• Christine Thomas, Stefan H Kreisel, Peter Oster, Martin Driessen, Volker Arolt, and Sharon K Inouye.
• Department of Geriatric Psychiatry, Centre of Psychiatry and Psychotherapy, Ev. Hospital Bielefeld-Bethel, Bielefeld, Germany. Christine.Thomas@evkb.de
• J Am Geriatr Soc. 2012 Aug 1;60(8):1471-7.

ObjectivesTo compare performance characteristics of the Confusion Assessment Method (CAM) algorithm for screening and delirium diagnosis with criteria for delirium from the International Classification of Diseases, Tenth Revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) in high-risk individuals.DesignProspective cohort study.SettingAcademic geriatric hospital.ParticipantsOne hundred two individuals aged 80 to 100 hospitalized for acute medical illness.MeasurementsComplete CAM instrument (nine items), scored using the four-item CAM diagnostic algorithm. Criterion standard classification of delirium was rated independently according to expert consensus based on DSM-IV and ICD-10 criteria for delirium.ResultsIn 79 hospitalized participants, the CAM performed well for delirium screening (delirium prevalence of 24% according to DSM-IV and 14% according to ICD-10). Of all CAM features, acute onset and fluctuating course are most important for diagnosis (area under the receiver operating characteristic curve (AUC) = 0.92 in DSM-IV and 0.83 in ICD-10). The CAM diagnostic algorithm had a sensitivity of 0.74, a specificity of 1.0, and an AUC of 0.88 compared with the DSM-IV reference standard and a sensitivity of 0.82, a specificity of 0.91, and an AUC of 0.85 compared with the ICD-10. Compared with the ICD-10, adding psychomotor change to the CAM algorithm improved specificity to 97%, but sensitivity fell to 55% (AUC = 0.96). Applying psychomotor change sequentially only to the group that the CAM algorithm identified as having no delirium improved sensitivity to 91% with specificity of 85% (AUC = 0.95).ConclusionAlthough the CAM diagnostic algorithm performed well against a DSM-IV reference standard, adding psychomotor change to the CAM algorithm improved specificity and diagnostic value against ICD-10 criteria overall in older adults with dementia and improved sensitivity and screening performance when applied sequentially in CAM-negative individuals.© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

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