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The Journals of Gerontology. Series A,... Nov 2022
Topics: Humans; Delirium
PubMed: 35943887
DOI: 10.1093/gerona/glac163 -
Current Opinion in Supportive and... Sep 2014Our review focuses on recent developments across many settings regarding the diagnosis, screening and management of delirium, so as to inform these aspects in the... (Review)
Review
PURPOSE OF REVIEW
Our review focuses on recent developments across many settings regarding the diagnosis, screening and management of delirium, so as to inform these aspects in the context of palliative and supportive care.
RECENT FINDINGS
Delirium diagnostic criteria have been updated in the long-awaited Diagnostic Statistical Manual of Mental Disorders, fifth edition. Studies suggest that poor recognition of delirium relates to its clinical characteristics, inadequate interprofessional communication and lack of systematic screening. Validation studies are published for cognitive and observational tools to screen for delirium. Formal guidelines for delirium screening and management have been rigorously developed for intensive care, and may serve as a model for other settings. Given that palliative sedation is often required for the management of refractory delirium at the end of life, a version of the Richmond Agitation-Sedation Scale, modified for palliative care, has undergone preliminary validation.
SUMMARY
Although formal systematic delirium screening with brief but sensitive tools is strongly advocated for patients in palliative and supportive care, it requires critical evaluation in terms of clinical outcomes, including patient comfort. Randomized controlled trials are needed to inform the development of guidelines for the management of delirium in this setting.
Topics: Antipsychotic Agents; Clinical Protocols; Delirium; Disease Management; Humans; Hypnotics and Sedatives; Palliative Care; Practice Guidelines as Topic; Risk Factors
PubMed: 25004177
DOI: 10.1097/SPC.0000000000000062 -
Clinics in Geriatric Medicine Nov 2023This article covers the epidemiology of delirium and the overlapping condition of altered mental status and encephalopathy that is relevant to those who practice in the... (Review)
Review
This article covers the epidemiology of delirium and the overlapping condition of altered mental status and encephalopathy that is relevant to those who practice in the emergency department.
Topics: Humans; Delirium; Emergency Service, Hospital
PubMed: 37798064
DOI: 10.1016/j.cger.2023.05.006 -
Deutsches Arzteblatt International Mar 2022Delirium is a common and serious complication of inpatient hospital care in older patients. The current approaches to prevention and treatment followed in German...
BACKGROUND
Delirium is a common and serious complication of inpatient hospital care in older patients. The current approaches to prevention and treatment followed in German hospitals are inconsistent. The aim of this study was to test the effectiveness of a standardized multiprofessional approach to the management of delirium in inpatients.
METHODS
The patients included in the study were all >65 years old, were treated for at least 3 days on an internal medicine, trauma surgery, or orthopedic ward at Münster University Hospital between January 2016 and December 2017, and showed cognitive deficits on standardized screening at the time of admission (a score of ≤=25 on the Montreal Cognitive Assessment [MoCA] test). Patients in the intervention group received standardized delirium prevention and treatment measures; those in the control group did not. The primary outcomes measured were the incidence and duration of delirium during the hospital stay; the secondary outcomes measured were cognitive deficits relevant to daily living at 12 months after discharge (MoCA and Instrumental Activities of Daily Living [I-ADL]).
RESULTS
The data of 772 patients were analyzed. Both the rate and the duration of delirium were lower in the intervention group than in the control group (6.8% versus 20.5%, odds ratio 0.28, 95% confidence interval [0.18; 0.45]; 3 days [interquartile range, IQR 2-4] versus 6 days [IQR 4-8]). A year after discharge, the patients with delirium in the intervention group showed fewer cognitive deficits relevant to daily living than those in the control group (I-ADL score 2.5 [IQR 2-4] versus 1 [IQR 1-2], P = 0.02).
CONCLUSION
Structured multiprofessional management reduces the incidence and duration of delirium and lowers the number of lasting cognitive deficits relevant to daily living after hospital discharge.
