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: 3010

  • Delirium Incidence and Functional Outcomes After Transcatheter and Surgical Aortic Valve Replacement. 2019 Shi, S. M. Sung, M. Afilalo, J. Lipsitz, L. A. Kim, C. A. Popma, J. J. Khabbaz, K. R. Laham, R. J. Guibone, K. Lee, J. Marcantonio, E. R. Kim, D. H.. J Am Geriatr Soc,
    • Title

      Delirium Incidence and Functional Outcomes After Transcatheter and Surgical Aortic Valve Replacement.

    • Authors
      Shi, S. M. Sung, M. Afilalo, J. Lipsitz, L. A. Kim, C. A. Popma, J. J. Khabbaz, K. R. Laham, R. J. Guibone, K. Lee, J. Marcantonio, E. R. Kim, D. H.
    • Year
      2019
    • Journal
      J Am Geriatr Soc
    • URL
    • Abstract
      BACKGROUND: Transcatheter aortic valve replacement (TAVR) may be associated with less delirium and allow faster recovery than surgical aortic valve replacement (SAVR). OBJECTIVE: To examine the association of delirium and its severity with clinical and functional outcomes after SAVR and TAVR. DESIGN: Prospective cohort study. SETTING: An academic medical center. PARTICIPANTS: A total of 187 patients, aged 70 years and older, undergoing SAVR (N = 77) and TAVR (N = 110) in 2014 to 2016. MEASUREMENTS: Delirium was assessed daily using the Confusion Assessment Method (CAM), with severity measured by the CAM-Severity (CAM-S) score (range = 0-19). Outcomes were prolonged hospitalization (9 days or more); institutional discharge; and functional status, measured by ability to perform 22 daily activities and physical tasks over 12 months. RESULTS: SAVR patients had a higher incidence of delirium than TAVR patients (50.7% vs 25.5%; P < .001), despite younger mean age (77.9 vs 83.7 years) and higher baseline Mini-Mental State Examination score (26.9 vs 24.7). SAVR patients with delirium had a shorter duration (2.2 vs 3.4 days; P = .04) with a lower mean CAM-S score (4.5 vs 5.7; P = .01) than TAVR patients with delirium. The risk of prolonged hospitalization in no, mild, and severe delirium was 18.4%, 30.8%, and 61.5% after SAVR (P for trend = .009) and 26.8%, 38.5%, and 73.3% after TAVR (P for trend = .001), respectively. The risk of institutional discharge was 42.1%, 58.3%, and 84.6% after SAVR (P for trend = .01) and 32.5%, 69.2%, and 80.0% after TAVR (P for trend <.001), respectively. Severe delirium was associated with delayed functional recovery after SAVR and persistent functional impairment after TAVR at 12 months. CONCLUSION: Less invasive TAVR was associated with lower incidence of delirium than SAVR. Once delirium developed, TAVR patients had more severe delirium and worse functional status trajectory than SAVR patients did. REGISTRATION: NCT01845207.
    • PubMed ID
  • Effect of perioperative administration of dexmedetomidine on delirium after cardiac surgery in elderly patients: a double-blinded, multi-center, randomized study. 2019 Shi, C. Jin, J. Qiao, L. Li, T. Ma, J. Ma, Z.. Clin Interv Aging, (571-5)
    • Title

      Effect of perioperative administration of dexmedetomidine on delirium after cardiac surgery in elderly patients: a double-blinded, multi-center, randomized study.

