Table 2 Classification performance for delirium diagnostic systems and their individual criteria as compared to cluster analysis-defined groups
Classification Systems and their Criteria | Whole sample (n = 200) | Dementia subsample (n = 117) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Sensitivity % | 95 % CI | Specificity % | 95 % CI | Accuracy % | 95 % CI | Sensitivity % | 95 % CI | Specificity % | 95 % CI | Accuracy % | 95 % CI | |
DSM-III-R | 81.6 | 67.5–90.8 | 89.4 | 83.1–93.6 | 87.5 | 81.9–91.6 | 78.0 | 62.0–88.9 | 86.8 | 76.7–93.2 | 83.8 | 75.5–89.7 |
A Alteration to maintain and shift attention | 85.7 [81.6] | 72.1–93.6 | 84.1 [89.4] | 77.1–89.4 | 84.5 [87.5] | 78.6–89.1 | 82.9 [78.0] | 67.3–92.3 | 78.9 [86.8] | 67.8–87.1 | 80.3 [83.8] | 71.8–86.9 |
B Disorganized thinking | 89.8 [81.6] | 77.0–96.2 | 79.5 [87.4] | 72.0–85.4 | 82.0 [86.0] | 75.8–86.9 | 87.8 [78.0] | 73.0–95.4 | 68.4 [85.5] | 56.6–78.3 | 75.2 [82.9] | 66.2–82.5 |
C Alterations in two of: consciousness, perception, sleep – wake cycle, motor activity, orientation and memory. | 100 [81.6] | 90.9–99.8 | 43.7 [89.4] | 35.7–52.0 | 57.5 [87.5] | 50.3–64.4 | 100 [78.0] | 89.3–99.8 | 18.4 [86.8] | 10.8–29.3 | 47.0 [83.8] | 37.8–56.4 |
D Acute onset and fluctuation tendency. | 81.6 [83.7] | 67.5–90.8 | 87.4 [88.1] | 80.8–92.1 | 86.0 [87.0] | 80.2–90.3 | 78.0 [80.5] | 62.0–88.9 | 85.5 [84.2] | 75.1–92.2 | 82.9 [82.9] | 74.6–89.0 |
E Evidenced or presumed etiological cause. | 83.7 [81.6] | 69.8–92.2 | 80.8 [89.4] | 73.4–86.6 | 81.5 [87.5] | 75.3–86.5 | 80.5 [78.0] | 64.6–90.6 | 78.9 [86.8] | 67.8–87.1 | 79.5 [83.8] | 70.8–86.2 |
DSM-IV | 71.4 | 56.5–83.0 | 90.7 | 84.6–94.6 | 86.0 | 80.2–90.3 | 65.9 | 49.3–79.4 | 90.8 | 81.4–95.9 | 82.1 | 73.6–88.3 |
A Disturbance of consciousness and attention | 83.7 [73.5] | 69.8–92.2 | 87.4 [88.7] | 80.8–92.1 | 86.5 [85.0] | 80.8–90.8 | 80.5 [68.3] | 64.6–90.6 | 84.2 [88.2] | 73.6–91.2 | 82.9 [81.2] | 74.6–89.0 |
B Cognition alteration or perceptual disturbance, not explained by a dementia. | 83.7 [73.5] | 69.8–92.2 | 80.1 [90.7] | 72.7–86.0 | 81.0 [86.5] | 74.7–86.0 | 80.5 [68.3] | 64.6–90.6 | 78.9 [90.8] | 67.8–87.1 | 79.5 [82.9] | 70.8–86.2 |
C Acute onset and fluctuation tendency. | 83.7 [71.4] | 69.8–92.2 | 88.1 [89.4] | 81.6–92.6 | 87.0 [85.0] | 81.3–91.2 | 80.5 [65.9] | 64.6–90.6 | 86.8 [88.2] | 76.7–93.2 | 84.6 [80.3] | 76.5–90.4 |
D Evidence for etiology. | 75.5 [79.6] | 60.8–86.2 | 81.5 [90.7] | 74.1–87.1 | 80.0 [88.0] | 73.6–85.2 | 70.7 [75.6] | 54.3–83.3 | 80.3 [90.8] | 69.2–88.2 | 76.9 [85.5] | 68.0–84.0 |
