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.

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Total Results: 3105

  • Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium: Results of the REDUCE Study. 2019 Rood, P. J. T. Zegers, M. Slooter, A. J. C. Beishuizen, A. Simons, K. S. van der Voort, P. H. J. van der Woude, M. C. E. Spronk, P. E. van der Hoeven, J. G. Pickkers, P. van den Boogaard, M.. Anesthesiology,
    • Title

      Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium: Results of the REDUCE Study.

    • Authors
      Rood, P. J. T. Zegers, M. Slooter, A. J. C. Beishuizen, A. Simons, K. S. van der Voort, P. H. J. van der Woude, M. C. E. Spronk, P. E. van der Hoeven, J. G. Pickkers, P. van den Boogaard, M.
    • Year
      2019
    • Journal
      Anesthesiology
    • URL
    • Abstract
      WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Delirium is a frequently occurring disorder in intensive care unit patients associated with impaired short-term and long-term outcomesProphylactic haloperidol neither reduces delirium incidence nor its short-term clinical consequencesMany intensive care unit survivors suffer from long-term impairment of physical, cognitive, or mental health status, but there is a gap in knowledge regarding which factors are associated with such a change in quality of life in the post-intensive care unit period WHAT THIS ARTICLE TELLS US THAT IS NEW: Prophylactic haloperidol does not affect long-term outcome of critically ill patients at high risk for deliriumEvery additional day of sedation-induced coma is associated with further decline of long-term physical and mental function BACKGROUND:: Delirium incidence in intensive care unit patients is high and associated with impaired long-term outcomes. The use of prophylactic haloperidol did not improve short-term outcome among critically ill adults at high risk of delirium. This study evaluated the effects of prophylactic haloperidol use on long-term quality of life in this group of patients and explored which factors are associated with change in quality of life. METHODS: A preplanned secondary analysis of long-term outcomes of the pRophylactic haloperidol usE for DeliriUm in iCu patients at high risk for dElirium (REDUCE) study was conducted. In this multicenter randomized clinical trial, nondelirious intensive care unit patients were assigned to prophylactic haloperidol (1 or 2 mg) or placebo (0.9% sodium chloride). In all groups, patients finally received study medication for median duration of 3 days [interquartile range, 2 to 6] until onset of delirium or until intensive care unit discharge. Long-term outcomes were assessed using the Short Form-12 questionnaire at intensive care unit admission (baseline) and after 1 and 6 months. Quality of life was summarized in the physical component summary and mental component summary scores. Differences between the haloperidol and placebo group and factors associated with changes in quality of life were analyzed. RESULTS: Of 1,789 study patients, 1,245 intensive care unit patients were approached, of which 887 (71%) responded. Long-term quality of life did not differ between the haloperidol and placebo group (physical component summary mean score of 39 +/- 11 and 39 +/- 11, respectively, and P = 0.350; and mental component summary score of 50 +/- 10 and 51 +/- 10, respectively, and P = 0.678). Age, medical and trauma admission, quality of life score at baseline, risk for delirium (PRE-DELIRIC) score, and the number of sedation-induced coma days were significantly associated with a decline in long-term quality of life. CONCLUSIONS: Prophylactic haloperidol use does not affect long-term quality of life in critically ill patients at high risk for delirium. Several factors, including the modifiable factor number of sedation-induced coma days, are associated with decline in long-term outcomes.
    • PubMed ID
  • Differences in 90-day mortality of delirium subtypes in the intensive care unit: A retrospective cohort study. 2019 Rood, P. J. T. van de Schoor, F. van Tertholen, K. Pickkers, P. van den Boogaard, M.. J Crit Care, (120-124)
    • Title

      Differences in 90-day mortality of delirium subtypes in the intensive care unit: A retrospective cohort study.

