Delirium Bibliography

The searchable delirium bibliography page is one of our most popular features, allowing you to quickly gain access to the literature on delirium and acute care of older persons.  The HELP team keeps it updated for you on a monthly basis!  Feel free to search by author, title, keywords. It is primarily intended for clinicians and researchers interested in exploring these topics.

Each article is indexed by keywords taken from MEDLINE and other relevant databases.

You may base your search on as many search terms as you like. A search term can be a keyword, an author's name, all or part of an article's title, or any word or phrase that you might expect to find in an article's abstract. You may then indicate whether you would like to limit the search to one or more options.

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You may further restrict to a topic category. Note: If you do not enter any search terms, the results will include all of the entries for the selected topic category.

More information about each entry on this page is available by moving the mouse over the green information symbols.

Please note that Pub Med Central (PMC) full text links are provided wherever available.  However, due to copyright restrictions, only abstracts can be provided for articles not available in PMC.

Total Results: 2405

  • Validation of the 4AT questionnaire in the emergency department 2017 Gagné, A. Voyer, P. Boucher, V. Pelletier, M. Gouin, E. Berthelot, S. Daoust, R. Laguë, A. Bédard, C. Émond, M.. Canadian Journal of Emergency Medicine,
    • Title

      Validation of the 4AT questionnaire in the emergency department

    • Authors
      Gagné, A. Voyer, P. Boucher, V. Pelletier, M. Gouin, E. Berthelot, S. Daoust, R. Laguë, A. Bédard, C. Émond, M.
    • Year
      2017
    • Journal
      Canadian Journal of Emergency Medicine
    • URL
    • Abstract
      Introduction: Delirium is a very prevalent cognitive impairment in elderly inpatients, but it often goes undetected, especially in the emergency department (ED). The tools currently available to screen or diagnose patients at risk of delirium are very time-consuming and are impossible to systematically perform in the ED environment. For this reason, short tests are necessary to screen for delirium in this fast-paced setting. The objective of this study was to evaluate the performance of the French version of the Rapid Assessment Test for Delirium (4AT) for the detection of delirium and cognitive impairment in older patients. The 4AT takes less than 2 minutes to administer, which is a great advantage on the others tests. Methods: The study was conducted in four emergency departments across the province of Québec. Participants were independent or semi-independent patients aged 65 and older, admitted to hospital and who had an 8-hour exposure to the ED. The Telephone Interview for Cognitive Status (TICS) was administered at the initial interview and the Confusion Assessment Method (CAM) as well as the 4AT were administered to patients twice a day during their ED or hospital stay. The 4AT's sensitivity and specificity were compared to that of the CAM (for delirium), and to that of the TICS (for cognitive impairment). Results: 324 patients were included in the study, with a mean age of 76 years old. Among the recruited participants, 21 (6.5%) had a prevalent delirium according to the CAM, and 30 (10.2%) had an incident delirium. According to the 4AT, 48 patients (14.9%) had cognitive impairment and 81 (25.2%) had a prevalent delirium. According to the TICS, 87 patients (29.2%) have cognitive impairment. The 4AT has a sensitivity of 68,4% (IC 95% : 47,5-89,3) and a specificity of 73.2% (IC 95% : 67,8-78,7) for delirium, and a sensitivity of 50% (IC 95% : 35,9- 64,1) and a specificity of 87,0% (IC 95% : 81,2-92) for cognitive impairment. Conclusion: The French Version of the 4AT could be a fast and reliable screening tool for delirium and cognitive impairment in ED. Further research is necessary for its validation in the ED.
    • PubMed ID
  • Incidence, prognostic factors and impact of postoperative delirium after major vascular surgery: A meta-analysis and systematic review. 2017 Aitken, S. J. Blyth, F. M. Naganathan, V.. Vasc Med, 22:5 (387-97)
    • Title

      Incidence, prognostic factors and impact of postoperative delirium after major vascular surgery: A meta-analysis and systematic review.

