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: 3226

  • Clinical management of delirium: The response depends on the subtypes. An observational cohort study in 602 patients. 2019 Zipser, C. M. Knoepfel, S. Hayoz, P. Schubert, M. Ernst, J. von Kanel, R. Boettger, S.. Palliat Support Care, (1-8)
    • Title

      Clinical management of delirium: The response depends on the subtypes. An observational cohort study in 602 patients.

    • Authors
      Zipser, C. M. Knoepfel, S. Hayoz, P. Schubert, M. Ernst, J. von Kanel, R. Boettger, S.
    • Year
      2019
    • Journal
      Palliat Support Care
    • URL
    • Abstract
      OBJECTIVE: The hypoactive, hyperactive, and mixed subtypes of delirium differently impact patient management and prognosis, yet the evidence remains sparse. Therefore, we examined the outcome of varying management strategies in the subtypes of delirium. METHODS: In this observational cohort study, 602 patients were managed for delirium over 20 days with the following strategies: supportive care alone or in combination with psychotropics, single, dual, or triple+ psychotropic regimens. Cox regression models were calculated for time to remission and benefit rates (BRs) of management strategies. RESULTS: Generally, the mixed subtype of delirium caused more severe and persistent delirium, and the hypoactive subtype was more persistent than the hyperactive subtype. The subtypes of delirium were similarly predictive for mortality (P = 0.697) and transfer to inpatient psychiatric care (P = 0.320). In the mixed subtype, overall, psychotropic drugs were administered more often (P = 0.016), and particularly triple+ regimens were administered more commonly compared to hypoactive delirium (P = 0.007). Patients on supportive care benefited most, whereas those on triple+ regimens did worst in terms of remission in all groups of hypoactive, hyperactive, and mixed subtypes (BR: 4.59, CI 2.01-10.48; BR: 4.59, CI 1.76-31.66; BR: 3.36, CI 1.73-6.52; all P < 0.05). SIGNIFICANCE OF RESULTS: The mixed subtype was more persistent to management than the hypoactive and hyperactive subtypes. Delirium management remains controversial and, generally, supportive care benefited patients most. Psychopharmacological management for delirium requires careful choosing of and limiting the number of psychotropics.
    • PubMed ID
  • Predisposing and precipitating factors for delirium in neurology: a prospective cohort study of 1487 patients. 2019 Zipser, C. M. Deuel, J. Ernst, J. Schubert, M. Weller, M. von Kanel, R. Boettger, S.. J Neurol,
    • Title

      Predisposing and precipitating factors for delirium in neurology: a prospective cohort study of 1487 patients.

    • Authors
      Zipser, C. M. Deuel, J. Ernst, J. Schubert, M. Weller, M. von Kanel, R. Boettger, S.
    • Year
      2019
    • Journal
      J Neurol
    • URL
    • Abstract
      INTRODUCTION: Predisposing and precipitating factors for delirium are well known; however, their interaction and impact on delirium in neurological patients remains largely unknown. Therefore, those factors were evaluated in hospitalized patients with neurological disorders. METHODS: In this prospective cohort study, 1487 neurological patients were included, 356 patients with delirium and 1131 without delirium. Relevant neurological- and medical-related clusters were assessed with multiple regression analyses, prediction models, and cluster analysis evaluating their association with delirium. RESULTS: The 1-year incidence of delirium in this cohort was 23.9%. Delirium developed in 31% of patients with stroke, in 39.5% with epilepsy, and in 58.4% with ICH. The most relevant predisposing factors were substance-use disorders (OR 4.24, 2.28-7.78, p < 0.001), advanced age (OR 3.44, CI 2.40-4.92, p < 0.001), and neurodegenerative disorders (OR 2.58, CI 1.47-4.54, p = 0.001). The most relevant precipitating factors were meningitis (OR 21.52, CI 1.22-379.83, p = 0.036), acute renal failure (OR 10.01, CI 1.13-88.73, p = 0.039), and intracranial hemorrhage (OR 3.62, CI 2.08-6.30, p < 0.001). Delirious patients were hospitalized 6 days longer, had higher in-hospital mortality, and were discharged more often to nursing homes and rehabilitation. Best predictor for delirium was the coexistence of advanced age with epilepsy (58.3%, p < 0.001), while patients aged < 65 years without epilepsy and stroke rarely developed delirium (5.1%, p < 0.001). CONCLUSIONS: Delirium is common in elder neurological patients and associated with worse outcome. Primary cerebral conditions most frequently precipitate delirium in neurology. Neurologists are advised to monitor symptoms of delirium in the presence of risk factors to enable both timely diagnostic work-up and management of delirium.
    • PubMed ID
  • Risk factors for postoperative delirium after spinal surgery: a systematic review and meta-analysis. 2019 Zhu, C. Wang, B. Yin, J. Xue, Q. Gao, S. Xing, L. Wang, H. Liu, W. Liu, X.. Aging Clin Exp Res,
    • Title

