***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Delirium occurs commonly among older hospitalized patients and is frequently not recognized . In an effort to identify tools useful to clinicians in the diagnosis of delirium , test characteristics of four screening instruments were compared . METHODS Patients 65 years of age or older who were admitted to one of four medical and surgical wards of a university teaching hospital were followed up prospect ively . Potential subjects were excluded if unavailable for interviews or discharged within 48 hours of admission , or if judged too impaired to participate in the daily interviews . Research assistants administered four instruments used to detect delirium : Digit Span Test , Vigilance ' A ' Test , Clinical Assessment of Confusion , and Confusion Assessment Method .  Abnormal scores on these tests or suspicion of acute confusion prompted a referral to the clinician-investigators who then assessed the patient daily for delirium based on the Diagnostic and Statistical Manual of Mental Disorders , Revised Third Edition criteria . RESULTS Delirium occurred in 64 ( 14.8 % ) of 432 subjects . The positive likelihood ratios for all of the instruments were significantly more than 1 . The instruments remained useful when applied to selected subgroups : subjects in whom acute mental status changes were documented , subjects on surgical services , and subjects with impaired cognitive status on admission . Combinations of any two instruments did not perform substantially better than the instrument with the best test characteristics : the Clinical Assessment of Confusion . All instruments were more useful at confirming delirium than in excluding it . CONCLUSION The four instruments studied , which are suitable for use at the bedside , can aid the clinician in identifying patients likely to be suffering from delirium OBJECTIVES This paper aim ed to measure the prevalence and outcomes of delirium for patients over 70 admitted to a general hospital for acute medical care and to assess the validity of the  Delirium Rating Scale-Revised-98 ( DRS-R-98 ) in this setting . METHODS Prospect i ve study in a British acute general hospital providing sole emergency medical services for its locality . We screened consecutive patients over 70 with an unplanned emergency hospital admission and recruited a cohort of 249 patients likely to have mental health problems . They were assessed for health status at baseline and followed over 6 months . A sub- sample of 93 participants was assessed clinical ly for delirium . RESULTS 27 % ( 95 % confidence interval ( CI ) 23 - 31 ) of all older medical patients admitted to hospital had DRS-diagnosed delirium , and 41 % ( 95 % CI 37 - 45 ) had dementia ( including 19 % with co-morbid delirium and dementia ) . Compared with clinician diagnosis , DRS-R-98  sensitivity was at least 0.75 , specificity 0.71 . Compared with reversible cognitive impairment , sensitivity was at least 0.50 , specificity 0.67 . DRS-diagnosed delirium was associated with cognitive impairment , mood , behavioural and psychological symptoms , activities of daily living , and number of drugs prescribed , supporting construct validity . Of those with DRS-diagnosed delirium , 37 % died within 6 months ( relative risk 1.4 , 95 % CI 0.97 - 2.2 ) , 43 % had reversible cognitive impairment , but only 25 % had clinical ly important recovery in activities of daily living . Behavioural and psychological symptoms were common and mostly resolved , but new symptoms frequently developed . CONCLUSION Delirium is common . Some , but not all , features are reversible . DRS-R-98 has reasonable validity in population s where co-morbid dementia is prevalent OBJECTIVE To develop and vali date a new st and ardized confusion assessment method ( CAM ) that enables nonpsychiatric clinicians to detect delirium quickly in high-risk setting s. DESIGN Prospect i ve validation study . SETTING Conducted in general medicine wards and in an outpatient geriatric assessment center at Yale University ( site 1 ) and in general medicine wards at the University of Chicago ( site 2 ) . PATIENTS The study included 56 subjects , ranging in age from 65 to 98 years . At site 1 , 10 patients with and 20 without delirium participated ; at site 2 , 16 patients with and 10 without delirium participated . MEASUREMENTS AND MAIN RESULTS An expert panel developed the CAM through a consensus building process . The CAM instrument , which can be completed in less than 5 minutes , consists of nine operationalized criteria from the Diagnostic and Statistical Manual of Mental Disorders ( DSM-III-R ) . An