    • Authors
      Aitken, S. J. Blyth, F. M. Naganathan, V.
    • Year
      2017
    • Journal
      Vasc Med
    • URL
    • Abstract
      Although postoperative delirium is a common complication and increases patient care needs, little is known about the predictors and outcomes of delirium in patients having vascular surgery. This review aimed to determine the incidence, prognostic factors and impact of postoperative delirium in vascular surgical patients. MEDLINE and EMBASE were systematically searched for articles published between January 2000 and January 2016 on delirium after vascular surgery. The primary outcome was the incidence of delirium. Secondary outcomes were contributing prognostic factors and impact of delirium. Study quality and risk of bias was assessed using the QUIPS tool for systematic reviews of prognostic studies, and MOOSE guidelines for reviews of observational studies. Quantitative analyses of extracted data were conducted using meta-analysis where possible to determine incidence of delirium and prognostic factors. A qualitative review of outcomes was performed. Fifteen articles were eligible for inclusion. Delirium incidence ranged between 5% and 39%. Meta-analysis found that patients with delirium were older than those without delirium (OR 3.6, p<0.001). Prognostic factors predicting delirium included increased age (OR 1.04, p<0.001), pre-existing cognitive impairment (OR 9.8, p=0.01), hypertension, pre-existing depression and open aortic surgery. Delirious patients remained in hospital 6 days longer ( p<0.001) and had more complications than patients without delirium. Data were limited on the impact of procedure complexity, endovascular compared to open surgery or type of anaesthetic. Postoperative delirium occurs frequently, resulting in major morbidity for vascular patients. Improved quality of prognostic studies may identify modifiable peri-operative factors to improve quality of care for vascular surgical patients.
    • PubMed ID
  • Altered cortical brain activity in end stage liver disease assessed by multi-channel near-infrared spectroscopy: Associations with delirium. 2017 Yoshimura, A. Goodson, C. Johns, J. T. Towe, M. M. Irvine, E. S. Rendradjaja, N. A. Max, L. K. LaFlam, A. Ledford, E. C. Probert, J. Tieges, Z. Edwin, D. H. MacLullich, A. M. J. Hogue, C. W. Lindquist, M. A. Gurakar, A. Neufeld, K. J. Kamiya, A.. Sci Rep, 7:1
    • Title

      Altered cortical brain activity in end stage liver disease assessed by multi-channel near-infrared spectroscopy: Associations with delirium.

    • Authors
      Yoshimura, A. Goodson, C. Johns, J. T. Towe, M. M. Irvine, E. S. Rendradjaja, N. A. Max, L. K. LaFlam, A. Ledford, E. C. Probert, J. Tieges, Z. Edwin, D. H. MacLullich, A. M. J. Hogue, C. W. Lindquist, M. A. Gurakar, A. Neufeld, K. J. Kamiya, A.
    • Year
      2017
    • Journal
      Sci Rep
    • URL
    • Abstract
      Delirium is a common and serious psychiatric syndrome caused by an underlying medical condition. It is associated with significant mortality and increased healthcare resource utilization. There are few biological markers of delirium, perhaps related to the etiologic heterogeneity of the syndrome. Functional near-infrared spectroscopy (fNIRS) is an optical topography system to measure changes in the concentration of oxygenated hemoglobin ([oxy-Hb]) in the cerebral cortex. We examined whether altered cortical brain activity in delirious patients with end stage liver disease (ESLD) is detected by fNIRS. We found that the [oxy-Hb] change during the verbal fluency task (VFT) was reduced in patients with ESLD compared with healthy controls (HC) in the prefrontal and bi-temporal regions. The [oxy-Hb] change during the sustained attention task (SAT) was elevated in patients with ESLD compared to HC in the prefrontal and left temporal regions. Notably, [oxy-Hb] change in the left dorsolateral prefrontal cortex during SAT showed a positive correlation with the severity of delirium. Our results suggest that [oxy-Hb] change in the prefrontal cortex during the sustained attention task measured with fNIRS might serve as a biological marker associated with delirium in ESLD patients.
    • PubMed ID
  • Comprehensive geriatric care reduces acute perioperative delirium in elderly patients with hip fractures: A meta-analysis. 2017 Wang, Y. Tang, J. Zhou, F. Yang, L. Wu, J.. Medicine, 96:26
    • Title

      Comprehensive geriatric care reduces acute perioperative delirium in elderly patients with hip fractures: A meta-analysis.