      Risk factors for postoperative delirium after spinal surgery: a systematic review and meta-analysis.

    • Authors
      Zhu, C. Wang, B. Yin, J. Xue, Q. Gao, S. Xing, L. Wang, H. Liu, W. Liu, X.
    • Year
      2019
    • Journal
      Aging Clin Exp Res
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium is common in older patients after spinal surgery. Many reports investigating the risk factors for delirium after spinal surgery have been published recently. METHODS: A literature search was performed using the Cochrane Library, Web of Science, PubMed, Embase, and Springer databases from inception to February 2019. Relevant studies involving patients with delirium who underwent spinal surgery were included if the studies contained data about blood transfusion or other related factors, such as haemoglobin, haematocrit, and blood loss levels. The Newcastle-Ottawa Scale was used for the study-quality evaluation. The pooled odds ratios or (standard) mean differences of the individual risk factors were estimated using the Mantel-Haenszel or inverse-variance methods. RESULTS: Fifteen observational studies met the inclusion criteria; the studies included a total of 583,290 patients (5431 patients with delirium and 577,859 patients without delirium). In addition to an advanced age, the results of the meta-analyses showed that living in an institution, diabetes, cerebral vascular diseases, pulmonary diseases, opioid use, length of surgery, intraoperative blood loss, blood transfusions, intraoperative infusion, preoperative albumin, postoperative albumin, preoperative haematocrit, postoperative haematocrit, preoperative haemoglobin, postoperative haemoglobin, preoperative sodium, postoperative sodium, Mini-Mental State Examination score, inability to ambulate, depression, number of medications, and treatment with multiple drugs (> three types) were significantly associated with delirium. CONCLUSION: The above-mentioned risk factors can be used to identify high-risk patients, and the appropriate prophylaxis strategies should be implemented to prevent delirium after spinal surgery.
    • PubMed ID
  • Dexmedetomidine for the prevention of postoperative delirium in elderly patients undergoing noncardiac surgery: A meta-analysis of randomized controlled trials. 2019 Zeng, H. Li, Z. He, J. Fu, W.. PLoS One, 14:8 (e0218088)
    • Title

      Dexmedetomidine for the prevention of postoperative delirium in elderly patients undergoing noncardiac surgery: A meta-analysis of randomized controlled trials.

