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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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: 2700

  • Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults. 2018 Punjasawadwong, Y. Chau-In, W. Laopaiboon, M. Punjasawadwong, S. Pin-On, P.. Cochrane Database of Systematic Reviews,
    • Title

      Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults.

    • Authors
      Punjasawadwong, Y. Chau-In, W. Laopaiboon, M. Punjasawadwong, S. Pin-On, P.
    • Year
      2018
    • Journal
      Cochrane Database of Systematic Reviews
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) may complicate a patient's postoperative recovery in several ways. Monitoring of processed electroencephalogram (EEG) or evoked potential (EP) indices may prevent or minimize POD and POCD, probably through optimization of anaesthetic doses. OBJECTIVES: To assess whether the use of processed EEG or auditory evoked potential (AEP) indices (bispectral index (BIS), narcotrend index, cerebral state index, state entropy and response entropy, patient state index, index of consciousness, A-line autoregressive index, and auditory evoked potentials (AEP index)) as guides to anaesthetic delivery can reduce the risk of POD and POCD in non-cardiac surgical or non-neurosurgical adult patients undergoing general anaesthesia compared with standard practice where only clinical signs are used. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and clinical trial registry databases up to 28 March 2017. We updated this search in February 2018, but these results have not been incorporated in the review. SELECTION CRITERIA: We included randomized or quasi-randomized controlled trials comparing any method of processed EEG or evoked potential techniques (entropy, BIS, AEP etc.) against a control group where clinical signs were used to guide doses of anaesthetics in adults aged 18 years or over undergoing general anaesthesia for non-cardiac or non-neurosurgical elective operations. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. Our primary outcomes were: occurrence of POD; and occurrence of POCD. Secondary outcomes included: all-cause mortality; any postoperative complications; and postoperative length of stay. We used GRADE to assess the quality of evidence for each outcome. MAIN RESULTS: We included six randomized controlled trials (RCTs) with 2929 participants comparing processed EEG or EP indices-guided anaesthesia with clinical signs-guided anaesthesia. There are five ongoing studies and one study awaiting classification.Anaesthesia administration guided by the indices from a processed EEG (bispectral index) probably reduces the risk of POD within seven days after surgery with risk ratio (RR) of 0.71 (95% CI 0.59 to 0.85; number needed to treat for an additional beneficial outcome (NNTB) of 17, 95% CI 11 to 34; 2197 participants; 3 RCTs; moderate quality of evidence). Three trials also showed the lower rate of POCD at 12 weeks after surgery (RR 0.71, 95% CI 0.53 to 0.96; NNTB 38, 95% CI 21 to 289; 2051 participants; moderate-quality evidence), but it is uncertain whether processed EEG indices reduce POCD at one week (RR 0.84, 95% CI 0.69 to 1.02; 3 trials; 1989 participants; moderate-quality evidence), and at 52 weeks (RR 0.30, 95% CI 0.05 to 1.80; 1 trial; 59 participants; very low quality of evidence). There may be little or no effect on all-cause mortality (RR 1.01, 95% CI 0.62 to 1.64; 1 trial; 1155 participants; low-quality evidence). One trial suggested a lower risk of any postoperative complications with processed EEG (RR 0.51, 95% CI 0.37 to 0.71; 902 participants, moderate-quality evidence). There may be little or no effect on reduced postoperative length of stay (mean difference -0.2 days, 95% CI -2.02 to 1.62; 1155 participants; low-quality evidence). AUTHORS' CONCLUSIONS: There is moderate-quality evidence that optimized anaesthesia guided by processed EEG indices could reduce the risk of postoperative delirium in patients aged 60 years or over undergoing non-cardiac surgical and non-neurosurgical procedures. We found moderate-quality evidence that postoperative cognitive dysfunction at three months could be reduced in these patients. The effect on POCD at one week and over one year after surgery is uncertain. There are no data available for patients under 60 years. Further blinded randomized controlled trials are needed to elucidate strategies for the amelioration of postoperative delirium and postoperative cognitive dysfunction, and their consequences such as dementia (including Alzheimer's disease (AD)) in both non-elderly (below 60 years) and elderly (60 years or over) adult patients. The one study awaiting classification and five ongoing studies may alter the conclusions of the review once assessed.
    • PubMed ID
  • Influence of physical restraint on delirium of adult patients in ICU: A nested case–control study. 2018 Pan, Yanbin Jiang, Zhixia Yuan, Changrong Wang, Lianhong Zhang, Jingjing Zhou, Jing Tao, Ming Quan, Mingtao Wu, Qiong. Journal of Clinical Nursing, 27:9/10 (1950-7)
    • Title