    • Authors
      Shi, C. Jin, J. Qiao, L. Li, T. Ma, J. Ma, Z.
    • Year
      2019
    • Journal
      Clin Interv Aging
    • URL
    • Abstract
      Objective: Postoperative delirium (POD) is a serious complication in elderly patients undergoing cardiac surgery. This study was aimed at investigating the effect of perioperative administration of dexmedetomidine for general anesthesia maintenance on occurrence and duration of POD in elderly patients after cardiac surgery. Methods: One hundred and sixty-four patients were enrolled after cardiac surgery between June 2009 and December 2016. Patients were assigned by a computer-generated randomization sequence in a 1:1 ratio to receive dexmedetomidine general anesthesia maintenance or propofol general anesthesia maintenance. POD was assessed every day with confusion assessment method for intensive care units (ICU) during the first 5 postoperative days. Results: There was no significance in incidence of POD between the dexmedetomidine group and the propofol group (P=0.0758). In patients treated with dexmedetomidine, the median onset time of delirium was delayed (second day vs first day) and the duration of delirium reduced (2 days vs 3 days) when compared with propofol-treated patients. The dexmedetomidine-treated patients also displayed a lower VAS score and less opiate analgesic consumption. No difference was observed in respect to other postoperative outcomes. Conclusion: For elderly patients, perioperative administration of dexmedetomidine reduced incidence, delayed onset and shortened duration of POD after cardiac surgery.
    • PubMed ID
  • Perspectives on the Delirium Experience and Its Burden: Common Themes Among Older Patients, Their Family Caregivers, and Nurses. 2019 Schmitt, E. M. Gallagher, J. Albuquerque, A. Tabloski, P. Lee, H. J. Gleason, L. Weiner, L. S. Marcantonio, E. R. Jones, R. N. Inouye, S. K. Schulman-Green, D.. Gerontologist, 59:2 (327-337)
    • Title

      Perspectives on the Delirium Experience and Its Burden: Common Themes Among Older Patients, Their Family Caregivers, and Nurses.

    • Authors
      Schmitt, E. M. Gallagher, J. Albuquerque, A. Tabloski, P. Lee, H. J. Gleason, L. Weiner, L. S. Marcantonio, E. R. Jones, R. N. Inouye, S. K. Schulman-Green, D.
    • Year
      2019
    • Journal
      Gerontologist
    • URL
    • Abstract
      BACKGROUND AND OBJECTIVES: While there are qualitative studies examining the delirium-related experiences of patients, family caregivers, and nurses separately, little is known about common aspects of delirium burden among all three groups. We describe common delirium burdens from the perspectives of patients, family caregivers, and nurses. RESEARCH DESIGN AND METHODS: We conducted semistructured qualitative interviews about delirium burden with 18 patients who had recently experienced a delirium episode, with 16 family caregivers, and with 15 nurses who routinely cared for patients with delirium. We recruited participants from a large, urban teaching hospital in Boston, Massachusetts. Interviews were recorded and transcribed. We used interpretive description as the approach to data analysis. RESULTS: We identified three common burden themes of the delirium experience: Symptom Burden (Disorientation, Hallucinations/Delusions, Impaired Communication, Memory Problems, Personality Changes, Sleep Disturbances); Emotional Burden (Anger/Frustration, Emotional Distress, Fear, Guilt, Helplessness); and Situational Burden (Loss of Control, Lack of Attention, Lack of Knowledge, Lack of Resources, Safety Concerns, Unpredictability, Unpreparedness). These burdens arise from different sources among patients, family caregivers, and nurses, with markedly differing perspectives on the burden experience. DISCUSSION AND IMPLICATIONS: Our findings advance the understanding of common burdens of the delirium experience for all groups and offer structure for instrument development and distinct interventions to address the burden of delirium as an individual or group experience. Our work reinforces that no one group experiences delirium in isolation. Delirium is a shared experience that will respond best to systemwide approaches to reduce associated burden.
    • PubMed ID
  • Association of Persistent Intense Thirst With Delirium Among Critically Ill Patients: A Cross-sectional Study. 2019 Sato, K. Okajima, M. Taniguchi, T.. J Pain Symptom Manage,
    • Title

      Association of Persistent Intense Thirst With Delirium Among Critically Ill Patients: A Cross-sectional Study.

    • Authors
      Sato, K. Okajima, M. Taniguchi, T.
    • Year
      2019
    • Journal
      J Pain Symptom Manage
    • URL
    • Abstract
      CONTEXT: Thirst is a prevalent distressing symptom often reported by patients in the intensive care unit (ICU). Little is known about the association of thirst with delirium. OBJECTIVE: We aimed to investigate the relationship between thirst and delirium. METHODS: This retrospective cross-sectional study enrolled 401 patients who were evaluated for thirst intensity in the ICU between March 2017 and October 2017. We assessed thirst intensity on a scale of 0-10 (with 10 being the worst) and defined intense thirst as a score >/=8. If intense thirst persisted for more than 24 hours, we defined it as persistent intense thirst. Delirium was screened using the Intensive Care Delirium Screening Checklist. Propensity score matching and inverse probability of treatment weighting analyses were performed. RESULTS: Of 401 patients, 66 (16.5%) had intense thirst sensation for more than 24 hours. After matching, patients with persistent intense thirst showed an increased risk for delirium compared with those without persistent intense thirst (odds ratio, 4.95; 95% confidence interval, 2.58-9.48; P < 0.001). Propensity score weighted logistic regression analysis also indicated that persistent intense thirst was significantly associated with delirium (odds ratio, 5.74; 95% confidence interval, 2.53-12.99; P < 0.001). CONCLUSION: Intense thirst persisting for more than 24 hours was associated with increased risk for delirium.
    • PubMed ID
  • Role of Epileptic Activity in Older Adults With Delirium, a Prospective Continuous EEG Study. 2019 Sambin, S. Gaspard, N. Legros, B. Depondt, C. De Breucker, S. Naeije, G.. Front Neurol, (263)
    • Title