DSM-5 | 73.5 | 58.7–84.6 | 88.1 | 81.6–92.6 | 84.5 | 78.6–89.1 | 68.3 | 51.8–81.4 | 86.8 | 76.7–93.2 | 80.3 | 71.8–86.9 |
A Disturbance in attention and awareness. | 85.7 [73.5] | 72.1–93.6 | 86.1 [88.1] | 79.3–91.0 | 86.0 [84.5] | 80.2–90.3 | 82.9 [68.3] | 67.3–92.3 | 82.9 [86.8] | 72.2–90.2 | 82.9 [80.3] | 74.6–89.0 |
B Acute onset and fluctuation tendency. | 83.7 [73.5] | 69.8–92.2 | 88.1 [86.8] | 81.6–92.6 | 87.0 [83.5] | 81.3–91.2 | 80.5 [68.3] | 64.6–90.6 | 86.8 [84.2] | 76.7–93.2 | 84.6 [78.6] | 76.5–90.4 |
C Additional cognitive change or perception disturbance. | 98.0 [73.5] | 87.8–99.9 | 36.4 [88.1] | 28.9–44.7 | 51.5 [84.5] | 44.4–58.6 | 97.6 [68.3] | 85.6–99.9 | 14.5 [86.8] | 7.8–24.8 | 43.6 [80.3] | 34.5–53.1 |
D No better explanation by another neurocognitive disorder nor reduced level of arousal. | 81.6 [75.5] | 67.5–90.8 | 84.1 [88.1] | 77.1–89.4 | 83.5 [85.0] | 77.5–88.2 | 78.0 [70.7] | 62.0–88.9 | 82.9 [86.8] | 72.2–90.2 | 81.2 [81.2] | 72.7–87.6 |
E Evidence for etiology. | 75.5 [81.6] | 60.8–86.2 | 81.5 [88.1] | 74.1–87.1 | 80.0 [86.5] | 73.6–85.2 | 70.7 [78.0] | 54.3–83.3 | 80.3 [86.8] | 69.2–88.2 | 76.9 [83.8] | 68.0–84.0 |
ICD-10 | 53.1 | 38.4–67.2 | 96.0 | 91.2–98.4 | 85.5 | 79.7–89.9 | 48.8 | 33.1–64.6 | 93.4 | 84.7–97.5 | 77.8 | 69.0–84.7 |
A Clouding of consciousness and attention alteration. | 81.6 [55.1] | 67.5–90.8 | 90.1 [94.0] | 83.9–94.1 | 88.0 [84.5] | 82.5–92.0 | 78.0 [51.2] | 62.0–88.9 | 88.2 [90.8] | 78.2–94.1 | 84.6 [76.9] | 76.5–90.4 |
B Disturbance of cognition (memory and orientation). | 98.0 [55.1] | 87.8–99.9 | 49.0 [96.0] | 40.8–57.2 | 61.0 [86.0] | 53.8–67.7 | 97.6 [51.2] | 85.6–99.9 | 22.4 [93.4] | 13.9–33.6 | 48.7 [78.6] | 39.4–58.1 |
C One psychomotor disturbance (shifts from hypo to hyperactivity, reaction time increased, speech increased /decreased, enhanced startle reaction) | 95.9 [53.1] | 84.9–99.3 | 66.2 [96.0] | 58.0–73.6 | 73.5 [85.5] | 66.7–79.4 | 95.1 [48.8] | 82.2–99.1 | 57.9 [93.4] | 46.0–68.9 | 70.9 [77.8] | 61.7–78.8 |
D Sleep-wake alteration (includes nocturnal worsening and hypnopompic disturbances) | 71.4 [67.3] | 56.5–83.0 | 72.2 [92.7] | 64.2–79.0 | 72.0 [86.5] | 65.1–78.0 | 70.7 [63.4] | 54.3–83.3 | 61.8 [92.1] | 49.9–72.5 | 65.0 [82.1] | 55.5–73.4 |
E Rapid onset and fluctuations. | 77.6 [53.1] | 63.0–87.7 | 89.4 [95.4] | 83.1–93.6 | 86.5 [85.0] | 80.8–90.8 | 75.6 [48.8] | 59.4–87.1 | 88.2 [92.1] | 78.2–94.1 | 83.8 [76.9] | 75.5–89.7 |
F Evidence for an etiologic cause. | 77.6 [59.2] | 63.0–87.7 | 80.1 [96.0] | 72.7–86.0 | 79.5 [87.0] | 73.1–84.7 | 73.2 [56.1] | 56.8–85.2 | 76.3 [93.4] | 64.9–85.0 | 75.2 [80.3] | 66.2–82.5 |