    • Authors
      Rood, P. J. T. van de Schoor, F. van Tertholen, K. Pickkers, P. van den Boogaard, M.
    • Year
      2019
    • Journal
      J Crit Care
    • URL
    • Abstract
      INTRODUCTION: Many intensive care unit (ICU) patients suffer from delirium which is associated with deleterious short-term and long-term effects, including mortality. We determined the association between different delirium subtypes and 90-day mortality. MATERIALS AND METHODS: Retrospective cohort study in ICU patients admitted in 2015-2017. Delirium, including its subtypes, was determined using the confusion assessment method-ICU (CAM-ICU) and Richmond agitation sedation scale (RASS). Exclusion criteria were insufficient assessments and persistent coma. Cox-regression analysis was used to determine associations of delirium subtypes with 90-day mortality, including relevant covariates (APACHE-IV, length of ICU stay and mechanical ventilation). RESULTS: 7362 ICU patients were eligible of whom 6323 (86%) were included. Delirium occurred in 1600 (25%) patients (stratified for delirium subtype: N=571-36% mixed, N=485-30% rapidly reversible, N=433-27% hypoactive, N=111-7% hyperactive). The crude hazard ratio (HR) for overall prevalent delirium with 90-day mortality was 2.84 (95%CI: 2.32-3.49), and the adjusted HR 1.29 (95%CI: 1.01-1.65). The adjusted HR for 90-day mortality was 1.57 (95%CI: 1.51-2.14) for the mixed subtype, 1.40 (95%CI: 0.71-2.73) for hyperactive, 1.31 (95%CI: 0.93-1.84) for hypoactive and 0.95 (95%CI: 0.64-1.42) for rapidly reversible delirium. CONCLUSION: After adjusting for covariates, including competing risk factors, only the mixed delirium subtype was significantly associated with 90-day mortality.
    • PubMed ID
  • The Role of Delirium and Other Risk Factors on Mortality in Elderly Patients with Critical Limb Ischemia Undergoing Major Lower Limb Amputation. 2019 Roijers, J. P. Hopmans, C. J. Janssen, T. L. Mulder, P. G. H. Buimer, M. G. Ho, G. H. de Groot, H. G. W. Veen, E. J. van der Laan, L.. Annals of Vascular Surgery,
    • Title

      The Role of Delirium and Other Risk Factors on Mortality in Elderly Patients with Critical Limb Ischemia Undergoing Major Lower Limb Amputation.

    • Authors
      Roijers, J. P. Hopmans, C. J. Janssen, T. L. Mulder, P. G. H. Buimer, M. G. Ho, G. H. de Groot, H. G. W. Veen, E. J. van der Laan, L.
    • Year
      2019
    • Journal
      Annals of Vascular Surgery
    • URL
    • Abstract
      Background: Delirium in patients with critical limb ischemia (CLI) is associated with increased mortality. The main goal of this study was to investigate the association between delirium and mortality in patients undergoing major lower limb amputation for CLI. In addition, other risk factors associated with mortality were analyzed. Methods: An observational cohort study was conducted including all patients aged ≥70 years with CLI undergoing a major lower limb amputation between January 2014 and July 2017. Delirium was scored using the Delirium Observation Screening Score in combination with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Risk factors for mortality were analyzed by calculating hazard ratios using a Cox proportional hazards model. Results: In total, 95 patients were included; of which, 29 (31%) patients developed a delirium during admission. Delirium was not associated with an increased risk of mortality (hazard ratio [HR] = 0.84; 95 % confidence interval [CI]: 0.51–1.73; P = 0.84). Variables independently associated with an increased risk of mortality were age (HR 1.1; 95% CI 1.0–1.1), cardiac history (HR 3.3; 95% CI 1.8–6.1), current smoking (HR 2.9; 95% CI 1.6–5.5), preoperative anemia (HR 2.8; 95% CI 1.1–7.2), and living in a nursing home (HR 2.2; 95% CI 1.1–4.4). Conclusion: Delirium was not associated with an increased mortality risk in elderly patients with CLI undergoing a major lower limb amputation. Factors related to an increased mortality risk were age, cardiac history, current smoking, preoperative anemia, and living in a nursing home.
    • PubMed ID
  • Initiative for prevention and early identification of delirium in medical-surgical units: Lessons learnt in the past five years. 2019 Rohatgi, N. Weng, Y. Bentley, J. Lansberg, M. G. Shepard, J. Mazur, D. Ahuja, N. Hopkins, J.. Am J Med,
    • Title

      Initiative for prevention and early identification of delirium in medical-surgical units: Lessons learnt in the past five years.