      Influence of physical restraint on delirium of adult patients in ICU: A nested case–control study.

    • Authors
      Pan, Yanbin Jiang, Zhixia Yuan, Changrong Wang, Lianhong Zhang, Jingjing Zhou, Jing Tao, Ming Quan, Mingtao Wu, Qiong
    • Year
      2018
    • Journal
      Journal of Clinical Nursing
    • URL
    • Abstract
      Aims and objectives: To investigate the impact of physical restraint on delirium of adult patients in intensive care unit. Background: Delirium is a common clinical syndrome in intensive care unit, correlated with various adverse clinical outcomes. Physical restraint is a precipitating factor for delirium; however, the effect of physical restraint on delirium, such as duration, number and appliance is still unclear. Design: A nested case–control study. Methods: A cohort of 593 intensive care unit patients were observed for 12 months, and 447 of them who received physical restraint were included for analysis. Delirium was assessed using the Confusion Assessment Method for the intensive care unit. During hospitalisation in intensive care unit, newly‐onset delirium patients (the delirium group), and nondelirium patients of similar age, same gender, and conditions of mechanical ventilation and sedative drug usage (the nondelirium group) were included as the matching criteria. Patient data were acquired by reviewing medical and nursing electronic records. Results: Among the 447 patients that had been physically restrained, 178 (39.8%) developed delirium. Delirium risk in patients with restraint ≥6 days was 26.30 times higher than in those <6 days. Patients who had two and three times of restraint had a 2.38‐fold and 3.62‐fold higher risk of delirium than those with one time of restraint. However, the appliance, site, time to apply and remove restraint had no effect on the incidence of delirium. Conclusions: The incidence of delirium is high when patients use physical restraint. Duration and number of restraint are positively related to delirium. Restrictions on the use of restraint in intensive care unit are required to reduce the occurrence of delirium. Relevance to clinical practice: To reduce delirium risk of patients in intensive care unit, nurses need to assess the risk of physical restraint and consider alternative measures, thereby to achieve the minimisation of the use of restraint.
    • PubMed ID
  • Development of a Novel Self-administered Cognitive Assessment Tool and Normative Data for Older Adults. 2018 Monsch, R. J. Burckhardt, A. C. Berres, M. Thomann, A. E. Ehrensperger, M. M. Steiner, L. A. Goettel, N.. J Neurosurg Anesthesiol,
    • Title

      Development of a Novel Self-administered Cognitive Assessment Tool and Normative Data for Older Adults.

