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.

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Total Results: 2941

  • Lower risk of postoperative delirium using laparoscopic approach for major abdominal surgery. 2019 Ito, K. Suka, Y. Nagai, M. Kawasaki, K. Yamamoto, M. Koike, D. Nomura, Y. Tanaka, N. Kawaguchi, Y.. Surg Endosc,
    • Title

      Lower risk of postoperative delirium using laparoscopic approach for major abdominal surgery.

    • Authors
      Ito, K. Suka, Y. Nagai, M. Kawasaki, K. Yamamoto, M. Koike, D. Nomura, Y. Tanaka, N. Kawaguchi, Y.
    • Year
      2019
    • Journal
      Surg Endosc
    • URL
    • Abstract
      BACKGROUND: A laparoscopic approach is increasingly being used for major abdominal surgeries and is reportedly associated with a lower incidence of postoperative complications. However, the association of laparoscopic approach and postoperative delirium remains unclear. We aimed to retrospectively investigate risk factors for postoperative delirium after abdominal surgery particularly assessing the association between a laparoscopic approach and postoperative delirium. METHODS: We retrospectively studied 801 patients who underwent major abdominal surgery between April 2012 and December 2013. Among these, 181 (22.6%) patients underwent a laparoscopic and 620 (77.4%) patients underwent an open procedure. A Cox proportional hazard model analysis was used to identify risk factors for the development of postoperative delirium or overall survival within 180 days after surgery. Cumulative incidence of postoperative delirium was assessed using a propensity score-matching analysis. RESULTS: Postoperative delirium occurred in 56 patients (7.0%). A Multivariate Cox proportional hazard model analysis revealed that a laparoscopic approach reduced the risk of postoperative delirium [hazard ratio (HR) 0.30, 95% confidence interval (CI) 0.07-0.84, p = 0.019]. Postoperative delirium was associated with worse overall survival within 180 days (HR 4.91, 95% CI 1.96-12.22, p = 0.001) after adjusting for other confounders using the Cox proportional hazard model analysis. Patients who developed postoperative delirium showed worse outcomes including higher rate of morbidity except delirium (p < 0.001), longer hospitalization (p < 0.001), and post-discharge institutionalization (p < 0.001). After propensity score-matching, cumulative incidence rates of postoperative delirium were significantly lower in the laparoscopic group compared to the open group (30-day cumulative incidence rate, 1.7% vs. 7.8%, p = 0.006). CONCLUSIONS: The risk of postoperative delirium after major abdominal surgery is reduced using laparoscopic approach. Postoperative delirium should be prevented as it precipitates adverse postoperative events.
    • PubMed ID
  • Delirium is associated with frequency band specific dysconnectivity in intrinsic connectivity networks: preliminary evidence from a large retrospective pilot case-control study. 2019 Fleischmann, R. Traenkner, S. Kraft, A. Schmidt, S. Schreiber, S. J. Brandt, S. A.. Pilot Feasibility Stud,
    • Title

      Delirium is associated with frequency band specific dysconnectivity in intrinsic connectivity networks: preliminary evidence from a large retrospective pilot case-control study.

