{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:12:13Z","timestamp":1760148733691,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T00:00:00Z","timestamp":1685664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>Delirium, an acute neuropsychiatric disorder characterized by a disturbance of attention and awareness, is often superimposed on dementia with its progressive cognitive decline. Despite the high frequency and clinical relevance of this condition, often called delirium-superimposed dementia (DSD), little is known about possible triggers. In this study using the GePsy-B databank, we investigated the impact of the underlying brain disorder and multimorbidity (MM) on DSD. MM was measured by CIRS and the number of ICD-10 diagnoses. Dementia was diagnosed by CDR, and delirium by DSM IV TR criteria. A total of 218 patients were diagnosed with DSD and these were compared to 105 patients with only dementia, 46 with only delirium, and 197 patients suffering from other psychiatric diseases, mainly depression. No significant differences between groups were found concerning CIRS scores. Based on CT scans, DSD cases were grouped into those with cerebral atrophy only (probably pure neurodegenerative), with brain infarction, or with white matter hyperintensities (WMH), but no between-group differences regarding the MM indices could be found. Regression analysis only revealed age and dementia stage as influencing factors. Conclusion: Our results suggest that neither MM nor morphologic changes in the brain are predisposing factors for DSD.<\/jats:p>","DOI":"10.3390\/geriatrics8030064","type":"journal-article","created":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T08:50:31Z","timestamp":1685695831000},"page":"64","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Contribution of Different Brain Disorders and Multimorbidity to Delirium Superimposed Dementia (DSD)"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6807-4060","authenticated-orcid":false,"given":"Tilman","family":"Wetterling","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Vivantes Klinikum Kaulsdorf, 12621 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Junghanns","sequence":"additional","affiliation":[{"name":"Campus L\u00fcbeck, University Hospital of Schleswig-Holstein, 23538 L\u00fcbeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.jpsychores.2015.06.012","article-title":"Delirium superimposed on dementia: A quantitative and qualitative evaluation of informal caregivers and health care staff experience","volume":"79","author":"Morandi","year":"2015","journal-title":"J. Psychosom. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1046\/j.1532-5415.2002.50468.x","article-title":"Delirium superimposed on dementia: A systematic review","volume":"50","author":"Fick","year":"2002","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jamda.2021.09.008","article-title":"Prevalence, risk factors, and Iipact of delirium on hospitalized older adults with dementia: A systematic review and meta-analysis","volume":"23","author":"Han","year":"2022","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1038\/s41582-022-00698-7","article-title":"The inter-relationship between delirium and dementia: The importance of delirium prevention","volume":"18","author":"Fong","year":"2022","journal-title":"Nat. Rev. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1001\/jamaneurol.2020.2273","article-title":"Association of delirium with long-term cognitive decline: A meta-analysis","volume":"77","author":"Goldberg","year":"2020","journal-title":"JAMA Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s41999-019-00261-6","article-title":"Delirium superimposed on dementia","volume":"11","author":"Morandi","year":"2020","journal-title":"Eur. Geriatr. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1002\/gps.5508","article-title":"Delirium in older adults is associated with development of new dementia: A systematic review and meta-analysis","volume":"36","author":"Pereira","year":"2021","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1016\/S2666-7568(22)00013-7","article-title":"The effect of baseline cognition and delirium on long-term cognitive impairment and mortality: A prospective population-based study","volume":"3","author":"Tsui","year":"2022","journal-title":"Lancet Healthy Longev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.2147\/NDT.S247957","article-title":"Current challenges in the recognition and management of delirium superimposed on dementia","volume":"17","author":"Nitchingham","year":"2021","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5, American Psychiatric Press. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_11","unstructured":"WHO (2023, April 12). ICD-10. Geneve. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/37958."},{"key":"ref_12","unstructured":"WHO (2023, April 12). ICD-11. Geneve. Available online: https:\/\/icd.who.int\/browse11\/l-m\/en."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1056\/NEJMcp1605501","article-title":"Delirium in hospitalized older adults","volume":"377","author":"Marcantonio","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3326","DOI":"10.1016\/j.jacc.2019.04.034","article-title":"Vascular cognitive impairment and dementia: JACC Scientific Expert Panel","volume":"73","author":"Iadecola","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1177\/1099800419849489","article-title":"Structural brain changes in delirium: An integrative review","volume":"21","author":"Kalvas","year":"2019","journal-title":"Biol. Res. Nurs."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1017\/S1041610213001191","article-title":"Prevalence of delirium among outpatients with dementia","volume":"25","author":"Hasegawa","year":"2013","journal-title":"Int. Psychogeriatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"105864","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105864","article-title":"Emerging concepts in vascular dementia: A review","volume":"30","author":"Bir","year":"2021","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1212\/WNL.0000000000007654","article-title":"CNS small vessel disease: A clinical review","volume":"92","author":"Cannistraro","year":"2019","journal-title":"Neurology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/S2215-0366(20)30431-4","article-title":"Neuropsychiatric symptoms associated with cerebral small vessel disease: A systematic review and meta-analysis","volume":"8","author":"Clancy","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1002\/gps.4724","article-title":"A systematic review of neuroimaging in delirium: Predictors, correlates and consequences","volume":"33","author":"Nitchingham","year":"2018","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/S1474-4422(10)70104-6","article-title":"Cerebral small vessel disease: From pathogenesis and clinical characteristics to therapeutic challenges","volume":"9","author":"Pantoni","year":"2010","journal-title":"Lancet Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Violan, C., Foguet-Boreu, Q., Flores-Mateo, G., Salisbury, C., Blom, J., Freitag, M., Glynn, L., Muth, C., and Valderas, J.