    • Authors
      Monsch, R. J. Burckhardt, A. C. Berres, M. Thomann, A. E. Ehrensperger, M. M. Steiner, L. A. Goettel, N.
    • Year
      2018
    • Journal
      J Neurosurg Anesthesiol
    • URL
    • Abstract
      BACKGROUND: Preexisting cognitive impairment in surgical patients is one of the leading risk factors for adverse cognitive outcomes such as postoperative delirium and postoperative cognitive dysfunction. We developed a self-administered tablet computer application intended to assess the individual risk for adverse postoperative cognitive outcomes. This cross-sectional study aimed to establish normative data for the tool. MATERIALS AND METHODS: Healthy volunteers aged 65 years and above were administered the Mini-Mental State Examination, Geriatric Depression Scale, and Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery to assess cognitive health. All subjects completed the tablet computer application without assistance. Primary outcome measure was the test performance. Regression models were built for each cognitive domain score with the covariates age, sex, and education in cognitively healthy subjects. Demographically adjusted standard scores (z-scores) were computed for each subtest. RESULTS: A total of 283 participants (155 women, 128 men) were included in the final analysis. Participants' age was 73.8+/-5.2 years (mean+/-SD) and their level of education was 13.6+/-2.9 years. Mini-Mental State Examination score was 29.2+/-0.9 points, Geriatric Depression Scale score was 0.4+/-0.7 points, and Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery total score was 98.7+/-5.7 points. Older age was associated with poorer performance in the visual recognition task and in Trail Making Test B (P<0.05 after Bonferroni-Holm adjustments). CONCLUSIONS: This study provides normative data for a novel self-administered tablet computer application that is ultimately designed to measure the individual risk for adverse postoperative cognitive outcomes in elderly patients.
    • PubMed ID
  • Cooccurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness. 2018 Marra, A. Pandharipande, P. P. Girard, T. D. Patel, M. B. Hughes, C. G. Jackson, J. C. Thompson, J. L. Chandrasekhar, R. Ely, E. W. Brummel, N. E.. Crit Care Med,
    • Title

      Cooccurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness.

    • Authors
      Marra, A. Pandharipande, P. P. Girard, T. D. Patel, M. B. Hughes, C. G. Jackson, J. C. Thompson, J. L. Chandrasekhar, R. Ely, E. W. Brummel, N. E.
    • Year
      2018
    • Journal
      Crit Care Med
    • URL
    • Abstract
      OBJECTIVES: To describe the frequency of cooccurring newly acquired cognitive impairment, disability in activities of daily livings, and depression among survivors of a critical illness and to evaluate predictors of being free of post-intensive care syndrome problems. DESIGN: Prospective cohort study. SETTING: Medical and surgical ICUs from five U.S. centers. PATIENTS: Patients with respiratory failure or shock, excluding those with preexisting cognitive impairment or disability in activities of daily livings. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: At 3 and 12 months after hospital discharge, we assessed patients for cognitive impairment, disability, and depression. We categorized patients into eight groups reflecting combinations of cognitive, disability, and mental health problems. Using multivariable logistic regression, we modeled the association between age, education, frailty, durations of mechanical ventilation, delirium, and severe sepsis with the odds of being post-intensive care syndrome free. We analyzed 406 patients with a median age of 61 years and an Acute Physiology and Chronic Health Evaluation II of 23. At 3 and 12 months, one or more post-intensive care syndrome problems were present in 64% and 56%, respectively. Nevertheless, cooccurring post-intensive care syndrome problems (i.e., in two or more domains) were present in 25% at 3 months and 21% at 12 months. Post-intensive care syndrome problems in all three domains were present in only 6% at 3 months and 4% at 12 months. More years of education was associated with greater odds of being post-intensive care syndrome free (p < 0.001 at 3 and 12 mo). More severe frailty was associated with lower odds of being post-intensive care syndrome free (p = 0.005 at 3 mo and p = 0.048 at 12 mo). CONCLUSIONS: In this multicenter cohort study, one or more post-intensive care syndrome problems were present in the majority of survivors, but cooccurring problems were present in only one out of four. Education was protective from post-intensive care syndrome problems and frailty predictive of the development of post-intensive care syndrome problems. Future studies are needed to understand better the heterogeneous subtypes of post-intensive care syndrome and to identify modifiable risk factors.
    • PubMed ID
  • Precipitants of Delirium in Older Inpatients Admitted in Surgery for Post-Fall Hip Fracture: An Observational Study. 2018 Levinoff, E. Try, A. Chabot, J. Lee, L. Zukor, D. Beauchet, O.. The Journal of Frailty & Aging, 7:1 (34-39)
    • Title

      Precipitants of Delirium in Older Inpatients Admitted in Surgery for Post-Fall Hip Fracture: An Observational Study.