a priori hypothesis was established for the diagnostic value of four criteria : acute onset and fluctuating course , inattention , disorganized thinking , and altered level of consciousness . The CAM algorithm for diagnosis of delirium required the presence of both the first and the second criteria and of either the third or the fourth criterion . At both sites , the diagnoses made by the CAM were concurrently vali date d against the diagnoses made by psychiatrists . At sites 1 and 2 values for sensitivity were 100 % and 94 % , respectively ; values for specificity were 95 % and 90 % ; values for positive predictive accuracy were 91 % and 94 % ; and values for negative predictive accuracy were 100 % and 90 % . The CAM algorithm had the highest predictive accuracy for all possible combinations of the nine features of delirium . The CAM was shown to have convergent agreement with four other mental status tests , including the Mini-Mental State Examination . The interobserver reliability of the CAM was high ( kappa = 0.81 - 1.0 ) . CONCLUSIONS The CAM is sensitive , specific , reliable , and easy to use for identification of delirium Background : Major depression is a frequent and serious disorder in older medical in patients . Because the condition goes undetected and untreated in most of these patients , we conducted a r and omized clinical trial to evaluate the effectiveness of a strategy of systematic detection and multidisciplinary treatment of depression in this population . Methods : Consecutive patients aged 65 years or more admitted to general medical services in a primary care hospital between October 1999 and November 2002 were screened for depression with the Diagnostic Interview Schedule ( DIS ) within 48 hours after admission . Patients found to have major depression were r and omly allocated to receive the intervention or usual care . The intervention involved consultation and treatment by a psychiatrist and follow-up by a research nurse and the patient 's family physician . Research assistants , blind to group allocation , collected data from the patients at enrolment and at 3 and 6 months later using the Hamilton Depression Rating Scale ( HAMD ) , the Medical Outcomes 36-item Short Form ( SF-36 ) , the DIS , the Mini-Mental State Examination ( MMSE ) , the Older Americans Re sources and Services ( OARS ) question naire to assess basic and instrumental activities of daily living ( OARS-ADL and OARS-IADL ) and the Rating Scale for Side Effects . Data on the severity of illness , length of hospital stay , health services and medication use , mortality and process of care were also collected . The primary outcome measures were the HAMD and SF-36 . Results : Of 1500 eligible patients who were screened , 157 were found to have major depression and consented to participate ( 78 in the intervention group and 79 in the usual care group ) . At r and omization , there were no clinical ly or statistically significant differences between the 2 groups . Sixty-four patients completed follow-up to 6 months , 57 withdrew , and 36 died . At 6 months , there were no clinical ly or statistically significant differences the 2 groups in HAMD or SF-36 scores or any of the secondary outcome measures . Interpretation : We were unable to demonstrate that systematic detection and multidisciplinary care of depression was more beneficial than usual care for elderly medical in patients Delirium is a common neuropsychiatric complication in patients with advanced cancer . The Memorial Delirium Assessment Scale ( MDAS ) is a recently developed 10‐item severity rating instrument . The purpose of the current prospect i ve study was to further assess the clinical utility , factor structure , and validity of the MDAS in a relatively homogeneous population of patients with advanced cancer The purpose of this study undertaken in an acute care hospital was to evaluate sensitivity and specificity of the documentation of nurse-reported delirium symptoms in medical charts .  This is a descriptive study based on the clinical assessment s of a study nurse and nursing notes in the medical charts of 226 delirious older patients newly admitted to an acute care hospital . The results of this prospect i ve validation study indicated that documentation of delirium symptoms is poor . Disorientation , agitation and altered level of consciousness were the three symptoms yielding a higher level of sensitivity , but even so said symptoms were reported in less than a third of the medical charts . Univariate analysis suggested that higher comorbidity level , more severe symptoms of delirium and the use of physical restraints were associated with more valid documentation of delirium symptoms in medical charts . Lastly , this study corroborates results of previous studies , indicating that documentation of delirium symptoms in medical charts can be improved . Future study should target improving nurse documentation of delirium symptoms in medical charts very elderly subjects without the APOE4 allele . Am J Geriatr Psychiatry 2008 ; 16 : 781–5 . 