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Delirium is common in older patients admitted to hospital. Information obtained from patient's relatives or caregivers may contribute to improved detection. Our aim was to develop a caregiver based questionnaire, the Informant Assessment of Geriatric Delirium (I-AGeD), to assist in better recognition of delirium in elderly patients.A cross-sectional observational study using a scale construction patient cohort and two validation cohorts was conducted at geriatric departments of two teaching hospitals in The Netherlands. Delirium status, based on DSM-IV criteria, was assessed directly on admission by a geriatric resident and evaluated within the first 48 h of admission. Caregivers filled out a 37-item questionnaire of which 10 items were selected reflecting delirium symptoms, based on their discriminatory abilities, internal consistency and inter-item correlations.A total of 88 patients with complete study protocols in the construction cohort were included. Average age was 86.4 (SD 8.5), and 31/88 patients had delirium on admission. Internal consistency of the 10-item I-AGeD was high (Cronbach's alpha = 0.85). At a cut-off score of4 sensitivity was 77.4% and specificity 63.2%. In patients without dementia, sensitivity was 100% and specificity 65.2%. Validation occurred by means of two validation cohorts, one consisted of 59 patients and the other of 33 patients. Sensitivity and specificity in these samples ranged from 70.0% to 88.9% and 66.7% to 100%, respectively.The newly constructed caregiver based I-AGeD questionnaire is a valid screening instrument for delirium on admission to hospital in geriatric patients.

Delirium is a common neuropsychiatric disorder with wide ranging symptoms and significant morbid impact. Disturbances of motor behavior are an important feature of delirium and form the basis for the most commonly studied clinical subtype. This article reviews the relevance of motoric disturbance to delirium phenomenology and discusses possible neurobiological causes for different presentations of motor behavior in delirium. Evidence is presented to support the usefulness of using motorically defined subtypes based on identified differences according to underlying origins, pathophysiologies, responsiveness to therapy and natural course. Methodological issues relating to motoric subtype studies are addressed and suggestions for future research are made.

Three-dimensional interactive display of CT data from 23 cases of craniofacial and spinal pathology using a solids processing computer system was compared with conventional two-dimensional CT display. Three-dimensional display gave a more complete perspective of complex displacement patterns of facial and spinal fractures, and more clearly defined surface anatomy of osseous tumors and malformations. In 7 cases however, processing algorithms for three-dimensional display caused subtle anatomic features and non-displaced fractures to be obscured. These false negatives were clinically significant in cases of petrous bone pathology and in non-displaced spinal fractures that affected stability.