      Role of Epileptic Activity in Older Adults With Delirium, a Prospective Continuous EEG Study.

    • Authors
      Sambin, S. Gaspard, N. Legros, B. Depondt, C. De Breucker, S. Naeije, G.
    • Year
      2019
    • Journal
      Front Neurol
    • URL
    • Abstract
      Background/Objectives: Delirium occurs in up to 50 % of hospitalized old patients and is associated with increased morbidity and mortality. Acute medical conditions favor delirium, but the pathophysiology is unclear. Preliminary evidence from retrospective and prospective studies suggests that a substantial minority of old patients with unexplained delirium have non-convulsive seizures or status epilepticus (NCSE). Yet, seeking epileptic activity only in unexplained cases of delirium might result in misinterpretation of its actual prevalence. We aimed to systematically investigate the role of epileptic activity in all older patients with delirium regardless of the underlying etiology. Design, Setting: Prospective observational study in a tertiary medical center. Adults >65 years with delirium underwent at least 24 h of continuous electro-encephalographic monitoring (cEEG). Background patterns and ictal and interictal epileptic discharges were identified, as well as clinical and biological characteristics. Participants: Fifty patients were included in the study. Results: NCSE was found in 6 (12%) patients and interictal discharges in 15 (30%). There was no difference in the prevalence of epileptic activity rates between delirium associated with an acute medical condition and delirium of unknown etiology. Conclusion: Epileptic activity may play a substantial role in the pathophysiology of delirium by altering brain functioning and neuronal metabolism. No clinical or biological marker was found to distinguish delirious patients with or without epileptic activity, underlining the importance of cEEG in this context.
    • PubMed ID
  • Surgical delay is a risk factor of delirium in hip fracture patients with mild–moderate cognitive impairment. 2019 Pioli, G. Bendini, C. Giusti, A. Pignedoli, P. Cappa, M. Iotti, E. Ferri, M. A. Bergonzini, E. Sabetta, E.. Aging Clinical and Experimental Research, 31:1 (41-47)
    • Title

      Surgical delay is a risk factor of delirium in hip fracture patients with mild–moderate cognitive impairment.

    • Authors
      Pioli, G. Bendini, C. Giusti, A. Pignedoli, P. Cappa, M. Iotti, E. Ferri, M. A. Bergonzini, E. Sabetta, E.
    • Year
      2019
    • Journal
      Aging Clinical and Experimental Research
    • URL
    • Abstract
      Aim: To investigate the relationship between onset of delirium and time to surgery in hip fracture (HF) patients with a different degree of cognitive impairment. Methods: Retrospective analysis of a prospective database of 939 older adults, aged ≥ 75 years admitted with a fragility HF. Subjects underwent a Comprehensive Geriatric Assessment on admission, evaluating health status, prefracture functional status in basic and instrumental activities of daily living, and walking ability. According to the Short Portable Mental Status Questionnaire score, patients were stratified into three categories: cognitively healthy (0–2 errors), mildly to moderately impaired (3–7 errors) and severely impaired (8–10 errors). Time to surgery (from admission) was expressed as days. The occurrence of delirium was ascertained daily by Confusion Assessment Method. Results: Two hundred ninety-two (31.1%) patients experienced delirium during in-hospital stay. They were older, with a higher degree of comorbidity and functional impairment compared to patients without delirium. In multivariate analysis, surgical delay resulted a significant independent risk factor for delirium (HR 1.11, 95% CI 1.01–1.24), along with age, prefracture functional disability and cognitive impairment. When the analysis was performed accounting for the cognitive categories, surgical delay demonstrated to increase the risk of delirium only in the subcategory of mildly to moderately impaired patients, while no significant effect was demonstrated in patients cognitively healthy or severely impaired. Conclusions: The study supports the concept that older adults with HF should undergo surgery quickly. Patients with mild-to-moderate cognitive impairment should be primarily considered as the best target for interventions aiming to reduce time to surgery.
    • PubMed ID
  • Cerebrospinal Fluid Spermidine, Glutamine and Putrescine Predict Postoperative Delirium Following Elective Orthopaedic Surgery. 2019 Pan, X. Cunningham, E. L. Passmore, A. P. McGuinness, B. McAuley, D. F. Beverland, D. O'Brien, S. Mawhinney, T. Schott, J. M. Zetterberg, H. Green, B. D.. Sci Rep, 9:1 (4191)
    • Title