    • Authors
      Rohatgi, N. Weng, Y. Bentley, J. Lansberg, M. G. Shepard, J. Mazur, D. Ahuja, N. Hopkins, J.
    • Year
      2019
    • Journal
      Am J Med
    • URL
    • Abstract
      BACKGROUND: Delirium is an acute change in mental status affecting 10-64% of hospitalized patients, and may be preventable in 30-40% cases. In October 2013, a task force for delirium prevention and early identification in medical-surgical units was formed at our hospital. We studied if our standardized protocol prevented delirium among high-risk patients. METHODS: We studied 105,455 patient encounters between November 2013 and January 2018. Since November 2013, there has been ongoing education to decrease deliriogenic medications use. Since 2014, nurses screen all patients for presence or absence of delirium using confusion assessment method (CAM). Since 2015, nurses additionally screen all patients for risk of delirium. In 2015, a physician order set for delirium was created. Non-pharmacological measures are implemented for high-risk or CAM positive patients. RESULTS: 98.8% of patient encounters had CAM screening, and 99.6% had delirium risk screening. Since 2013, odds of opiate use decreased by 5.0% per year (P<0.001), and odds of benzodiazepines use decreased by 8.0% per year (P<0.001). There was no change in anticholinergics use. In the adjusted analysis, since 2015, odds of delirium decreased by 25.3% per year among high-risk patients (N=21,465; P<0.001). Among high-risk patients or those diagnosed with delirium (N=22,121), estimated LOS decreased by 0.13days per year (P<0.001), odds of inpatient mortality decreased by 16.0% per year (P=0.011), and odds of discharge to nursing home decreased by 17.1% per year (P<0.001). CONCLUSION: With high clinician engagement and simplified workflows, our delirium initiative has shown sustained results.
    • PubMed ID
  • Delirium is associated with higher mortality in transcatheter aortic valve replacement: systemic review and meta-analysis. 2019 Prasitlumkum, N. Mekritthikrai, R. Kewcharoen, J. Kanitsoraphan, C. Mao, M. A. Cheungpasitporn, W.. Cardiovasc Interv Ther,
    • Title

      Delirium is associated with higher mortality in transcatheter aortic valve replacement: systemic review and meta-analysis.

    • Authors
      Prasitlumkum, N. Mekritthikrai, R. Kewcharoen, J. Kanitsoraphan, C. Mao, M. A. Cheungpasitporn, W.
    • Year
      2019
    • Journal
      Cardiovasc Interv Ther
    • URL
    • Abstract
      Post-operative delirium (POD) has been recognized as an independent risk factor for mortality. Recent studies suggest that POD is associated with higher mortality rates in patients undergoing transcatheter aortic valve replacement (TAVR). However, a systematic review and meta-analysis of the literature has not been performed. This study assessed the association between POD and TAVR by performing a systematic review and meta-analysis of the literature. We comprehensively searched the databases of MEDLINE and EMBASE from inception to April 2018. Included studies were prospective or retrospective cohort studies that compared mortality among patients undergoing TAVR both with and without POD. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Seven studies consisting of 20,086 subjects undergoing TAVR (1517 with POD and 18,569 without POD) were included in this meta-analysis. POD demonstrated a trend towards higher all-cause mortality (pooled odd ratio 1.52, 95% confidence interval 0.98-2.37, p = 0.062, I(2) = 72%). POD was associated with a significant increased long-term mortality (pooled odd ratio 2.11, 95% confidence interval 1.21-3.68, p = 0.009, I(2) = 62.5%). POD was associated with an increased risk of long-term all-cause mortality in patients undergoing TAVR. Our study suggests POD could be a potential risk factor of mortality among patients undergoing TAVR. Further studies implementing preventative and treatment strategies against delirium and its effect on POD and its associated mortality are needed.
    • PubMed ID
  • The Reliability and Validity of the Chinese Version of Confusion Assessment Method Based Scoring System for Delirium Severity (CAM-S). 2019 Mei, X. Chen, Y. Zheng, H. Shi, Z. Marcantonio, E. R. Xie, Z. Shen, Y.. Journal of Alzheimer's Disease, 69:3 (706-716)
    • Title

