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: 3010

  • Biomarker Predictors of Delirium in Acutely Ill Patients: A Systematic Review. 2019 Michels, M. Michelon, C. Damasio, D. Vitali, A. M. Ritter, C. Dal-Pizzol, F.. J Geriatr Psychiatry Neurol,
    • Title

      Biomarker Predictors of Delirium in Acutely Ill Patients: A Systematic Review.

    • Authors
      Michels, M. Michelon, C. Damasio, D. Vitali, A. M. Ritter, C. Dal-Pizzol, F.
    • Year
      2019
    • Journal
      J Geriatr Psychiatry Neurol
    • URL
    • Abstract
      Delirium is a serious and common disorder that affects up to 80% of acutely ill patients, mainly the aged. In recent years, several studies pointed out possible biomarkers that could be used alone or in combination with other resources in the diagnosis and follow-up of critically ill patients who develop delirium. In this context, a systematic review was conducted to determine the predictive value of several biomarkers in acutely (critically and noncritically) ill adult patients with delirium. Studies that used the confusion assessment method (CAM) and CAM-intensive care unit as the diagnostic method were considered. The most recent search was performed in November 2017. There was no language restriction. Initially, 626 articles were screened and 39 were included in the study. A comprehensive evaluation of the abstracts resulted in the exclusion of 202 studies, leaving 39 articles as potentially relevant. Inflammatory markers, S100beta and cortisol, could predict delirium occurrence in a specific subgroup population of critically ill patients.
    • PubMed ID
  • Predicting postoperative delirium severity in older adults: The role of surgical risk and executive function. 2019 Lindroth, H. Bratzke, L. Twadell, S. Rowley, P. Kildow, J. Danner, M. Turner, L. Hernandez, B. Brown, R. Sanders, R. D.. Int J Geriatr Psychiatry,
    • Title

      Predicting postoperative delirium severity in older adults: The role of surgical risk and executive function.

    • Authors
      Lindroth, H. Bratzke, L. Twadell, S. Rowley, P. Kildow, J. Danner, M. Turner, L. Hernandez, B. Brown, R. Sanders, R. D.
    • Year
      2019
    • Journal
      Int J Geriatr Psychiatry
    • URL
    • Abstract
      OBJECTIVES: Delirium is an important postoperative complication, yet predictive risk factors for postoperative delirium severity remain elusive. We hypothesized that the NSQIP risk calculation for serious complications (NSQIP-SC) or risk of death (NSQIP-D), and cognitive tests of executive function (Trail Making Test A and B [TMTA, TMTB]), would be predictive of postoperative delirium severity. Further, we demonstrate how advanced statistical techniques can be used to identify candidate predictors. METHODS/DESIGN: Data from an ongoing perioperative prospective cohort study of 100 adults (>65yo) undergoing non-cardiac surgery were analyzed. In addition to NSQIP-SC, NSQIP-D, TMTA and TMTB; participant age, sex, American Society of Anesthesiologists (ASA) score, tobacco use, surgery type, depression, Framingham risk score, and preoperative blood pressure were collected. The Delirium Rating Scale-R-98 (DRS) measured delirium severity, the Confusion Assessment Method (CAM) identified delirium. LASSO and Best Subsets linear regression were employed to identify predictive risk factors. RESULTS: Ninety-seven participants with a mean age of 71.68+4.55, 55% male (31/97 CAM+, 32%) and a mean Peak DRS of 21.5+6.40 were analyzed. LASSO and Best Subsets regression identified NSQIP-SC and TMTB to predict postoperative delirium severity (p<0.001, Adj. R2: 0.30). NSQIP-SC and TMTB were also selected as predictors for postoperative delirium incidence (AUROC 0.81, 95%CI 0.72-0.90). CONCLUSIONS: In this cohort, we identified NSQIP Risk score for Serious Complications and a measure of executive function, TMT-B, to predict postoperative delirium severity using advanced modeling techniques. Future studies should investigate the utility of these variables in a formal delirium severity prediction model.
    • PubMed ID
  • Subsyndromal delirium is associated with poor functional outcome after ischaemic stroke. 2019 Klimiec-Moskal, E. Lis, A. Pera, J. Slowik, A. Dziedzic, T.. European Journal of Neurology,
    • Title

      Subsyndromal delirium is associated with poor functional outcome after ischaemic stroke.