    • Authors
      Levinoff, E. Try, A. Chabot, J. Lee, L. Zukor, D. Beauchet, O.
    • Year
      2018
    • Journal
      The Journal of Frailty & Aging
    • URL
    • Abstract
      CONCLUSION: We have shown that an association exists between psychotropic medication prescription and incident delirium in patients with hip fractures, even when adjusting for cognitive impairment. Hence, the prescription of psychotropic drugs should be judicious in these patients so as minimize the risk of adverse outcomes. RESULTS: The results demonstrated that 17.5% of participants with a diagnosis of delirium had a longer length of hospitalization (p = 0.01), a lower baseline functional status (p = 0.03) and pre-operative cognitive impairment (p = 0.01). Patients receiving new psychotropic medications in hospital were more likely to have delirium (OR = 4.6, p = 0.01) which was independent of pre-operative cognitive impairment. MEASUREMENTS: The main outcome variable was incident delirium, which was assessed by chart reviews of notes and observations recorded by nurses and physicians when patients were admitted post operatively to the surgical unit. Covariates included age, sex, length of stay, delay to surgery, number of medical comorbidities, number of medications and hip fracture location, and were extracted from medical records. Baseline mobility and functional status, preoperative cognitive impairment, postoperative complications, regular psychotropic medications, psychotropic medications in hospital, and location of discharge were also assessed through chart review. BACKGROUND: Hip fractures precipitate several acute adverse outcomes in elderly people, thus leading to chronic adverse outcomes. OBJECTIVES: The objective of our study was to examine the clinical characteristics associated with incident delirium in community dwelling elderly individuals who have a hip fracture. DESIGN: Retrospective observational cohort study. SETTING: Data was collected from an academic tertiary hospital affiliated with McGill University. PARTICIPANTS: 114 elderly individuals who were above 65 years of age, who underwent surgery for a fractured hip.
    • PubMed ID
  • Neural predisposing factors of postoperative delirium in elderly patients with femoral neck fracture. 2018 Kyeong, S. Shin, J. E. Yang, K. H. Lee, W. S. Chung, T. S. Kim, J. J.. Sci Rep, 8:1 (7602)
    • Title

      Neural predisposing factors of postoperative delirium in elderly patients with femoral neck fracture.

    • Authors
      Kyeong, S. Shin, J. E. Yang, K. H. Lee, W. S. Chung, T. S. Kim, J. J.
    • Year
      2018
    • Journal
      Sci Rep
    • URL
    • Abstract
      Elderly adults are more likely to develop delirium after major surgery, but there is limited knowledge of the vulnerability for postoperative delirium. In this study, we aimed to identify neural predisposing factors for postoperative delirium and develop a prediction model for estimating an individual's probability of postoperative delirium. Among 57 elderly participants with femoral neck fracture, 25 patients developed postoperative delirium and 32 patients did not. We preoperatively obtained data for clinical assessments, anatomical MRI, and resting-state functional MRI. Then we evaluated gray matter (GM) density, fractional anisotropy, and the amplitude of low-frequency fluctuation (ALFF), and conducted a group-level inference. The prediction models were developed to estimate an individual's probability using logistic regression. The group-level analysis revealed that neuroticism score, ALFF in the dorsolateral prefrontal cortex, and GM density in the caudate/suprachiasmatic nucleus were predisposing factors. The prediction model with these factors showed a correct classification rate of 86% using a leave-one-out cross-validation. The predicted probability computed from the logistic model was significantly correlated with delirium severity. These results suggest that the three components are the most important predisposing factors for postoperative delirium, and our prediction model may reflect the core pathophysiology in estimating the probability of postoperative delirium.
    • PubMed ID
  • Music intervention to prevent delirium among older patients admitted to a trauma intensive care unit and a trauma orthopaedic unit. 2018 Johnson, K. Fleury, J. McClain, D.. Intensive Crit Care Nurs,
    • Title

      Music intervention to prevent delirium among older patients admitted to a trauma intensive care unit and a trauma orthopaedic unit.