    • Authors
      Fleischmann, R. Traenkner, S. Kraft, A. Schmidt, S. Schreiber, S. J. Brandt, S. A.
    • Year
      2019
    • Journal
      Pilot Feasibility Stud
    • URL
    • Abstract
      Background: Pathophysiological concepts in delirium are not sufficient to define objective biomarkers suited to improve clinical approaches. Advances in neuroimaging have revalued electroencephalography (EEG) as a tool to assess oscillatory network activity in neuropsychiatric disease. Yet, research in the field is limited to small populations and largely confined to postoperative delirium, which impedes generalizability of findings and planning of prospective studies in other populations. This study aimed to assess effect sizes of connectivity measures in a large mixed population to demonstrate that there are measurable EEG differences between delirium and control patients. Methods: This retrospective pilot study investigated EEG measures as biomarkers in delirium using a case-control design including patients diagnosed with delirium (DSM-5 criteria) and age-/gender-matched controls drawn from a database of 9980 patients (n = 129 and 414, respectively). Assessors were not blinded for groups. Power spectra and connectivity estimates, using the weighted phase log index, of continuous EEG data were compared between conditions. Alterations of information flow through nodes of intrinsic connectivity networks (ICN; default mode, salience, and executive control network) were evaluated in source space using betweenness centrality. This was done frequency specific and network nodes were defined by the multimodal human cerebral cortex parcellation based on human connectome project data. Results: Delirium and control patients exhibited distinct EEG power, connectivity, and network characteristics (F (72,540) = 70.3, p < .001; F (493,1079) = 2.69, p < .001; and F (718,2159) = 1.14, p = .007, respectively). Connectivity analyses revealed global alpha and regional beta band disconnectivity that was accompanied by theta band hyperconnectivity in delirious patients. Source and network analyses yielded that these changes are not specific to single intrinsic connectivity networks but affect multiple nodes of networks engaged in level of consciousness, attention, working memory, executive control, and salience detection. Effect sizes were medium to strong in this mixed population of delirious patients. Conclusions: We quantified effect sizes for EEG connectivity and network analyses to be expected in delirium. This study implicates that theta band hyperconnectivity and alpha band disconnectivity may be essential mechanisms in the pathophysiology of delirium. Upcoming prospective studies will build upon these results and evaluate the clinical utility of identified EEG measures as therapeutic and prognostic biomarkers.
    • PubMed ID
  • Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction. 2019 Densky, J. Eskander, A. Kang, S. Chan, J. Tweel, B. Sitapara, J. Ozer, E. Agrawal, A. Carrau, R. Rocco, J. Teknos, T. N. Old, M.. JAMA Otolaryngol Head Neck Surg,
    • Title

      Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction.

    • Authors
      Densky, J. Eskander, A. Kang, S. Chan, J. Tweel, B. Sitapara, J. Ozer, E. Agrawal, A. Carrau, R. Rocco, J. Teknos, T. N. Old, M.
    • Year
      2019
    • Journal
      JAMA Otolaryngol Head Neck Surg
    • URL
    • Abstract
      Importance: Postoperative delirium (POD) is associated with an increased rate of adverse events, higher health care costs, and longer hospital stays. At present, limited data are available regarding the risk factors for developing POD in patients undergoing head and neck free flap reconstruction. Identification of patients at high risk of developing POD will allow implementation of risk-mitigation strategies. Objective: To determine the frequency of and risk factors associated with POD in patients undergoing free flap reconstruction secondary to head and neck disease. Design, Setting, and Participants: This retrospective cohort study included 515 patients undergoing free flap reconstruction from January 1, 2006, through December 31, 2012, at the James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Care Center, a tertiary care cancer hospital. Preoperative, intraoperative, and postoperative data were collected retrospectively. Data from January 1, 2006, through December 31, 2012, were analyzed, and the final date of data analysis was January 8, 2018. Interventions: Head and neck free flap reconstruction. Main Outcomes and Measures: The primary outcome was the development of POD as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Univariable and multivariable logistic regression were used to identify risk factors associated with POD. Results: Five hundred fifteen patients underwent free flap reconstruction during the study period (66.2% male; mean [SD] age, 60.1 [12.8] years). Of these, 56 patients (10.9%) developed POD. On multivariable analysis, risk factors associated with POD included increased age (odds ratio [OR], 1.06; 95% CI, 1.02-1.11), male sex (OR, 5.02; 95% CI, 1.47-17.20), increased operative time (OR for each 1-minute increase, 1.004 [95% CI, 1.001-1.006]; OR for each 1-hour increase, 1.26 [95% CI, 1.08-1.46]), advanced nodal disease (OR, 3.00; 95% CI, 1.39-6.46), and tobacco use (OR, 7.23; 95% CI, 1.43-36.60). Preoperative abstinence from alcohol was identified as a protective factor (OR, 0.24; 95% CI, 0.12-0.51). Conclusions and Relevance: This study identified variables associated with a higher risk of developing POD. Although many of these risk factors are nonmodifiable, they provide a target population for quality improvement initiatives. Furthermore, preoperative alcohol abstinence may be useful in preventing POD.
    • PubMed ID
  • Deprescribing in the Pharmacologic Management of Delirium: A Randomized Trial in the Intensive Care Unit. 2019 Campbell, N. L. Perkins, A. J. Khan, B. A. Gao, S. Farber, M. O. Khan, S. Wang, S. Boustani, M. A.. J Am Geriatr Soc,
    • Title

      Deprescribing in the Pharmacologic Management of Delirium: A Randomized Trial in the Intensive Care Unit.