    • Authors
      Zeng, H. Li, Z. He, J. Fu, W.
    • Year
      2019
    • Journal
      PLoS One
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium (POD) among the elderly population that undergoes noncardiac surgery is significantly associated with adverse clinical outcomes. We conducted this meta-analysis to evaluate the effectiveness and safety of dexmedetomidine for the prophylaxis of POD among the elderly population after noncardiac surgery. METHODS: We searched Embase, PubMed, and the Cochrane Library from inception date to March 2019 for randomized controlled trials (RCTs) that compared dexmedetomidine and placebo for the prevention of POD and evaluated the major cardiovascular outcomes among elderly people after noncardiac surgery. Two authors independently screened the studies and extracted data from the published articles. The main outcome was the incidence of POD. The secondary outcomes included the occurrence of bradycardia, hypotension, hypertension, tachycardia, myocardial infarction, stroke, hypoxaemia, and all-cause mortality. RESULTS: A total of 6 RCTs with 2102 participants were included. Compared with placebo, dexmedetomidine significantly reduced the prevalence of POD (RR = 0.61, 95% CI 0.34-0.76, P = 0.001, I2 = 66%), and the risk of tachycardia (RR = 0.48, 95% CI 0.30-0.76, P = 0.002, I2 = 0%), hypertension (RR = 0.59, 95% CI 0.44-0.79, P < 0.001, I2 = 20%), stroke (RR = 0.22, 95% CI 0.06-0.76, P = 0.02, I2 = 0%), and hypoxaemia (RR = 0.50, 95% CI 0.32-0.78, P = 0.002, I2 = 0%) in elderly patients who underwent noncardiac surgery. However, dexmedetomidine accelerated the occurrence of bradycardia (RR = 1.36, 95% CI 1.11-1.67, P = 0.003, I2 = 0%). Furthermore, no significant differences were observed in the incidence of hypotension, myocardial infarction, and all-cause mortality between the dexmedetomidine and placebo groups. CONCLUSIONS: Among elderly patients after noncardiac surgery, the prophylactic use of dexmedetomidine, compared with the use of placebo, was related to a decline in the incidence of POD.
    • PubMed ID
  • Risk factors for delirium: Are therapeutic interventions part of it? 2019 Xing, J. Yuan, Z. Jie, Y. Liu, Y. Wang, M. Sun, Y.. Neuropsychiatric Disease and Treatment, (1321-7)
    • Title

      Risk factors for delirium: Are therapeutic interventions part of it?

    • Authors
      Xing, J. Yuan, Z. Jie, Y. Liu, Y. Wang, M. Sun, Y.
    • Year
      2019
    • Journal
      Neuropsychiatric Disease and Treatment
    • URL
    • Abstract
      Background: Delirium is associated with increased morbidity and mortality in critically ill patients. Research on risk factors for delirium allows clinicians to identify high-risk patients, which is the basis for early prevention and diagnosis. Besides the risk factors for delirium that are commonly studied, here we more focused on the less-studied therapeutic interventions for critically ill patients which are potentially modifiable. Materials and methods: A total of 320 non-comatose patients admitted to the ICU for more than 24 hrs during 9 months were eligible for the study. Delirium was screened once daily using the CAM-ICU. Demographics, admission clinical data, and daily interventions were collected. Results: Ninety-two patients (28.75%) experienced delirium at least once. Delirious patients were more likely to have longer duration of mechanical ventilation, ICU stay, and hospital stay. Most of the less-studied therapeutic interventions were linked to delirium in the univariate analysis, including gastric tube, artificial airway, deep intravenous catheter, arterial line, urinary catheter, use of vasoactive drugs, and sedative medication. After adjusting with age and ICU length of stay, mechanical ventilation (OR: 5.123; 95% CI: 2.501–10.494), Acute Physiology and Chronic Health Evaluation (APACHE) II score≥20 at admission (OR: 1.897; 95% CI: 1.045–3.441), and gastric tube (OR: 1.935, 95% CI: 1.012–3.698) were associated with increased risk of delirium in multivariate analysis. Conclusion: Delirium was associated with prolonged mechanical ventilation, ICU stay, and hospital stay. Multivariate risk factors were gastric tube, mechanical ventilation, and APACHE II score. Although being a preliminary study, this study suggests the necessity of earliest removal of tubes and catheters when no longer needed.
    • PubMed ID
  • Intraoperative hyperglycemia increases the incidence of postoperative delirium. 2019 Windmann, V. Spies, C. Knaak, C. Wollersheim, T. Piper, S. K. Vorderwulbecke, G. Kurpanik, M. Kuenz, S. Lachmann, G.. Minerva Anestesiol,
    • Title

      Intraoperative hyperglycemia increases the incidence of postoperative delirium.