      The Reliability and Validity of the Chinese Version of Confusion Assessment Method Based Scoring System for Delirium Severity (CAM-S).

    • Authors
      Mei, X. Chen, Y. Zheng, H. Shi, Z. Marcantonio, E. R. Xie, Z. Shen, Y.
    • Year
      2019
    • Journal
      Journal of Alzheimer's Disease
    • URL
    • Abstract
      Previous studies showed that the Confusion Assessment Method based delirium severity evaluation tool (CAM-S) had good reliability and validity. However, there is no Chinese version of the CAM-S. Therefore, we set out to perform a prospective investigation in older Chinese patients who had total joint replacement surgery under general anesthesia in Tenth People's Hospital in Shanghai, P.R. China. A total of 576 participants, aged 60 years or older, were screened, 179 participants were enrolled, and 125 of them were included for the final analysis. Pre-operative evaluations were conducted one day before the surgery. Postoperative evaluations were conducted twice daily from postoperative day 1 to day 3. The incidence of postoperative delirium was 24.8%. The Chinese version of CAM-S [including a Short Form (CAM-S Short Form) and a Long Form (CAM-S Long Form)] had an optimal reliability reflected by internal consistency (Cronbach's α = 0.748 and 0.839 for CAM-S Short Form and CAM-S Long Form respectively), split-halves reliability (Pearson correlation coefficient = 0.372 and 0.384 for CAM-S Short Form and CAM-S Long Form respectively), and inter-rater reliability (intra-class correlation coefficients = 0.629 and 0.945 for CAM-S Short Form and CAM-S Long Form respectively). Additionally, the Chinese version of CAM-S also showed a good discriminate validity. The domain scores of CAM-S were inversely correlated with corresponding domain scores of the MMSE. Finally, a receiver operating characteristic (ROC) analysis obtained an optimal cutoff point of 2.5 for CAM-S Short Form and 3.5 for CAM-S Long Form in recognizing delirium diagnosed by CAM. The areas under the ROC were 0.989 (95% CI 0.972 - 1.000, p < 0.001) and 0.964 (95% CI 0.946 - 0.982, p < 0.001), respectively. These data suggest that the Chinese version of CAM-S has good reliability and validity in evaluating postoperative delirium in geriatric Chinese patients and may be a useful tool to assess the severity of delirium.
    • PubMed ID
  • Family intervention improves outcomes for patients with delirium: Systematic review and meta-analysis. 2019 McKenzie, J. Joy, A.. Australas J Ageing,
    • Title

      Family intervention improves outcomes for patients with delirium: Systematic review and meta-analysis.