Topics: Activities of Daily Living; Aged; Delirium; Hospitalization; Hospitals; Humans; Length of Stay
PubMed: 35197189
DOI: 10.3238/arztebl.m2022.0131 -
Anaesthesia Jan 2022Delirium is a common condition affecting hospital inpatients, including those having surgery and on the intensive care unit. Delirium is also common in patients with... (Review)
Review
Delirium is a common condition affecting hospital inpatients, including those having surgery and on the intensive care unit. Delirium is also common in patients with COVID-19 in hospital settings, and the occurrence is higher than expected for similar infections. The short-term outcomes of those with COVID-19 delirium are similar to that of classical delirium and include increased length of stay and increased mortality. Management of delirium in COVID-19 in the context of a global pandemic is limited by the severity of the syndrome and compounded by the environmental constraints. Practical management includes effective screening, early identification and appropriate treatment aimed at minimising complications and timely escalation decisions. The pandemic has played out on the national stage and the effect of delirium on patients, relatives and healthcare workers remains unknown but evidence from the previous SARS outbreak suggests there may be long-lasting psychological damage.
Topics: Brain; COVID-19; Delirium; Health Personnel; Humans; Inflammation Mediators; Intensive Care Units
PubMed: 35001383
DOI: 10.1111/anae.15627 -
BMC Neurology Mar 2022Delirium is a common disorder affecting around 31% of patients in the intensive care unit (ICU). Delirium assessment scores such as the Confusion Assessment Method (CAM)... (Review)
Review
BACKGROUND
Delirium is a common disorder affecting around 31% of patients in the intensive care unit (ICU). Delirium assessment scores such as the Confusion Assessment Method (CAM) are time-consuming, they cannot differentiate between different types of delirium and their etiologies, and they may have low sensitivities in the clinical setting. While today, electroencephalography (EEG) is increasingly being applied to delirious patients in the ICU, a lack of clear cut EEG signs, leads to inconsistent assessments.
METHODS
We therefore conducted a scoping review on EEG findings in delirium. One thousand two hundred thirty-six articles identified through database search on PubMed and Embase were reviewed. Finally, 33 original articles were included in the synthesis.
RESULTS
EEG seems to offer manifold possibilities in diagnosing delirium. All 33 studies showed a certain degree of qualitative or quantitative EEG alterations in delirium. Thus, normal routine (rEEG) and continuous EEG (cEEG) make presence of delirium very unlikely. All 33 studies used different research protocols to at least some extent. These include differences in time points, duration, conditions, and recording methods of EEG, as well as different patient populations, and diagnostic methods for delirium. Thus, a quantitative synthesis and common recommendations are so far elusive.
CONCLUSION
Future studies should compare the different methods of EEG recording and evaluation to identify robust parameters for everyday use. Evidence for quantitative bi-electrode delirium detection based on increased relative delta power and decreased beta power is growing and should be further pursued. Additionally, EEG studies on the evolution of a delirium including patient outcomes are needed.
Topics: Delirium; Electroencephalography; Humans; Intensive Care Units
PubMed: 35277128
DOI: 10.1186/s12883-022-02557-w -
International Psychogeriatrics Aug 2023We examined whether preadmission history of depression is associated with less delirium/coma-free (DCF) days, worse 1-year depression severity and cognitive impairment.
OBJECTIVES
We examined whether preadmission history of depression is associated with less delirium/coma-free (DCF) days, worse 1-year depression severity and cognitive impairment.
DESIGN AND MEASUREMENTS
A health proxy reported history of depression. Separate models examined the effect of preadmission history of depression on: (a) intensive care unit (ICU) course, measured as DCF days; (b) depression symptom severity at 3 and 12 months, measured by the Beck Depression Inventory-II (BDI-II); and (c) cognitive performance at 3 and 12 months, measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) global score.
SETTING AND PARTICIPANTS
Patients admitted to the medical/surgical ICU services were eligible.
