부산대학교 도서관

Keywords: ADRD; delirium; dementia; expert panel; instrument Abstract Background The ability to rate delirium severity is key to providing optimal care for persons with Alzheimer's Disease and Related Dementias (ADRD). Such ratings would allow clinicians to assess response to treatment, recovery time and prognosis, nursing burden and staffing needs, and to provide nuanced, appropriate patient-centered care. Given the lack of existing tools, we defined content domains for a new delirium severity instrument for use in individuals with mild to moderate ADRD, the DEL-S-AD. Methods We built upon our previous study in which we created a content domain framework to inform development of a general delirium severity instrument, the DEL-S. We engaged a new expert panel to discuss issues of measurement in delirium and dementia and to determine which content domains from the prior framework were useful in characterizing delirium severity in ADRD. We also asked panelists to identify new domains. Our panel included eight interdisciplinary members with expertise in delirium and dementia. Panelists participated in two rounds of review followed by two surveys over 2months. Results Panelists endorsed the same content domains as for general delirium severity, including Cognitive, Level of Consciousness, Inattention, Psychiatric-Behavioral, Emotional Dysregulation, Psychomotor Features, and Functional; however, they excluded six of the original subdomains which they considered unhelpful in the context of ADRD: cognitive impairment; anxiety; fear/sense of unease; depression; gait/walking; and incontinence. Debated measurement challenges included assessment at one point in time versus over time, accounting for differences in clinical settings, and accurate assessment of symptoms related to delirium versus dementia. Conclusions By capturing a range of characteristics of delirium severity potentially present in patients with ADRD, a population that may already have attention, functional, and emotional changes at baseline, the DEL-S-AD provides a novel rating tool that will be useful for clinical and research purposes to improve patient care. Article Note: Dena Schulman-Green and Tammy Hshieh are the co-first authors. Richard N. Jones and Sharon K. Inouye are the co-senior authors. Funding informationThis work was funded by the National Institute on Aging, grants #R01AG044518 and R33AG071744 to S.K. Inouye and R. Jones, MPIs. CAPTION(S): Appendix S1. Expert panel description and discussion points from review rounds 1&2. Table S1. Description of expert panelists (n = 8) for identification of content domains of delirium severity in ADRD patients. Table S2. Key discussion points from expert review round 1. Table S3. Expert panel sample qualitative comments on delirium domains and subdomains across rounds of review. Table S4. Discussion of excluded domains from expert review round 2. Byline: Dena Schulman-Green, Tammy Hshieh, Dimitrios Adamis, Michael S. Avidan, Dan G. Blazer, Donna M. Fick, Esther Oh, Alessandro Morandi, Catherine Price, Joe Verghese, Eva M. Schmitt, Richard N. Jones, Sharon K. Inouye,