    • Authors
      Windmann, V. Spies, C. Knaak, C. Wollersheim, T. Piper, S. K. Vorderwulbecke, G. Kurpanik, M. Kuenz, S. Lachmann, G.
    • Year
      2019
    • Journal
      Minerva Anestesiol
    • URL
    • Abstract
      BACKGROUND: Hyperglycemia frequently occurs during major surgery and is associated with adverse postoperative outcomes. This study aimed to investigate the influence of intraoperative hyperglycemia on incidences of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). METHODS: 87 Patients aged >/=65 years undergoing elective surgery were included in this prospective observational subproject of the BioCog study. Blood glucose levels were measured every 20 minutes intraoperatively. Hyperglycemia was defined as blood glucose levels >/=150 mg*dL-1. Patients were assessed for POD twice daily until postoperative day 7. The occurrence of POCD was determined 3 months after surgery. Multivariable logistic regression was used to identify associations between hyperglycemia and POD as well as POCD. Secondary endpoints comprised duration of hyperglycemia, maximum glucose level (Glucosemax) and differences between diabetic and non- diabetic patients. RESULTS: POD occurred in 41 (47.1%), POCD in 5 (15.2%) patients. In two separate multivariable logistic regression models, hyperglycemia was significantly associated with POD (OR 3.86 (CI 95% 1.13, 39.49), p=0.044) but not POCD (3.59 (NaN, NaN), p=0.157). Relative duration of hyperglycemia was higher in POD patients compared to patients without POD (20 [0; 71] % versus 0 [0; 55] %, p=0.075), whereas the maximum glucose levels during surgery were similar between the two groups. Considering only non-diabetic patients, relative duration of hyperglycemia (p=0.003) and Glucosemax (p=0.015) were significantly higher in patients with POD. CONCLUSIONS: Intraoperative hyperglycemia was independently associated with POD but not POCD. Relative duration of hyperglycemia appeared thereby to also play a role. Especially hyperglycemic non-diabetic patients might be at high risk for POD.
    • PubMed ID
  • External Validation of Two Models to Predict Delirium in Critically Ill Adults Using Either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for Delirium Assessment. 2019 Wassenaar, A. Schoonhoven, L. Devlin, J. W. van Haren, F. M. P. Slooter, A. J. C. Jorens, P. G. van der Jagt, M. Simons, K. S. Egerod, I. Burry, L. D. Beishuizen, A. Matos, J. Donders, A. R. T. Pickkers, P. van den Boogaard, M.. Crit Care Med, 47:10 (e827-e835)
    • Title

      External Validation of Two Models to Predict Delirium in Critically Ill Adults Using Either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for Delirium Assessment.