    • Authors
      Wang, Y. Tang, J. Zhou, F. Yang, L. Wu, J.
    • Year
      2017
    • Journal
      Medicine
    • URL
    • Abstract
      BACKGROUND: The aim of the current meta-analysis was to assess the treatment effect of comprehensive geriatric care in reducing acute perioperative delirium in older patients with hip fractures, compared with the effect of a routine orthopedic treatment protocol. METHODS: We conducted a search of multiple databases to identify randomized controlled trials (RCTs) and quasi-RCTs comparing comprehensive geriatric care and routine orthopedic treatment regarding the following outcomes: incidence of delirium, assessment of cognitive status, and duration of delirium. Odds ratios (ORs) and mean differences (MDs) were pooled using either a fixed-effects or a random-effects model, depending on the heterogeneity of the trials included in the analysis. RESULTS: Six RCTs and 1 quasi-RCT provided data from 1840 patients. These data revealed that comprehensive geriatric care may reduce the incidence of perioperative delirium (OR = 0.71; 95% confidence interval [CI], 0.57-0.89; P = .003) and that it was associated with higher cognitive status during hospitalization or at 1 month postoperatively (MD = 1.03; 95% CI, 0.93-1.13; P
    • PubMed ID
  • Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients: An interrupted time series analysis. 2017 van de Pol, I. van Iterson, M. Maaskant, J.. Intensive Crit Care Nurs, (18-25)
    • Title

      Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients: An interrupted time series analysis.

    • Authors
      van de Pol, I. van Iterson, M. Maaskant, J.
    • Year
      2017
    • Journal
      Intensive Crit Care Nurs
    • URL
    • Abstract
      INTRODUCTION: Delirium in critically-ill patients is a common multifactorial disorder that is associated with various negative outcomes. It is assumed that sleep disturbances can result in an increased risk of delirium. This study hypothesized that implementing a protocol that reduces overall nocturnal sound levels improves quality of sleep and reduces the incidence of delirium in Intensive Care Unit (ICU) patients. METHODS: This interrupted time series study was performed in an adult mixed medical and surgical 24-bed ICU. A pre-intervention group of 211 patients was compared with a post-intervention group of 210 patients after implementation of a nocturnal sound-reduction protocol. Primary outcome measures were incidence of delirium, measured by the Intensive Care Delirium Screening Checklist (ICDSC) and quality of sleep, measured by the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcome measures were use of sleep-inducing medication, delirium treatment medication, and patient-perceived nocturnal noise. RESULTS: A significant difference in slope in the percentage of delirium was observed between the pre- and post-intervention periods (-3.7% per time period, p=0.02). Quality of sleep was unaffected (0.3 per time period, p=0.85). The post-intervention group used significantly less sleep-inducing medication (p<0.001). Nocturnal noise rating improved after intervention (median: 65, IQR: 50-80 versus 70, IQR: 60-80, p=0.02). CONCLUSIONS: The incidence of delirium in ICU patients was significantly reduced after implementation of a nocturnal sound-reduction protocol. However, reported sleep quality did not improve.
    • PubMed ID
  • Poorer outcomes and greater healthcare costs for hospitalised older people with dementia and delirium: A retrospective cohort study. 2017 Tropea, Joanne LoGiudice, Dina Liew, Danny Gorelik, Alexandra Brand, Caroline. International Journal of Geriatric Psychiatry, 32:5 (539-47)
    • Title

      Poorer outcomes and greater healthcare costs for hospitalised older people with dementia and delirium: A retrospective cohort study.