    • Authors
      McKenzie, J. Joy, A.
    • Year
      2019
    • Journal
      Australas J Ageing
    • URL
    • Abstract
      OBJECTIVE: To determine if family caregiver involvement in interventions with patients with delirium improves patient outcomes. METHODS: A search of three databases (Medline-Ovid, CINAHL and Embase) was conducted. Eligibility criteria included adult patients and involvement of family caregivers in any delirium intervention. Data were extracted from each study (determined by PEDro scale) using a customised form. A meta-analysis was undertaken which compared the length of hospital stay and duration of delirium. PROSPERO registration number is CRD42017077650. RESULTS: Five studies involving 505 participants published over a 5-year period were suitable for inclusion. Low-level evidence demonstrated family caregiver involvement may reduce caregiver's anxiety and hospital staff viewed administration of education to family caregivers as efficient. Meta-analysis suggested family interventions reduce length of hospital stay for patients with delirium. It remains unclear if it affects the duration of delirium. CONCLUSION: Family caregivers providing interventions to patients with delirium can improve patient outcomes.
    • PubMed ID
  • Vital signs and impaired cognition in older emergency department patients: The APOP study. 2019 Lucke, J. A. de Gelder, J. Blomaard, L. C. Heringhaus, C. Alsma, J. Klein Nagelvoort Schuit, S. C. E. Brink, A. Anten, S. Blauw, G. J. de Groot, B. Mooijaart, S. P.. PLoS One, 14:6 (e0218596)
    • Title

      Vital signs and impaired cognition in older emergency department patients: The APOP study.

    • Authors
      Lucke, J. A. de Gelder, J. Blomaard, L. C. Heringhaus, C. Alsma, J. Klein Nagelvoort Schuit, S. C. E. Brink, A. Anten, S. Blauw, G. J. de Groot, B. Mooijaart, S. P.
    • Year
      2019
    • Journal
      PLoS One
    • URL
    • Abstract
      BACKGROUND/OBJECTIVES: Cognitive impairment is a frequent problem among older patients attending the Emergency Department (ED) and can be the result of pre-existing cognitive impairment, delirium, or neurologic disorders. Another cause can also be acute disturbance of brain perfusion and oxygenation, which may be reversed by optimal resuscitation. This study aimed to assess the relationship between vital signs, as a measure of acute hemodynamic changes, and cognitive impairment in older ED patients. DESIGN: Prospective cohort study. SETTING: ED's of two tertiary care and two secondary care hospitals in the Netherlands. PARTICIPANTS: 2629 patients aged 70-years and older. MEASUREMENTS: Vital signs were measured at the moment of ED arrival as part of routine clinical care. Cognition was measured using the Six-Item Cognitive Impairment Test (6-CIT). RESULTS: The median age of patients was 78 years (IQR 74-84). Cognitive impairment was present in 738 patients (28.1%). When comparing lowest with highest quartiles, a systolic blood pressure of <129 mmHg (OR 1.30, 95% confidence interval (95%CI) 0.98-1.73)was associated with increased risk of cognitive impairment. A higher respiratory rate (>21/min) was associated with increased risk of impaired cognition (OR 2.16, 95% CI 1.58-2.95) as well as oxygen saturation of <95% (OR 1.64, 95%CI 1.24-2.19). CONCLUSION: Abnormal vital signs associated with decreased brain perfusion and oxygenation are also associated with cognitive impairment in older ED patients. This may partially be explained by the association between disease severity and delirium, but also by acute disturbance of brain perfusion and oxygenation. Future studies should establish whether normalization of vital signs will also acutely improve cognition.
    • PubMed ID
  • Clinical Pharmacist Impact on Intensive Care Unit Delirium: Intervention and Monitoring. 2019 Lightfoot, M. Sanders, A. Burke, C. Patton, J.. Hosp Pharm, 54:3 (180-185)
    • Title

      Clinical Pharmacist Impact on Intensive Care Unit Delirium: Intervention and Monitoring.