    • Authors
      Johnson, K. Fleury, J. McClain, D.
    • Year
      2018
    • Journal
      Intensive Crit Care Nurs
    • URL
    • Abstract
      PURPOSE: Evaluate music listening for delirium prevention among patients admitted to a Trauma Intensive Care and Trauma Orthopaedic Unit. The Roy Adaptation Model provided the theoretical framework focusing on modifying contextual stimuli. METHODS: Randomised controlled trial, 40 patients aged 55 and older. INTERVENTION: Participants randomly assigned to receive music listening or usual care for 60minutes, twice a day, over three days. Pre-recorded self-selected music using an iPod and headsets, with slow tempo, low pitch and simple repetitive rhythms to alter physiologic responses. OUTCOMES: Heart rate, respiratory rate, systolic and diastolic blood pressure, confusion assessment method. RESULTS: Repeated measures ANOVA, F(4, 134)=4.75, p=.001, suggested statistically significant differences in heart rate pre/post music listening, and F(1, 37)=10.44, p=.003 in systolic blood pressure pre/post music listening. Post-hoc analysis reported changes at three time periods of statistical significance; (p=.010), (p=.005) and (p=.039) and a change in systolic blood pressure pre/post music listening; (p=.001) of statistical significance. All participants screened negative for delirium. CONCLUSION: Music addresses pathophysiologic mechanisms that contribute to delirium; neurotransmitter imbalance, inflammation and acute physiologic stressors. Music to prevent delirium is one of few that provide support in a critical care setting.
    • PubMed ID
  • Melatonin and sleep in preventing hospitalized delirium: A randomized clinical trial. 2018 Jaiswal, S. J. McCarthy, T. J. Wineinger, N. E. Kang, D. Y. Song, J. Garcia, S. van Niekerk, C. J. Lu, C. Y. Loeks, M. Owens, R. L.. Am J Med,
    • Title

      Melatonin and sleep in preventing hospitalized delirium: A randomized clinical trial.

    • Authors
      Jaiswal, S. J. McCarthy, T. J. Wineinger, N. E. Kang, D. Y. Song, J. Garcia, S. van Niekerk, C. J. Lu, C. Y. Loeks, M. Owens, R. L.
    • Year
      2018
    • Journal
      Am J Med
    • URL
    • Abstract
      PURPOSE: Studies suggest that melatonin may prevent delirium, a condition of acute brain dysfunction occurring in 20-30% of hospitalized older adults that is associated with increased morbidity and mortality. We examined the effect of melatonin on delirium prevention in hospitalized older adults while measuring sleep parameters as a possible underlying mechanism. METHODS: This was a randomized clinical trial measuring the impact of 3 mg of melatonin nightly on incident delirium and both objective and subjective sleep in inpatients age >/= 65, admitted to Internal Medicine wards (non-ICU). Delirium incidence was measured by bedside nurses using the confusion assessment method (CAM). Objective sleep measurements (nighttime sleep duration, total sleep time per 24 hours, and sleep fragmentation as determined by average sleep bout length) were obtained via actigraphy. Subjective sleep quality was measured using the Richards Campbell Sleep Questionnaire. RESULTS: Delirium occurred in 22.2% (8/36) of subjects who received melatonin vs. in 9.1% (3/33) who received placebo (p=0.19). Melatonin did not significantly change objective or subjective sleep measurements. Nighttime sleep duration and total sleep time did not differ between subjects who became delirious vs. those who did not, but delirious subjects had more sleep fragmentation (sleep bout length 7.0+/-3.0 vs. 9.5+/-5.3 min; p=0.03). CONCLUSIONS: Melatonin given as a nightly dose of 3mg did not prevent delirium in non-ICU hospitalized patients, or improve subjective or objective sleep.
    • PubMed ID
  • Delirium as a predictor of mortality in US Medicare beneficiaries discharged from the emergency department: a national claims-level analysis up to 12 months. 2018 Israni, J. Lesser, A. Kent, T. Ko, K.. BMJ Open, 8:5
    • Title

      Delirium as a predictor of mortality in US Medicare beneficiaries discharged from the emergency department: a national claims-level analysis up to 12 months.