    • Authors
      Klimiec-Moskal, E. Lis, A. Pera, J. Slowik, A. Dziedzic, T.
    • Year
      2019
    • Journal
      European Journal of Neurology
    • URL
    • Abstract
      Background and purpose: Subsyndromal delirium (SSD) refers to patients with delirious symptoms who do not meet the criteria for delirium. The aim was to determine the prognostic significance of SSD in stroke patients. Methods: In all, 564 patients with ischaemic stroke (median age 71 years, 50.5% female) were included. The Confusion Assessment Method was used to assess symptoms of delirium and the Diagnostic and Statistical Manual of Mental Disorders, 5th edn, criteria were used to diagnose delirium. SSD was defined as one or more core features of delirium without fulfilling diagnostic criteria. Functional outcome was assessed using the modified Rankin Scale at 3 and 12 months after stroke. Results: Delirium was diagnosed in 23.4% of patients and SSD in 10.3% of patients. SSD was associated with increased risk of poor functional outcome. The adjusted odds ratios (ORs) for unfavourable outcome at 3 and 12 months were 2.88 [95% confidence interval (CI) 1.43–5.79, P < 0.01] and 2.93 (95% CI 1.39–6.22, P < 0.01), respectively. In multivariate analysis, delirium was an independent predictor of poor functional outcome at 3 months (OR 6.41, 95% CI 3.36–12.21, P < 0.01) and 12 months (OR 6.11, 95% CI 3.05–12.27, P < 0.01) after stroke. Delirium was also independently associated with increased risk of death within 3 months (hazard ratio 3.68, 95% CI 1.69–8.02, P < 0.01) and 12 months (hazard ratio 3.76, 95% CI 2.05–6.90, P < 0.01). SSD was not associated with increased risk of death. Conclusions: In SSD patients the risk of poor functional outcome after stroke is increased and intermediate between patients with and patients without delirium.
    • PubMed ID
  • SF-36 scores predict postoperative delirium after surgery for cervical spondylotic myelopathy. 2019 Kin, K. Yasuhara, T. Tomita, Y. Umakoshi, M. Morimoto, J. Date, I.. J Neurosurg Spine, (1-6)
    • Title

      SF-36 scores predict postoperative delirium after surgery for cervical spondylotic myelopathy.

    • Authors
      Kin, K. Yasuhara, T. Tomita, Y. Umakoshi, M. Morimoto, J. Date, I.
    • Year
      2019
    • Journal
      J Neurosurg Spine
    • URL
    • Abstract
      OBJECTIVECervical spondylotic myelopathy (CSM) is one of the most common causes of spinal cord dysfunction. Surgery for CSM is generally effective, but postoperative delirium is a potential complication. Although there have been some studies that investigated postoperative delirium after spine surgery, no useful tool for identifying high-risk patients has been established, and it is unknown if 36-Item Short Form Health Survey (SF-36) scores can predict postoperative delirium. The objective of this study was to evaluate the correlation between preoperative SF-36 scores and postoperative delirium after surgery for CSM.METHODSSixty-seven patients who underwent surgery for CSM at the authors' institution were enrolled in this study. Medical records of these patients were retrospectively reviewed. Patient background, preoperative laboratory data, preoperative SF-36 scores, the preoperative Japanese Orthopaedic Association (JOA) score for the evaluation of cervical myelopathy, and perioperative factors were selected as potential risk factors for postoperative delirium. These factors were evaluated using univariable and multivariable logistic regression analysis.RESULTSTen patients were diagnosed with postoperative delirium. Univariable analysis revealed that the physical functioning score (p = 0.01), general health perception score (p < 0.01), and vitality score (p < 0.01) of the SF-36 were significantly lower in patients with postoperative delirium than in those without. The total number of medications was significantly higher in the delirium group compared with the no-delirium group (p = 0.02). In contrast, there were no significant differences between the delirium group and the no-delirium group in cervical JOA scores (p = 0.20). Multivariable analysis revealed that a low general health perception score was an independent risk factor for postoperative delirium (p = 0.02; odds ratio 0.810, 95% confidence interval 0.684-0.960).CONCLUSIONSSome of the SF-36 scores were significantly lower in patients with postoperative delirium than in those without. In particular, the general health perception score was independently correlated with postoperative delirium. SF-36 scores could help identify patients at high risk for postoperative delirium and aid in the development of prevention strategies.
    • PubMed ID
  • Effects of massage on outcomes of adult intensive care unit patients: a systematic review. 2019 Jagan, S. Park, T. Papathanassoglou, E.. Nurs Crit Care,
    • Title

      Effects of massage on outcomes of adult intensive care unit patients: a systematic review.

