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Commentary on Richardson et al. detecting delirium superimposed on dementia: diagnostic accuracy of a simple combined arousal and attention testing procedure

Published online by Cambridge University Press:  29 August 2017

Ravi Bhat ,
Nicola T. Lautenschlager  and
Rosie Watson
Ravi Bhat*
Affiliation:
Department of Rural Health, Melbourne Medical School, The University of Melbourne, Shepparton, Australia
Nicola T. Lautenschlager
Affiliation:
Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia NorthWestern Mental Health, Melbourne Health, Melbourne, Victoria, Australia
Rosie Watson
Affiliation:
Royal Melbourne Hospital, Melbourne, Australia The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
*
Email: rbhat@unimelb.edu.au
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Extract

Consciousness consists of two components: arousal and awareness of the environment and self. Arousal refers to the behavioral continuum that occurs between sleep and wakefulness, while awareness to the content of consciousness (Laureys, 2014). In normal physiological states, with the exception of REM sleep, the level of arousal is positively correlated with awareness (Laureys, 2014) such that arousal is graded and measured by the degree to which it is diminished. This conceptualization appears to have led experts, including the DSM-5, to consider delirium as a condition to not associated with impairments in arousal (Schiff and Plum, 2000, American Psychiatric Association, 2013). However, arousal can be both diminished and heightened, not unlike the performance of an old-fashioned incandescent bulb at different voltages, giving barely sufficient light at low voltages and brightening up unbearably at high voltages (MacIsaac et al., 1999). Delirium is associated with both hypo-arousal and hyper-arousal (Han et al., 2017). A small but significant proportion of delirious older patients (10%; n = 155) in the emergency department in this study had normal arousal at the time of the short arousal assessment (Han et al., 2014).

Type
Commentary
Information
International Psychogeriatrics , Volume 29 , Issue 10 , October 2017 , pp. 1583 - 1584
Copyright
Copyright © International Psychogeriatric Association 2017 

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