    • Authors
      Campbell, N. L. Perkins, A. J. Khan, B. A. Gao, S. Farber, M. O. Khan, S. Wang, S. Boustani, M. A.
    • Year
      2019
    • Journal
      J Am Geriatr Soc
    • URL
    • Abstract
      OBJECTIVE: Benzodiazepines and anticholinergics are risk factors for delirium in the intensive care unit (ICU). We tested the impact of a deprescribing intervention on short-term delirium outcomes. DESIGN: Multisite randomized clinical trial. SETTING: ICUs of three large hospitals. PARTICIPANTS: Two hundred adults aged 18 years or older and admitted to an ICU with delirium, according to the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU (CAM-ICU). Participants had a contraindication to haloperidol (seizure disorder or prolonged QT interval) or preference against haloperidol as a treatment for delirium, and were excluded for serious mental illness, stroke, pregnancy, or alcohol withdrawal. Participants were randomized to a deprescribing intervention or usual care. The intervention included electronic alerts combined with pharmacist support to deprescribe anticholinergics and benzodiazepines. MEASUREMENTS: Primary outcomes were delirium duration measured by the CAM-ICU and severity measured by the Delirium Rating Scale Revised-98 (DRS-R-98) and the CAM-ICU-7; secondary outcomes included adverse events and mortality. RESULTS: Participants had a mean age of 61.8 (SD = 14.3) years, 59% were female, and 52% were African American, with no significant differences in baseline characteristics between groups. No differences between groups were identified in the number exposed to anticholinergics (P = .219) or benzodiazepines (P = .566), the median total anticholinergic score (P = .282), or the median total benzodiazepine dose in lorazepam equivalents (P = .501). Neither median delirium/coma-free days (P = .361) nor median change in delirium severity scores (P = .582 for DRS-R-98; P = .333 for CAM-ICU-7) were different between groups. No differences in adverse events or mortality were identified. CONCLUSIONS: When added to state-of-the-art clinical services, this deprescribing intervention had no impact on medication use in ICU participants. Given the age of the population, results of clinical outcomes may not be easily extrapolated to older adults. Nonetheless, improved approaches for deprescribing or preventing anticholinergics and benzodiazepines should be developed to determine the impact on delirium outcomes.
    • PubMed ID
  • Reliability of mobility measures in older medical patients with cognitive impairment. 2019 Braun, T. Thiel, C. Schulz, R. J. Gruneberg, C.. BMC Geriatr, 19:1 (20)
    • Title

      Reliability of mobility measures in older medical patients with cognitive impairment.

    • Authors
      Braun, T. Thiel, C. Schulz, R. J. Gruneberg, C.
    • Year
      2019
    • Journal
      BMC Geriatr
    • URL
    • Abstract
      BACKGROUND: Mobility is a key indicator of physical functioning in older people, but there is limited evidence of the reliability of mobility measures in older people with cognitive impairment. This study aimed to examine the test-retest reliability and measurement error of common measurement instruments of mobility and physical functioning in older patients with dementia, delirium or other cognitive impairment. METHODS: A cross-sectional study was performed in a geriatric hospital. Older acute medical patients with cognitive impairment, indicated by a Mini-Mental State Examination (MMSE) score of 0.7) for group-comparisons in all examined instruments. Most mobility measurements have limited use for individual monitoring of mobility over time in older hospital patients with cognitive impairment because of the large measurement error (> 20% of scale width), even though relative reliability estimations seem sufficient (> 0.9) for this purpose. TRIAL REGISTRATION: German Clinical Trials Register ( DRKS00005591 ). Registered 2 February 2015.
    • PubMed ID
  • Effectiveness of Melatonin for the Prevention of Intensive Care Unit Delirium. 2019 Baumgartner, L. Lam, K. Lai, J. Barnett, M. Thompson, A. Gross, K. Morris, A.. Pharmacotherapy,
    • Title

      Effectiveness of Melatonin for the Prevention of Intensive Care Unit Delirium.