21 . Verghese J , Lipton RB , Hall CB , Kuslansky G , Katz MJ . Low blood pressure and the risk of dementia  in very old individuals . Neurology 2003 ; 61 : 1667–72 . 22 . Johnson DK , Wilkins CH , Morris JC . Accelerated weight loss may precede diagnosis in Alzheimer disease . Arch Neurol 2006 ; 63 : 1312–7 . 23 . Goldman WP , Morris JC . Evidence that age-associated memory impairment is not a normal variant of aging . Alzheimer Dis Assoc Disord 2001 ; 15 : 72–9 . 24 . Str and berg TE , Tilvis RS . C-reactive protein , cardiovascular risk factors , and mortality in a prospect i ve study in the elderly . Arterioscler Thromb Vasc Biol 2000 ; 20 : 1057– 60 . 25 . Schupf N , Tang MX , Albert SM et al. Decline in cognitive and functional skills increases mortality risk in nondemented elderly . Neurology 2005 ; 65 : 1218–26 . 26 . Williams GC . Pleiotropy , natural selection , and the evolution of senescence . Evolution 1957 ; 11 : 398–411 . 27 . Toupance B , Godelle B , Gouyon PH , Schachter F. A model for antagonistic pleiotropic gene action for mortality and advanced age . Am J Hum Genet 1998 ; 62 : 1525–34 . doi : 10.1093/ageing/afn278 Published electronically 15 January OBJECTIVE To determine how an ultra-brief structured tool that would require usually less than a minute for delirium assessment compares with a clinical assessment based on Diagnostic and Statistical Manual-IV ( DSM-IV ) in a geriatric postacute care ( PAC ) rehabilitation unit . DESIGN Prospect i ve observational cohort study . SETTING Postacute geriatric hospital ward of a Veteran 's Affairs hospital . PARTICIPANTS Consecutively admitted patients between 50 and 100 years old for inpatient postacute medical care . MEASUREMENTS Two teams , blinded to one another 's evaluations , performed daily delirium assessment s using either the Confusion Assessment Method for the intensive care unit ( CAM-ICU ) or clinical assessment based on DSM-IV . RESULTS There were 61 patients enrolled ( median 73 years old , range : 52 - 94 ) , who underwent 521 paired observations . Delirium was detected in 18 patients ( 29.5 % ) by one of the two screening methods over the course of the study , most of whom ( 14 patients , 23 % ) were delirious on the first day of enrollment . Delirium was identified by the CAM-ICU on 12.6 % of the observations and by the clinical assessment on 6 % of the observations ( κ = 0.25 , 95 % confidence interval [ CI ] : 0.09 , 0.40 ) . Examination of disagreement between the 2 evaluations revealed that patients with dementia ( κ = 0.11 , 95 % CI : -0.14 , 0.27 ) had 10.7 times higher odds ( 95 % CI : [ 3.1 , 36.8 ] , p value < .001 ) of having discordance than patients without dementia . CONCLUSIONS Different delirium assessment s may disagree depending on the study population . Dementia patients are especially challenging to evaluate for delirium Pfeiffer 's Short Portable Mental Status Question naire ( SPMSQ ) is a brief screening test for organic brain syndromes . The validity of the SPMSQ was evaluated in a r and om sample of 119 community residents and 282 consecutively admitted medical in patients . The SPMSQ proved to be a sensitive and specific screening test for moderate to severe dementia both in the community and hospital . Using the cut-off point ( number of errors accepted ) of three errors , the sensitivity of the test was 86.2 % and the specificity 99.0 % among medical in patients . The percentages in the community sample were 66.7 % and  
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IMPLICATION S The Confusion Assessment Method was the most widely used instrument to identify delirium , however , specific training is required to ensure optimum performance .
The Delirium Rating Scale and its revised version performed best in the psychogeriatric population but requires an operator with psychiatric training .
The  Nurses ' Delirium Screening Checklist  appears best suited to the surgical and recovery room setting .
The Single Question in Delirium shows promise in oncology patients .
The Memorial Delirium Assessment Scale , while demonstrating good measures of validity in the surgical and palliative care setting , may be better used a measure of delirium severity .