    • Authors
      Tropea, Joanne LoGiudice, Dina Liew, Danny Gorelik, Alexandra Brand, Caroline
    • Year
      2017
    • Journal
      International Journal of Geriatric Psychiatry
    • URL
    • Abstract
      Objective: To compare healthcare utilisation outcomes among older hospitalised patients with and without cognitive impairment, and to compare the costs associated with these outcomes. Methods: Retrospective cohort study of administrative data from a large teaching hospital in Melbourne, Australia from 1 July 2006 to 30 June 2012. People with cognitive impairment were defined as having dementia or delirium coded during the admission. Outcome measures included length of stay, unplanned readmissions within 28 days and costs associated with these outcomes. Regression analysis was used to compare differences between those with and without cognitive impairment. Results: There were 93 300 hospital admissions included in the analysis. 6459 (6.9%) involved cognitively impaired patients. The adjusted median length of stay was significantly higher for the cognitively impaired group compared with the non‐cognitively impaired group (7.4 days 6.7–10.0 vs 6.6 days, interquartile range 5.7–8.3; p < 0.001). There were no differences in odds of 28‐day readmission. When only those discharged back to their usual residence were included in the analysis, the risk of 28‐day readmission was significantly higher for those with cognitive impairment compared with those without. The cost of admissions involving patients with cognitive impairment was 51% higher than the cost of those without cognitive impairment. Conclusions: Hospitalised people with cognitive impairment experience significantly greater length of stay and when discharged to their usual residence are more likely to be readmitted to hospital within 28 days compared with those without cognitive impairment. The costs associated with hospital episodes and 28‐day readmissions are significantly higher for those with cognitive impairment. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    • PubMed ID
  • Attitudes, knowledge and practices concerning delirium: a survey among intensive care unit professionals. 2017 Trogrlić, Zoran Ista, Erwin Ponssen, Huibert H. Schoonderbeek, Jeannette F. Schreiner, Frodo Verbrugge, Serge J. Dijkstra, Annemieke Bakker, Jan Jagt, Mathieu. Nursing in Critical Care, 22:3 (133-140)
    • Title

      Attitudes, knowledge and practices concerning delirium: a survey among intensive care unit professionals.

    • Authors
      Trogrlić, Zoran Ista, Erwin Ponssen, Huibert H. Schoonderbeek, Jeannette F. Schreiner, Frodo Verbrugge, Serge J. Dijkstra, Annemieke Bakker, Jan Jagt, Mathieu
    • Year
      2017
    • Journal
      Nursing in Critical Care
    • URL
    • Abstract
      ABSTRACT Background Delirium is a common form of vital organ dysfunction in intensive care unit (ICU) patients and is associated with poor outcomes. Adherence to guideline recommendations pertaining to delirium is still suboptimal. Aims We performed a survey aimed at identifying barriers for implementation that should be addressed in a tailored implementation intervention targeted at improved ICU delirium guideline adherence. Design The survey was conducted among ICU professionals. Methods An online survey was conducted among 360 ICU health care professionals (nurses, physicians and delirium consultants) from six ICUs in the southwest of the Netherlands as part of a multicentre prospective implementation project [response rate: 64% of 565 invited; 283 (79%) were nurses]. Results Although the majority (83%) of respondents considered delirium a common and major problem in the ICU, we identified several barriers for implementation of a delirium guideline. The most important barriers were knowledge deficit, low delirium screening rate, lack of trust in the reliability of delirium screening tools, belief that delirium is not preventable, low familiarity with delirium guidelines, low satisfaction with physician-described delirium management, poor collaboration between nurses and physicians, reluctance to change delirium care practices, lack of time, disbelief that patients would receive optimal care when adhering to the guideline and the perception that the delirium guideline is cumbersome or inconvenient in daily practice. Conclusion Although ICU professionals consider delirium a serious problem, several important barriers to adhere to guidelines on delirium management are still present today. Relevance to clinical practice Identification of implementation barriers for adherence to guidelines pertaining to delirium is feasible with a survey. Results of this study may help to design-targeted implementation strategies for ICU delirium management.
    • PubMed ID
  • Can we predict a delirium after cardiac surgery? A validation study of a delirium risk checklist. 2017 Ten Broeke, M. Koster, S. Konings, T. Hensens, A. G. van der Palen, J.. Eur J Cardiovasc Nurs,
    • Title

      Can we predict a delirium after cardiac surgery? A validation study of a delirium risk checklist.

