
approaching patients with subjective memory impairment. However, I feel
that no approach to assessing patients with cognitive impairment is
complete without emphasising the importance of excluding medical
conditions that can cause or contribute to cognitive impairment.
In the elderly delirium can be missed in up to 70% of cases with
subsequent mortality, morbidity, delayed admissions and inappropriate
referrals to secondary psychiatric causing significant costs. Apart from
the important aspects mentioned in this review, assessment of any patient
with cognitive impairment in primary care should also include a review of
their diet, medications, relevant blood tests, urinalysis, and a thorough
physical examination.
The cognitive function tests mentioned in this review (GPCog and
MMSE) will help identify most cases of cognitive impairment, however, the
use of a more specific validated delirium diagnostic tool such as the
shortened version of the Confusion Assessment Method (CAM) will reduce
unrecognised cases of delirium. The shortened version of the Confusion
Assessment Method will only take a few minutes and can be completed by
general practitioners.
Having worked on elderly psychiatric inpatient units, I have seen
several cases of unrecognised delirium referred to secondary care and feel
that assessment of these patients in primary care should be more robust
especially in view of elderly population growth.
References:
1. Inouye SK. Delirium in hospitalized older patients: recognition
and risk factors. J Geriatr Psychiatry Neurol 1998; 11:118-125
2. Wei LA, Fearing MA, Sternberg EJ, Inouye SK The Confusion
Assessment Method: a systematic review of current usage, Journal of the
American Geriatrics Society 2008; 56:823-830
3. Reeves RR, Parker JD, Burke RS, Hart RH, Inappropriate psychiatric
admission of elderly patients with unrecognized delirium, Southern Medical
Journal 2010; 103: 111-115
4. Moraga, Arturo Vilches; Rodriguez-Pascual, Carlos, Acurate
diagnosis of delirium in elderly patients, Current Opinion in Psychiatry
2007; 20: 262–267
Competing interests:
None declared
Competing interests: No competing interests