      Cerebrospinal Fluid Spermidine, Glutamine and Putrescine Predict Postoperative Delirium Following Elective Orthopaedic Surgery.

    • Authors
      Pan, X. Cunningham, E. L. Passmore, A. P. McGuinness, B. McAuley, D. F. Beverland, D. O'Brien, S. Mawhinney, T. Schott, J. M. Zetterberg, H. Green, B. D.
    • Year
      2019
    • Journal
      Sci Rep
    • URL
    • Abstract
      Delirium is a marker of brain vulnerability, associated with increasing age, pre-existing cognitive impairment and, recently, cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease. This nested case-control study used a targeted quantitative metabolomic methodology to profile the preoperative CSF of patients (n = 54) who developed delirium following arthroplasty (n = 28) and those who did not (n = 26). The aim was to identify novel preoperative markers of delirium, and to assess potential correlations with clinical data. Participants without a diagnosis of dementia (>/=65 years) undergoing elective primary hip or knee arthroplasty were postoperatively assessed for delirium once-daily for three days. Groups were compared using multivariate, univariate and receiving operator characteristic (ROC) methods. Multivariate modelling using Orthogonal Partial Least Squares-Discriminant Analysis (OPLS-DA) of metabolomic data readily distinguished between delirium and control groups (R2 0.75). The biomarker performance of the two polyamines (spermidine/putrescine) was enhanced by ratio with CSF Abeta42 (ROC > 0.8), and spermidine significantly correlated with Abeta42 (pearson r = -0.32; P = 0.018). These findings suggest that spermidine and putrescine levels could be useful markers of postoperative delirium risk, particularly when combined with Abeta42, and this requires further investigation.
    • PubMed ID
  • The impact of the Hospital Elder Life Program on the treatment of asymptomatic bacteriuria: An unexpected benefit. 2019 O'Donnell, A. J. Walsh, T. L. Tang, A. Weinberg, L.. Geriatr Nurs,
    • Title

      The impact of the Hospital Elder Life Program on the treatment of asymptomatic bacteriuria: An unexpected benefit.

    • Authors
      O'Donnell, A. J. Walsh, T. L. Tang, A. Weinberg, L.
    • Year
      2019
    • Journal
      Geriatr Nurs
    • URL
    • Abstract
      Delirium in older adults is often inappropriately attributed to presumed urinary tract infections (UTIs) leading to unnecessary prescribing of antibiotics for asymptomatic bacteriuria. We sought to examine whether implementation of the Hospital Elder Life Program (HELP), a delirium prevention program, reduced the inappropriate treatment of asymptomatic bacteriuria. We conducted a secondary data analysis of administrative data and electronic health records on a descriptive study in which HELP was implemented at an academic community hospital. Patients aged 70 and older admitted before HELP was implemented (n=687) were compared to the intervention group after HELP implementation (n=637). HELP intervention participants, compared to pre-intervention patients, were less likely to receive inappropriate treatment for asymptomatic bacteriuria (3.0% versus 6.7%, adjusted odds ratio=0.46, 95% confidence interval=0.26-0.79, P=0.005). HELP was associated with a reduction in the treatment of asymptomatic bacteriuria. Therefore, HELP may decrease adverse events and costs related to unnecessary exposure to antibiotics.
    • PubMed ID
  • Continuous EEG Monitoring in a Consecutive Patient Cohort with Sepsis and Delirium. 2019 Nielsen, R. M. Urdanibia-Centelles, O. Vedel-Larsen, E. Thomsen, K. J. Moller, K. Olsen, K. S. Lauritsen, A. O. Eddelien, H. S. Lauritzen, M. Benedek, K.. Neurocrit Care,
    • Title

      Continuous EEG Monitoring in a Consecutive Patient Cohort with Sepsis and Delirium.