    • Authors
      Wassenaar, A. Schoonhoven, L. Devlin, J. W. van Haren, F. M. P. Slooter, A. J. C. Jorens, P. G. van der Jagt, M. Simons, K. S. Egerod, I. Burry, L. D. Beishuizen, A. Matos, J. Donders, A. R. T. Pickkers, P. van den Boogaard, M.
    • Year
      2019
    • Journal
      Crit Care Med
    • URL
    • Abstract
      OBJECTIVES: To externally validate two delirium prediction models (early prediction model for ICU delirium and recalibrated prediction model for ICU delirium) using either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for delirium assessment. DESIGN: Prospective, multinational cohort study. SETTING: Eleven ICUs from seven countries in three continents. PATIENTS: Consecutive, delirium-free adults admitted to the ICU for greater than or equal to 6 hours in whom delirium could be reliably assessed.None. MEASUREMENTS AND MAIN RESULTS: The predictors included in each model were collected at the time of ICU admission (early prediction model for ICU delirium) or within 24 hours of ICU admission (recalibrated prediction model for ICU delirium). Delirium was assessed using the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist. Discrimination was determined using the area under the receiver operating characteristic curve. The predictive performance was determined for the Confusion Assessment Method-ICU and Intensive Care Delirium Screening Checklist cohort, and compared with both prediction models' original reported performance. A total of 1,286 Confusion Assessment Method-ICU-assessed patients and 892 Intensive Care Delirium Screening Checklist-assessed patients were included. Compared with the area under the receiver operating characteristic curve of 0.75 (95% CI, 0.71-0.79) in the original study, the area under the receiver operating characteristic curve of the early prediction model for ICU delirium was 0.67 (95% CI, 0.64-0.71) for delirium as assessed using the Confusion Assessment Method-ICU and 0.70 (95% CI, 0.66-0.74) using the Intensive Care Delirium Screening Checklist. Compared with the original area under the receiver operating characteristic curve of 0.77 (95% CI, 0.74-0.79), the area under the receiver operating characteristic curve of the recalibrated prediction model for ICU delirium was 0.75 (95% CI, 0.72-0.78) for assessing delirium using the Confusion Assessment Method-ICU and 0.71 (95% CI, 0.67-0.75) using the Intensive Care Delirium Screening Checklist. CONCLUSIONS: Both the early prediction model for ICU delirium and recalibrated prediction model for ICU delirium are externally validated using either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for delirium assessment. Per delirium prediction model, both assessment tools showed a similar moderate-to-good statistical performance. These results support the use of either the early prediction model for ICU delirium or recalibrated prediction model for ICU delirium in ICUs around the world regardless of whether delirium is evaluated with the Confusion Assessment Method-ICU or Intensive Care Delirium Screening Checklist.
    • PubMed ID
  • Risk Factors and Incidence of Postoperative Delirium in Patients Undergoing Laryngectomy. 2019 Wang, Y. Yu, H. Qiao, H. Li, C. Chen, K. Shen, X.. Otolaryngol Head Neck Surg,
    • Title

      Risk Factors and Incidence of Postoperative Delirium in Patients Undergoing Laryngectomy.

    • Authors
      Wang, Y. Yu, H. Qiao, H. Li, C. Chen, K. Shen, X.
    • Year
      2019
    • Journal
      Otolaryngol Head Neck Surg
    • URL
    • Abstract
      OBJECTIVE: To explore the risk factors and incidence of postoperative delirium (POD) in patients undergoing laryngectomy for laryngeal cancer. STUDY DESIGN: Prospective cohort study. SETTING: Shanghai Eye, Ear, Nose, and Throat Hospital, Fudan University. SUBJECTS AND METHODS: A total of 323 patients underwent laryngectomy from April 4, 2018, to December 28, 2018. Perioperative data were collected. The primary outcome was the presence of POD as defined by the Confusion Assessment Method diagnostic algorithm. Univariate and multivariable logistic regression analyses were used to identify risk factors associated with POD. RESULTS: Of the patients who underwent laryngectomy during the study period, 99.1% were male, with a mean age of 60.0 years. Of these patients, 28 developed POD, with most episodes (88.1%) occurring during the first 3 postoperative days. The type of POD was hyperactive in 7 cases and hypoactive in 21 cases. The mean duration of POD was 1 day. The mean Delirium Rating Scale-Revised-98 score (a measure of POD severity) was 11.5. For the multivariable analysis, risk factors associated with POD included advanced cancer stage, lower educational level, higher American Society of Anesthesiologists classification, and intraoperative hypotension lasting at least 30 minutes. Intraoperative dexmedetomidine use was protective against POD. CONCLUSION: This study identified risk factors associated with POD, providing a target population for quality improvement initiatives. Furthermore, intraoperative dexmedetomidine use can reduce POD.
    • PubMed ID
  • Regional cerebral oxygen saturation and postoperative delirium in endovascular surgery: a prospective cohort study. 2019 Wang, X. Feng, K. Liu, H. Liu, Y. Ye, M. Zhao, G. Wang, T.. Trials, 20:1 (504)
    • Title

      Regional cerebral oxygen saturation and postoperative delirium in endovascular surgery: a prospective cohort study.

