• A J Treloar and A J Macdonald.
• Section of Old Age Psychiatry, United Medical and Dental Schools (Guy's) Bexley, UK.
• Int J Geriatr Psychiatry. 1997 Jun 1;12(6):609-13.

ObjectiveTo study performance of DSM-III-R, ICD-10 and CAMDEX diagnoses of delirium as predictors of improvement in mental state in survivors, and to develop a brief rating scale which will predict reversibility of cognitive dysfunction.DesignProspective cohort study.SettingAcute geriatric inpatient units.PatientsA random sample of consecutive acute admissions of patients over the age of 65 (N = 80).Main MeasurementsSerial assessments of mental state and cognitive function and observational data. Establishment of DSM-III-R, ICD-10, CAMDEX diagnoses.Outcome MeasurePatients with more than five points of 20% improvement in Mini Mental State Examination following the most severely impaired assessment operationally designated 'reversible cognitive dysfunction'.Main ResultsDiagnoses of delirium by DSM-III-R and ICD-10 do not predict improvement in cognitive function well; CAMDEX does rather better. Discriminant function analysis yielded the Reversible Cognitive Dysfunction Scale (RCDS), a simple clinical scale which accurately predicted improvement. This comprised reduced conscious level, poor attention, poor contact with the patient, incoherent speech, reduced psychomotor activity, lack of awareness of surroundings and poor orientation and memory.ConclusionsThe concept of and diagnostic criteria for delirium should be reconsidered. The RCDS merits further evaluation.

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