    • Authors
      Nielsen, R. M. Urdanibia-Centelles, O. Vedel-Larsen, E. Thomsen, K. J. Moller, K. Olsen, K. S. Lauritsen, A. O. Eddelien, H. S. Lauritzen, M. Benedek, K.
    • Year
      2019
    • Journal
      Neurocrit Care
    • URL
    • Abstract
      BACKGROUND: Delirium is common during sepsis, although under-recognized. We aimed to assess the value of continuous electroencephalography (cEEG) to aid in the diagnosis of delirium in septic patients. METHODS: We prospectively evaluated 102 consecutive patients in a medical intensive care unit (ICU), who had sepsis or septic shock, without evidence of acute primary central nervous system disease. We initiated cEEG recording immediately after identification. The median cEEG time per patient was 44 h (interquartile range 21-99 h). A total of 6723 h of cEEG recordings were examined. The Confusion Assessment Method for the ICU (CAM-ICU) was administered six times daily to identify delirium. We analyzed the correlation between cEEG and delirium using 1252 two-minute EEG sequences recorded simultaneously with the CAM-ICU scorings. RESULTS: Of the 102 included patients, 66 (65%) had at least one delirium episode during their ICU stay, 30 (29%) remained delirium-free, and 6 (6%) were not assessable due to deep sedation or coma. The absence of delirium was independently associated with preserved high-frequency beta activity (> 13 Hz) (P < 10(-7)) and cEEG reactivity (P < 0.001). Delirium was associated with preponderance of low-frequency cEEG activity and absence of high-frequency cEEG activity. Sporadic periodic cEEG discharges occurred in 15 patients, 13 of whom were delirious. No patient showed clinical or electrographic evidence of non-convulsive status epilepticus. CONCLUSIONS: Our findings indicate that cEEG can help distinguish septic patients with delirium from non-delirious patients.
    • PubMed ID
  • Delirium risk factors and associated outcomes in a neurosurgical cohort: a case-control study. 2019 Morshed, R. A. Young, J. S. Safaee, M. Sankaran, S. Berger, M. S. McDermott, M. W. Hervey-Jumper, S. L.. World Neurosurg,
    • Title

      Delirium risk factors and associated outcomes in a neurosurgical cohort: a case-control study.

    • Authors
      Morshed, R. A. Young, J. S. Safaee, M. Sankaran, S. Berger, M. S. McDermott, M. W. Hervey-Jumper, S. L.
    • Year
      2019
    • Journal
      World Neurosurg
    • URL
    • Abstract
      OBJECTIVE: There are limited reports examining delirium in cohorts of neurosurgical patients across inpatient settings without separation based on subspecialty distinction. It is of interest to identify consistent delirium risk factors across various cranial pathologies and inpatient settings which will inform future interventional studies. METHODS: Delirium rates, patient and hospitalization risk factors, and clinical outcomes in 235 patients undergoing a cranial procedure were examined in a retrospective fashion. RESULTS: Fifty-two (22.1%) experience delirium during their hospital stay. Patient factors predictive of delirium on univariate logistic regression were older age, a diagnosis of hydrocephalus or intracranial infection, transfer from an outside hospital, and admission through the emergency department. Hospitalization factors predictive of delirium included longer length of ICU stay, abnormal sodium values preceding delirium, a new postoperative infection, and the presence of a neurological deficit. Using recursive partitioning, age >/= 72.56 years and ICU length of stay >/= 5 days were identified as critical thresholds for predicting delirium (OR 4.61 and 18.2, respectively). On multivariate logistic regression analysis, age (unit OR 1.05), length of ICU stay (unit OR 1.2), and a neurological deficit (OR 5.4) were predictive of delirium. Furthermore, delirium was significantly associated with a longer length of admission as well as decreased likelihood for discharge home. CONCLUSION: Delirium is a frequent occurrence after neurosurgery with older age, longer ICU stay, and a neurological deficit being consistent risk factors across inpatient settings. These results help identify at-risk patients for delirium on a neurosurgical service in order to enact interventions pre-emptively.
    • PubMed ID
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