    • Authors
      Israni, J. Lesser, A. Kent, T. Ko, K.
    • Year
      2018
    • Journal
      BMJ Open
    • URL
    • Abstract
      BACKGROUND: Delirium is common among seniors discharged from the emergency department (ED) and associated with increased risk of mortality. Prior research has addressed mortality associated with seniors discharged from the ED with delirium, however has generally relied on data from one or a small number of institutions and at single time points. OBJECTIVES: Analyse mortality rates among seniors discharged from the ED with delirium up to 12 months at the national level. DESIGN: Retrospective cohort study. SETTING: Analysed data from the Centers for Medicare & Medicaid Services limited data sets for 2012-2013. PARTICIPANTS: Medicare fee-for-service beneficiaries aged 65 years or older discharged from the ED. We focused on new incident cases of delirium, patients with any prior claims for delirium, hospice claims or end-stage renal disease were excluded. Sample size included 26 245 delirium claims, and a randomly selected sample of 262 450 controls. OUTCOME MEASURES: Mortality within 12 months after discharge from the ED, excluding patients transferred or admitted as inpatients. RESULTS: Among all beneficiaries, 46 508 (16.1%) died within 12 months, of which 39 404 (15.0%) were in the non-delirium (ie, control group) and 7104 (27.1%) were in the delirium cohort, respectively. Mortality was strongest at 30 days with an adjusted HR of 4.82 (95% CI 4.60 to 5.04). Over time, delirium was consistently associated with increased mortality risk compared with controls up to 12 months (HR 2.07; 95% CI 2.01 to 2.13). Covariates that affected mortality included older age, comorbidity and presence of dementia. CONCLUSIONS: Our results demonstrate delirium is a significant marker of mortality among seniors in the ED, and mortality risk is most salient in the first 3 months following an ED visit. Given the significant clinical and financial implications, there is a need to increase delirium screening and management within the ED to help identify and treat this potentially fatal condition.
    • PubMed ID
  • An evaluation of patient-specific characteristics on attainment of target sedation in an intensive care unit. 2018 Humphrey, M. Everhart, S. Kosmisky, D. Anderson, W. E.. Heart Lung,
    • Title

      An evaluation of patient-specific characteristics on attainment of target sedation in an intensive care unit.

    • Authors
      Humphrey, M. Everhart, S. Kosmisky, D. Anderson, W. E.
    • Year
      2018
    • Journal
      Heart Lung
    • URL
    • Abstract
      BACKGROUND: Sedation of mechanically ventilated patients should optimize comfort and safety while avoiding over-sedation and adverse outcomes. To our knowledge, characteristics associated with attaining target sedation are unknown. OBJECTIVES: Evaluate current sedation practice at a single center and explore which patient characteristics are associated with attaining target sedation. METHODS: This is a single-center, retrospective chart review of sedated, ventilated patients in a medical/surgical ICU. Demographic and clinical data were collected. Univariate and multivariate logistic regression analyses were used with attaining target sedation as the dependent variable. RESULTS: Of the 100 patients included (median 60.5 years), 50 attained target sedation. Univariate analyses (a = 0.10) revealed factors associated with target sedation were age (P = 0.08), history of alcohol abuse (P = 0.08), multiple comorbidities (P = 0.09), and delirium monitoring (P = 0.002). Multivariate analysis revealed an association between delirium monitoring/documentation and attaining target sedation (P = 0.005; OR 9.2; 95% CI 2.3-36.8). CONCLUSIONS: Patients without appropriate delirium monitoring/documentation had significantly reduced likelihood of achieving target sedation.
    • PubMed ID
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