RESULTS
Of 821 subjects eligible at enrollment, 261 (33%) had preadmission history of depression. After adjusting for covariates, preadmission history of depression was not associated with less DCF days (OR 0.78, 95% CI, 0.59-1.03 = 0.077). A prior history of depression was associated with higher BDI-II scores at 3 and 12 months (3 months OR 2.15, 95% CI, 1.42-3.24 = <0.001; 12 months OR 1.89, 95% CI, 1.24-2.87 = 0.003). We did not observe an association between preadmission history of depression and cognitive performance at either 3 or 12 months (3 months beta coefficient -0.04, 95% CI, -2.70-2.62 = 0.97; 12 months 1.5, 95% CI, -1.26-4.26 = 0.28).
CONCLUSION
Patients with a depression history prior to ICU stay exhibit a greater severity of depressive symptoms in the year after hospitalization.
Topics: Humans; Delirium; Depression; Prospective Studies; Risk Factors; Intensive Care Units; Cognition
PubMed: 34763741
DOI: 10.1017/S1041610221002556 -
Alzheimer's & Dementia : the Journal of... Jan 2024Delirium, a common syndrome with heterogeneous etiologies and clinical presentations, is associated with poor long-term outcomes. Recording and analyzing all delirium...
BACKGROUND
Delirium, a common syndrome with heterogeneous etiologies and clinical presentations, is associated with poor long-term outcomes. Recording and analyzing all delirium equally could be hindering the field's understanding of pathophysiology and identification of targeted treatments. Current delirium subtyping methods reflect clinically evident features but likely do not account for underlying biology.
METHODS
The Delirium Subtyping Initiative (DSI) held three sessions with an international panel of 25 experts.
RESULTS
Meeting participants suggest further characterization of delirium features to complement the existing Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision diagnostic criteria. These should span the range of delirium-spectrum syndromes and be measured consistently across studies. Clinical features should be recorded in conjunction with biospecimen collection, where feasible, in a standardized way, to determine temporal associations of biology coincident with clinical fluctuations.
DISCUSSION
The DSI made recommendations spanning the breadth of delirium research including clinical features, study planning, data collection, and data analysis for characterization of candidate delirium subtypes.
HIGHLIGHTS
Delirium features must be clearly defined, standardized, and operationalized. Large datasets incorporating both clinical and biomarker variables should be analyzed together. Delirium screening should incorporate communication and reasoning.
Topics: Humans; Delirium; Research Design; Data Collection; Diagnostic and Statistical Manual of Mental Disorders
PubMed: 37522255
DOI: 10.1002/alz.13419 -
European Neurology 2023In the elderly, the association of delirium and dementia can cause diagnostic problems because they share the same symptom of confusion. Delirium is often misdiagnosed... (Review)
Review
BACKGROUND
In the elderly, the association of delirium and dementia can cause diagnostic problems because they share the same symptom of confusion. Delirium is often misdiagnosed as dementia and treated inappropriately, ignoring that it could be successfully addressed, which can lead to increased health risks up to death.
SUMMARY
Confusion indicates that functional reserve fails to compensate for the action of stressors. The decline in reserve is linked to aging-related changes in blood flow, mitochondria, cerebrospinal fluid, and immune function, as well as the appearance of structural precursors of disease. It is greater in dementia that adds a large burden of pathology, especially degenerative and vascular.
KEY MESSAGES
Based on their common background linking normal and pathological brain aging, it can be argued that delirium and dementia are always associated to some extent and can aggravate each other. The clinical approach to their association, which currently relies on the preliminary diagnosis of delirium according to ad hoc protocols, could be simplified by taking delirium for granted so that its causative stressors, usually the most common diseases of old age and/or drug abuse, could be addressed immediately. This approach would benefit all demented patients: not only those who are in such a serious condition that they need to be hospitalized due to the risk of death, but also those with clouded delirium.
Topics: Humans; Aged; Dementia; Delirium; Aging
PubMed: 36958295
DOI: 10.1159/000530226 -
Journal of the American College of... Feb 2015
Topics: Aged; Aged, 80 and over; Delirium; Humans; Perioperative Care; Postoperative Complications; Risk Assessment; Risk Factors
PubMed: 25535170
DOI: 10.1016/j.jamcollsurg.2014.10.019