    • Authors
      Ten Broeke, M. Koster, S. Konings, T. Hensens, A. G. van der Palen, J.
    • Year
      2017
    • Journal
      Eur J Cardiovasc Nurs
    • URL
    • Abstract
      BACKGROUND: Delirium is a common temporary mental disorder that often occurs in patients who undergo cardiac surgery. It is important to prevent the negative side effects of delirium by identifying high-risk patients before surgery. Koster and colleagues designed a risk model to identify patients with an increased risk of postoperative delirium after cardiac surgery. AIM: The aim of this study was to validate the risk model for delirium and further improve the risk model. METHODS: A delirium risk checklist containing predictors associated with postoperative delirium was used during the preoperative outpatient screening in 329 patients. The delirium observation screening scale was used preoperatively and postoperatively to assess delirium. RESULTS: Compared with the model of Koster and colleagues age greater than 70 years and a history of delirium were confirmed as statistically significant predictors of postoperative delirium, while cognitive impairment and alcohol abuse were almost significant factors. The European system for cardiac operative risk evaluation (EuroSCORE), comorbidity and type of surgery could not predict a postoperative delirium again. The area under the curve of this model was 0.79 (95% confidence interval (CI) 0.73-0.86; P<0.001). Based on the data of this study the model was improved with the following independent predictors of postoperative delirium: age, more than one comorbidity, history of delirium and a lower standardised mini mental state examination score as with an area under the curve of 0.79 (95% CI 0.73-0.85; P<0.001). CONCLUSION: The risk model could not be fully validated. It is difficult to validate a risk model over time; there are different circumstances such as the increased focus on the prevention of delirium.
    • PubMed ID
  • Trials of statins in delirium-stymied by complex methods? 2017 Skrobik, Y. Devlin, J.. Lancet Respir med,
  • An integrative literature review exploring the clinical management of delirium in patients with advanced cancer 2017 Lawley, H. Hewison, A.. J Clin Nurs,
    • Title

      An integrative literature review exploring the clinical management of delirium in patients with advanced cancer

    • Authors
      Lawley, H. Hewison, A.
    • Year
      2017
    • Journal
      J Clin Nurs
    • URL
    • Abstract
      AIM: The aim of this paper is to present the findings of an integrative literature review of the evidence for the clinical management of delirium in patients with advanced cancer. BACKGROUND: Patients with advanced cancer frequently experience delirium which can be distressing for both patients and their families. Current guidelines recommend that underlying causes of the delirium be addressed and a course of antipsychotics considered. However the research into the effectiveness of treatments for delirium in people with advanced cancer is limited. DESIGN: Integrative literature review. DATA SOURCES: Systematic searches of the MEDLINE, CINAHL, ProQuest Nursing and Allied Health and PsychInfo databases were conducted in April 2016 to include papers published in 2000 and later. The returns were screened using inclusion and exclusion criteria and the seven studies found to be suitable were subject to review. REVIEW METHODS: Findings of the seven papers were extracted, appraised critically and reviewed using a narrative approach. RESULTS: A number of interventions, including the use of atypical antipsychotics, opioid rotation, methylphenidate hydrochloride and celiac plexus block were reported however there was limited evidence of their effectiveness. One study reported the use of exercise therapy as a non-pharmacological intervention. CONCLUSION: A variety of interventions to treat delirium in patients with advanced cancer have been tested through non-blinded, non-randomised trials which has not produced a clear evidence-base for practice. There is a need for further research (particularly randomised control trials) to determine the most effective treatments for patients with advanced cancer experiencing delirium. This article is protected by copyright. All rights reserved.
    • PubMed ID
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