-M. (2014). Prevalence, determinants and patterns of multimorbidity in primary care: A systematic review of observational studies. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0102149"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1007\/s00391-018-1425-5","article-title":"Does multimorbidity in older psychiatric patients lead to higher transfer rates between psychiatric and somatic departments?","volume":"52","author":"Wetterling","year":"2019","journal-title":"Z. Gerontol. Geriatr."},{"key":"ref_25","unstructured":"American Psychiatric Association (2000). Diagnostic and Statistical MANUAL of Mental Disorders: DSM IV TR, American Psychiatric Press. [4th ed.]."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: The confusion assessment method. A new method for detection of delirium","volume":"113","author":"Inouye","year":"1990","journal-title":"Ann. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1159\/000224151","article-title":"Validation of a German version of the Confusion Assessment Method for delirium detection in a sample of acute geriatric patients with a high prevalence of dementia","volume":"42","author":"Hestermann","year":"2009","journal-title":"Psychopathology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1176\/jnp.13.2.229","article-title":"Validation of the Delirium Rating Scale-revised-98: Comparison with the delirium rating scale and the cognitive test for delirium","volume":"3","author":"Trzepacz","year":"2001","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1192\/bjp.140.6.566","article-title":"A new clinical scale for the staging of dementia","volume":"140","author":"Hughes","year":"1982","journal-title":"Br. J. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1111\/j.1532-5415.1968.tb02103.x","article-title":"Cumulative illness rating scale","volume":"16","author":"Linn","year":"1968","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.1111\/j.1532-5415.2008.01935.x","article-title":"A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients","volume":"56","author":"Salvi","year":"2008","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/S0749-0690(02)00059-9","article-title":"Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment","volume":"18","author":"Guigoz","year":"2002","journal-title":"Clin. Geriatr. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Guy, W. (1976). ECDEU Assessment Manual for Psychopharmacology, U.S. Department of Health, Education, and Welfare.","DOI":"10.1037\/e591322011-001"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Krzych, \u0141.J., Rachfalska, N., and Putowski, Z. (2020). Delirium superimposed on dementia in perioperative period and intensive care. J. Clin. Med., 9.","DOI":"10.3390\/jcm9103279"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1002\/jhm.2077","article-title":"Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults","volume":"8","author":"Fick","year":"2013","journal-title":"J. Hosp. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1111\/j.1532-5415.2012.04066.x","article-title":"Diagnosing delirium in older hospitalized adults with dementia: Adapting the confusion assessment method to international classification of diseases, tenth revision, diagnostic criteria","volume":"60","author":"Thomas","year":"2012","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Gross, A.L., Tommet, D., D\u2019Aquila, M., Schmitt, E., Marcantonio, E.R., Helfand, B., Inouye, S.K., Jones, R.N., and BASIL Study Group (2018). Harmonization of delirium severity instruments: A comparison of the DRS-R-98, MDAS, and CAM-S using item response theory. BMC Med. Res. Methodol., 18.","DOI":"10.1186\/s12874-018-0552-4"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1111\/jgs.15503","article-title":"Frailty and delirium in older adults: A systematic review and meta-analysis of the literature","volume":"66","author":"Persico","year":"2018","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.jamda.2013.12.084","article-title":"Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients","volume":"15","author":"Morandi","year":"2014","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.parkreldis.2018.09.025","article-title":"Defining delirium in idiopathic Parkinson\u2019s disease: A systematic review","volume":"64","author":"Lawson","year":"2019","journal-title":"Park. Relat. Disord."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1111\/acps.13514","article-title":"Challenges in diagnosis and management of delirium in Lewy body disease","volume":"147","author":"Richardson","year":"2022","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1111\/jgs.16836","article-title":"A systematic review of delirium biomarkers and their alignment with the NIA-AA research framework","volume":"69","author":"Wang","year":"2021","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1002\/gps.5088","article-title":"Delirium and Alzheimer disease: A proposed model for shared pathophysiology","volume":"34","author":"Fong","year":"2019","journal-title":"Int. J. Geriatr. Psychiatry"}],"container-title":["Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3417\/8\/3\/64\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:47:54Z","timestamp":1760125674000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3417\/8\/3\/64"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,2]]},"references-count":44,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["geriatrics8030064"],"URL":"https:\/\/doi.org\/10.3390\/geriatrics8030064","relation":{},"ISSN":["2308-3417"],"issn-type":[{"type":"electronic","value":"2308-3417"}],"subject":[],"published":{"date-parts":[[2023,6,2]]}}}