    • Authors
      Baumgartner, L. Lam, K. Lai, J. Barnett, M. Thompson, A. Gross, K. Morris, A.
    • Year
      2019
    • Journal
      Pharmacotherapy
    • URL
    • Abstract
      STUDY OBJECTIVE: Intensive care unit (ICU) delirium is an acute brain dysfunction that has been associated with increased mortality, prolonged ICU and hospital lengths of stay, and development of post-ICU cognitive impairment. Melatonin may help to restore sleep and reduce the occurrence of ICU delirium. The purpose of this study was to evaluate the effectiveness of melatonin for the prevention of ICU delirium in critically ill adults. DESIGN: Retrospective, observational cohort study. SETTING: Large academic medical center. PATIENTS: A total of 232 adults were included who were admitted to the medical-surgical or cardiac ICUs between 2013 and 2017 who had a negative Confusion Assessment Method for the ICU (CAM-ICU). Of those, the melatonin group consisted of 117 patients who received melatonin for at least 48 hours; the control group consisted of 115 patients who were admitted for at least 4 days (average time of melatonin initiation), did not receive melatonin during their ICU stay, and did not receive antipsychotics within the first 4 days of their ICU stay. MEASUREMENTS AND MAIN RESULTS: The primary outcome was development of delirium, which was assessed by using the CAM-ICU. The CAM-ICU was measured twice daily by nursing staff. The development of delirium was significantly lower in the melatonin group: 9 (7.7%) versus 28 (24.3%) patients (p=0.001). This finding remained significant in multivariate logistic models controlling for age, sex, history of hypertension, need for emergent surgery, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation, ICU length of stay, dexmedetomidine use, and benzodiazepine use. For those patients who developed delirium, patients in the control group had, on average, 20.9 delirium-free days without coma in 28 days compared with 19.9 days in the melatonin group (p=0.72). In the melatonin group, melatonin was used for a mean +/- SD of 6.3 +/- 7.9 days, with a median dose of 3.5 mg/night (range 1-10 mg). CONCLUSION: The development of ICU delirium was significantly lower in the melatonin group compared with that in the control group. To our knowledge, this is one of the only studies that has examined the use of melatonin for the prevention of ICU delirium. Melatonin may be a promising agent for the prevention of ICU delirium; however, a randomized study is needed to further validate its efficacy. This article is protected by copyright. All rights reserved.
    • PubMed ID
  • Validation of the Prediction of Delirium for Intensive Care model to predict subsyndromal delirium. 2019 Azuma, K. Mishima, S. Shimoyama, K. Ishii, Y. Ueda, Y. Sakurai, M. Morinaga, K. Fujikawa, T. Oda, J.. Acute Med Surg, 6:1 (54-59)
    • Title

      Validation of the Prediction of Delirium for Intensive Care model to predict subsyndromal delirium.