    • Authors
      Lightfoot, M. Sanders, A. Burke, C. Patton, J.
    • Year
      2019
    • Journal
      Hosp Pharm
    • URL
    • Abstract
      Purpose: The purpose of this study was to determine the impact of pharmacist monitoring with a clinical decision support system (CDSS) on clinical outcomes related to intensive care unit (ICU) delirium. Methods: This was a single-center, before-and-after study. This study compares patient outcomes of the preintervention group, which is the standard of care of pharmacist rounding, and the intervention group of pharmacy rounding with the CDSS rules. Using a CDSS, specific delirium risk factor rules were created to alert pharmacists to patients who have an increased risk of developing ICU delirium. Patients were included in the study if they were 18 years of age, admitted to the trauma intensive care unit (TICU), and had one of the CDSS rule alerts. The CDSS notified pharmacists in real time to patients in the intervention group that met these criteria to provide timely recommendations in an effort to prevent ICU delirium. Results: Compared with the preintervention group receiving the standard of care (n = 28), the intervention CDSS group (n = 33) had a nonsignificant trend in decreased incidence of delirium (33.3% vs 24.1%, P = .45), ICU length of stay (LOS) (10.11 vs 7.55 days, P = .26), and ventilator duration (7.11 vs 5.03 days, P = .26). The intervention group had a significantly shorter hospital LOS (14.74 vs 9.98 days, P = .04). There was a nonsignificant increase in mortality with the intervention group from nondelirium causes (24.2% vs 7%, P = .07). Conclusion: The utilization of a CDSS by clinical pharmacists to monitor for delirium-specific risk factors led to a significantly shorter hospital LOS. Further studies using this model are warranted to see the impact on the ICU population.
    • PubMed ID
  • Effects of dexamethasone on post-operative cognitive dysfunction and delirium in adults following general anaesthesia: a meta-analysis of randomised controlled trials. 2019 Li, L. Q. Wang, C. Fang, M. D. Xu, H. Y. Lu, H. L. Zhang, H. Z.. BMC Anesthesiol, 19:1 (113)
    • Title

      Effects of dexamethasone on post-operative cognitive dysfunction and delirium in adults following general anaesthesia: a meta-analysis of randomised controlled trials.

    • Authors
      Li, L. Q. Wang, C. Fang, M. D. Xu, H. Y. Lu, H. L. Zhang, H. Z.
    • Year
      2019
    • Journal
      BMC Anesthesiol
    • URL
    • Abstract
      BACKGROUND: Several studies have investigated the effects of dexamethasone on post-operative cognitive dysfunction (POCD) or post-operative delirium (POD); however, their conclusions have been inconsistent. Thus, we conducted a meta-analysis to determine the effects of dexamethasone on POCD and POD in adults following general anaesthesia. METHODS: The Cochrane Central Register of Controlled Trials (2018, Issue 11 of 12) in the Cochrane Library (searched 17 November 2018), MEDLINE OvidSP (1946 to 16 November 2018) and Embase OvidSP (1974 to 16 November 2018) were searched for randomised controlled trials that evaluated the incidence of POCD and POD following dexamethasone administration in adults (age >/= 18 years) under general anaesthesia. We used the Grading of Recommendations, Assessment, Development and Evaluations framework to assess the quality of the evidence. RESULTS: Five studies were included (three studies with 855 participants in the dexamethasone group and 538 participants in the placebo group for the incidence of POCD, and two studies with 410 participants in the dexamethasone group and 420 participants in the placebo group for the incidence of POD). There was no significant difference between the dexamethasone group and the placebo group in terms of the incidence of POCD 30 days after surgery (RR [relative risk] 1.00; 95% CI [confidence interval: 0.51, 1.96], P = 1.00, I(2) = 77%) or the incidence of POD (RR 0.96; 95% CI [0.68, 1.35], P = 0.80, I(2) = 0%). However, both analyses had some limitations because of limited evidence and clinical heterogeneity, and we considered the quality of the evidence for the post-operative incidence of POCD and POD to be very low. CONCLUSIONS: This meta-analysis revealed that prophylactic dexamethasone did not reduce the incidence of POCD and POD. Trials of alternative preventive strategies for POCD and POD, as well as a better understanding of the pathophysiology of those complex syndromes, are still needed to make progress in this field. TRIAL REGISTRATIONR: This study is registered with PROSPERO, 23 October 2018, number CRD42018114552. Available from https://www.crd.york.ac.uk/PROSPERO/#recordDetails .
    • PubMed ID
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