    • Authors
      Wang, X. Feng, K. Liu, H. Liu, Y. Ye, M. Zhao, G. Wang, T.
    • Year
      2019
    • Journal
      Trials
    • URL
    • Abstract
      BACKGROUND: Delirium is an acute mental disorder and common postoperative complication. Monitoring regional cerebral oxygen saturation (rSO2) in endovascular therapeutic surgery may allow real-time monitoring of cerebral desaturation, avoiding profound cerebral dysfunction, and reducing the incidence of delirium. We sought to examine the incidence of delirium in patients undergoing endovascular surgery. METHODS: This was a clinical cohort trial (registered with http://www.clinicaltrials.gov [NCT02356133]). We monitored the rSO2 of 43 patients undergoing general anesthesia and cerebral endovascular surgery. The occurrence of delirium after surgery was recorded with the Confusion Assessment Method (CAM). Multivariate logistic regression was performed to identify the main predictor of delirium. RESULTS: rSO2 was significantly different between the delirium and no-delirium groups. The occurrence of delirium was 35% in our cohort, and higher rSO2 desaturation scores were significantly associated with profound delirium (higher CAM score; odds ratio = 1.002; P = 0.021). The maximum declines of systolic blood pressure were 24.86 (21.78-27.93) and 32.98 (28.78-37.19) in the no-delirium and delirium groups, respectively, which were significantly different (P = 0.002) but not closely associated with delirium in multivariate analysis (P = 0.512). Anesthesia, mechanical ventilation duration, and having two vascular risk factors differed significantly between groups but were poorly associated with delirium outcome. CONCLUSIONS: Elevated rSO2 desaturation score was predictive of the occurrence of postoperative delirium following endovascular surgery. Monitoring rSO2 is invaluable for managing controlled hypotension during endovascular surgery and reducing postoperative delirium. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02356133 . Registered 1 February 2015. All statistical analysis results submitted August 4, 2018.
    • PubMed ID
  • The impact of analgosedation on mortality and delirium in critically ill patients: A systematic review and meta-analysis. 2019 Wang, C. T. Mao, Y. Zhao, L. Ma, B.. Intensive Crit Care Nurs, (7-14)
    • Title

      The impact of analgosedation on mortality and delirium in critically ill patients: A systematic review and meta-analysis.

    • Authors
      Wang, C. T. Mao, Y. Zhao, L. Ma, B.
    • Year
      2019
    • Journal
      Intensive Crit Care Nurs
    • URL
    • Abstract
      OBJECTIVES: To assess the impact of analgosedation on mortality and delirium in critically ill patients. RESEARCH METHODOLOGY: A systematic review and meta-analysis was conducted to identify studies through Pubmed, Cochrane Library, Embase and Web of Science published from June 2017 to July 2018. Only articles published in English were considered. The Cochrane Collaboration Risk of Bias Tool was used to evaluate the methodological quality of randomised trials, while Newcastle-Ottawa Scale (NOS) was used for cohort studies. RESULTS: Seventeen eligible studies were identified, including 2298 patients (1170 in the experimental group and 1128 in the control group). Varying analgesics and sedatives were investigated, showing a high clinical heterogeneity. Analgosedation significantly decreased the ICU mortality rate when compared to conventional analgesia and sedation [odds ratio (OR) 0.72, 95%CI 0.53-0.97; P=0.03]. No significant difference was demonstrated in 28-day/hospital mortality rate [OR 0.91, 95%CI 0.70-1.18; P=0.48] or in the incidence of delirium [OR 1.06, 95%CI 0.78-1.45; P=0.70]. However, subgroup analysis of trials indicated a significant increase in the delirium rate (OR: 1.88, 95%CI 1.14-3.10, p=0.01). CONCLUSION: The ICU mortality was decreased by implementing analgosedation, but the hospital mortality and the delirium rates were not. Because of the absence of higher quality study designs, clinical heterogeneity and inclusion of small number of studies, the analysis results must be cautiously interpreted.
    • PubMed ID
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