    • Authors
      Azuma, K. Mishima, S. Shimoyama, K. Ishii, Y. Ueda, Y. Sakurai, M. Morinaga, K. Fujikawa, T. Oda, J.
    • Year
      2019
    • Journal
      Acute Med Surg
    • URL
    • Abstract
      Aim: Subsyndromal delirium is associated with prolonged intensive care unit stays, and prolonged mechanical ventilation requirements. The Prediction of Delirium for Intensive Care (PRE-DELIRIC) model can predict delirium. This study was designed to verify if it can also predict development of subsyndromal delirium. Methods: We undertook a single-center, retrospective observation study in Japan. We diagnosed subsyndromal delirium based on the Intensive Care Delirium Screening Checklist. We calculated the sensitivity and specificity of the PRE-DELIRIC model and obtained a diagnostic cut-off value. Results: We evaluated data from 70 patients admitted to the mixed medical intensive care unit of the Tokyo Medical University Hospital (Tokyo, Japan) between May 2015 and February 2017. The prevalence of subsyndromal delirium by Intensive Care Delirium Screening Checklist was 31.4%. The area under the receiver operating characteristic curve was 0.83 of the PRE-DELIRIC model for subsyndromal delirium. The calculated cut-off value was 36 points with a sensitivity of 94.3% and specificity of 57.1%. Subsyndromal delirium was associated with a higher incidence of delirium (odds ratio, 8.81; P < 0.01). Conclusion: The PRE-DELIRIC model could be a tool for predicting subsyndromal delirium using a cut-off value of 36 points.
    • PubMed ID
  • Association Between Postoperative Delirium and Long-term Cognitive Function After Major Nonemergent Surgery. 2019 Austin, C. A. O'Gorman, T. Stern, E. Emmett, D. Sturmer, T. Carson, S. Busby-Whitehead, J.. JAMA Surg,
    • Title

      Association Between Postoperative Delirium and Long-term Cognitive Function After Major Nonemergent Surgery.

    • Authors
      Austin, C. A. O'Gorman, T. Stern, E. Emmett, D. Sturmer, T. Carson, S. Busby-Whitehead, J.
    • Year
      2019
    • Journal
      JAMA Surg
    • URL
    • Abstract
      Importance: Postoperative delirium is associated with decreases in long-term cognitive function in elderly populations. Objective: To determine whether postoperative delirium is associated with decreased long-term cognition in a younger, more heterogeneous population. Design, Setting, and Participants: A prospective cohort study was conducted at a single academic medical center (>/=800 beds) in the southeastern United States from September 5, 2017, through January 15, 2018. A total of 191 patients aged 18 years or older who were English-speaking and were anticipated to require at least 1 night of hospital admission after a scheduled major nonemergent surgery were included. Prisoners, individuals without baseline cognitive assessments, and those who could not provide informed consent were excluded. Ninety-day follow-up assessments were performed on 135 patients (70.7%). Exposures: The primary exposure was postoperative delirium defined as any instance of delirium occurring 24 to 72 hours after an operation. Delirium was diagnosed by the research team using the Confusion Assessment Method (CAM). Main Outcomes and Measures: The primary outcome was change in cognition at 90 days after surgery compared with baseline, preoperative cognition. Cognition was measured using a telephone version of the Montreal Cognitive Assessment (T-MoCA) with cognitive impairment defined as a score less than 18 on a scale of 0 to 22. Results: Of the 191 patients included in the study, 110 (57.6%) were women; the mean (SD) age was 56.8 (16.7) years. For the primary outcome of interest, patients with and without delirium had a small increase in T-MoCA scores at 90 days compared with baseline on unadjusted analysis (with delirium, 0.69; 95% CI, -0.34 to 1.73 vs without delirium, 0.67; 95% CI, 0.17-1.16). The initial multivariate linear regression model included age, preoperative American Society of Anesthesiologists Physical Status Classification System score, preoperative cognitive impairment, and duration of anesthesia. Preoperative cognitive impairment proved to be the only notable confounder: when adjusted for preoperative cognitive impairment, patients with delirium had a 0.70-point greater decrease in 90-day T-MoCA scores than those without delirium compared with their respective baseline scores (with delirium, 0.16; 95% CI, -0.63 to 0.94 vs without delirium, 0.86; 95% CI, 0.40-1.33). Conclusions and Relevance: Although a statistically significant association between 90-day cognition and postoperative delirium was not noted, patients with preoperative cognitive impairment appeared to have improvements in cognition 90 days after surgery; however, this finding was attenuated if they became delirious. Preoperative cognitive impairment alone should not preclude patients from undergoing indicated surgical procedures.
    • PubMed ID
  • 'I hope you get normal again': an explorative study on how delirious octogenarian patients experience their interactions with healthcare professionals and relatives after aortic valve therapy. 2018 Instenes, I. Fridlund, B. Amofah, H. A. Ranhoff, A. H. Eide, L. S. Norekval, T. M.. Eur J Cardiovasc Nurs,
    • Title

      'I hope you get normal again': an explorative study on how delirious octogenarian patients experience their interactions with healthcare professionals and relatives after aortic valve therapy.

    • Authors
      Instenes, I. Fridlund, B. Amofah, H. A. Ranhoff, A. H. Eide, L. S. Norekval, T. M.
    • Year
      2018
    • Journal
      Eur J Cardiovasc Nurs
    • URL
    • Abstract
      BACKGROUND:: Delirium affects nearly half of octogenarian patients after aortic valve replacement, resulting in impaired cognition, reduced awareness and hallucinations. Although healthcare professionals and relatives are often present during episodes, the nature of interactions with them is scarcely studied, and little is known about their long-term experiences. PURPOSE:: The purpose of this study was to explore and describe how octogenarian patients with post-aortic valve replacement delirium experience interactions with healthcare professionals and relatives within the first year and four years later. METHOD:: An explorative design with qualitative content analysis was used. Delirium was assessed for five consecutive days after aortic valve replacement using the Confusion Assessment Method. Delirious patients ( n=10) were interviewed 6-12 months post-discharge and four years later ( n=5). We used an inductive approach to identify themes in transcribed interviews. FINDINGS:: An overarching theme emerged: ' Healthcare professionals' and relatives' responses made a considerable impact on the delirium experience postoperatively and in a long-term'. Three sub-themes described the patients' experiences: ' the need for close supportive care', ' disrespectful behaviour created a barrier' and ' insensitive comments made lasting impressions'. Having healthcare professionals and relatives nearby made the patients feel secure, while lack of attention elevated patients' emotional distress. Four years later, patients clearly recalled negative comments and unsupportive actions in their delirious state. CONCLUSIONS:: Healthcare professionals and relatives have an essential role in the aortic valve replacement recovery process. Inconsiderate behaviour directed at older patients in delirium elevates distress and has long-term implications. Supportive care focused on maintaining the patients' dignity and integrity is vital.
    • PubMed ID
  • Establishing a successful perioperative geriatric service in an Australian acute surgical unit. 2018 Styan, L. Murphy, S. Fleury, A. McGowan, B. Wullschleger, M.. ANZ Journal of Surgery, 88:6 (607-611)
    • Title

      Establishing a successful perioperative geriatric service in an Australian acute surgical unit.

    • Authors
      Styan, L. Murphy, S. Fleury, A. McGowan, B. Wullschleger, M.
    • Year
      2018
    • Journal
      ANZ Journal of Surgery
    • URL
    • Abstract
      BACKGROUND: The purpose of this study was to assess the impact of a perioperative geriatric service (PGS) in an acute surgical unit (ASU) on patient and organizational outcomes. METHODS: Single centre retrospective cohort study. Inclusion criteria were patients over the age of 65 admitted to the ASU between January and June 2014 (pre-PGS) and 2015 (post-PGS). Chart reviews were performed to identify outcomes of interest including in-hospital morbidity and mortality, length of stay (LOS), 30-day representation and mortality. RESULTS: Geriatric admissions increased by 32% over the two study periods (154 pre-PGS and 203 post-PGS). Surgical intervention increased by 11% (P = 0.01). Significantly more medical complications (14% versus 33%, P < 0.001) were identified after the implementation of the PGS. Recognition of delirium in the over 80s also increased by 57%. Rate of surgical complications was unchanged over the study (28% pre-PGS and 34% post-PGS, P = 0.6). In-hospital (<1%, P = 0.5) and 30-day mortality (<1%, P = 0.6) remained low, as did 30-day representation (10% versus 8%, P = 0.5). A trend towards decreased LOS of 1 day was identified after the implementation of the PGS (P = 0.07). CONCLUSION: This study demonstrated successful implementation of a PGS into an ASU. This multi-disciplinary approach has been effective in maintaining low numbers of surgical complications, in-hospital mortality, LOS and patient representations despite an increased number of medical complications. This likely reflects more timely recognition and intervention of medically unwell patients with the PGS.
    • PubMed ID
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