    • Authors
      Jagan, S. Park, T. Papathanassoglou, E.
    • Year
      2019
    • Journal
      Nurs Crit Care
    • URL
    • Abstract
      BACKGROUND: The critical care experience is particularly stressful for patients, which can result in a number of physiological and psychological consequences, including haemodynamic instability, increased pain, agitation and delirium, leading to prolonged mechanical ventilation, length of stay and subsequent complications. Massage therapy encompasses different techniques to promote relaxation and to counter stress, therefore potentially affecting several patients' outcomes. AIMS: To systematically review evidence on the effects of massage on outcomes of adult critically ill patients. The outcome measures included pain, vital signs (VS), haemodynamic measurements, level of consciousness, sleep quality, muscle tension, anxiety, feelings of calm and relaxation, coping, arterial blood gases and serum biomarkers. METHOD: This was a systematic review based on focused literature searches (PubMed, CINAHL, Scopus, EMBASE-Ovid databases, Google Scholar). The Cochrane Collaboration's tool was used to assess the risk of bias. Eligibility criteria included published experimental and quasi-experimental studies reporting on the physiological and psychological outcomes of critically ill patients. RESULTS: Based on the selection criteria, 12 studies were included in the review. The main findings are as follows: 8 of 12 studies used randomized control designs with high internal validity, and there was a high level of evidence of favourable effects with respect to improvements in VS and a reduction in pain and anxiety. Outcomes that need to be more rigorously pursued include quality of sleep, analgesic and sedative dosages and level of consciousness. CONCLUSION: The results suggest that massage interventions can have positive effects on critically ill patients' outcomes. However, there are several gaps in the literature, along with methodological limitations, that require further consideration in critical care settings. RELEVANCE TO CLINICAL PRACTICE: The results of this systematic review can inform implementation of massage interventions in critical care, which can be challenging as a result of several barriers.
    • PubMed ID
  • Perioperative Dexmedetomidine Reduces Delirium in Elderly Patients after Lung Cancer Surgery. 2019 Huyan, T. Hu, X. Peng, H. Zhu, Z. Li, Q. Zhang, W.. Psychiatr Danub, 31:1 (95-101)
    • Title

      Perioperative Dexmedetomidine Reduces Delirium in Elderly Patients after Lung Cancer Surgery.

    • Authors
      Huyan, T. Hu, X. Peng, H. Zhu, Z. Li, Q. Zhang, W.
    • Year
      2019
    • Journal
      Psychiatr Danub
    • URL
    • Abstract
      BACKGROUND: Delirium, which is one of the most disturbing postoperative complications in elderly patients, shows high morbidity in patients undergoing lung cancer surgery. Dexmedetomidine (DEX) is considered a potential prophylactic agent for preventing patients' delirium after lung cancer surgery. SUBJECTS AND METHODS: Medical records of lung cancer patients over 65 years old with radical pulmonary resection at Henan Provincial People's Hospital from January 2015 to December 2017, China, were evaluated. Patients, care-providers, and investigators were all blinded to group assignment. DEX was administered in the preoperative and intraoperative periods. The incidence of delirium was calculated based on the Intensive Care Delirium Screening Checklist (ICDSC). Scores of >/=4 and 1-3 points represent the diagnoses of delirium and a pre-delirious state, respectively. RESULTS: During postoperative day 1 (POD 1) to POD 7, delirium occurs in both groups. During postoperative POD 1 to POD 7, the incidence of delirium is lower in the DEX group than that in the control group. Furthermore, there are more mild delirium patients but fewer moderate and severe delirium patients in the DEX group compared with the control group. Finally, patients in the DEX group have a shorter duration of delirium, lower numeric pain rating scale during movement and better sleep quality. CONCLUSION: Preoperative and intraoperative application of DEX can reduce the incidence and intensity of delirium after pulmonary resection in elderly patients with lung cancer.
    • PubMed ID
  • The Oslo Study of Clonidine in Elderly Patients with Delirium; LUCID: a randomised placebo-controlled trial. 2019 Hov, K. R. Neerland, B. E. Undseth, O. Bruun Bratholm Wyller, V. MacLullich, A. M. J. Qvigstad, E. Skovlund, E. Wyller, T. B.. Int J Geriatr Psychiatry,
    • Title

      The Oslo Study of Clonidine in Elderly Patients with Delirium; LUCID: a randomised placebo-controlled trial.

    • Authors
      Hov, K. R. Neerland, B. E. Undseth, O. Bruun Bratholm Wyller, V. MacLullich, A. M. J. Qvigstad, E. Skovlund, E. Wyller, T. B.
    • Year
      2019
    • Journal
      Int J Geriatr Psychiatry
    • URL
    • Abstract
      OBJECTIVES: The aim of this double-blinded randomised placebo-controlled trial was to investigate the efficacy of clonidine for delirium in medical inpatients > 65 years. METHODS: Acutely admitted medical patients > 65 years with delirium or subsyndromal delirium were eligible for inclusion. Included patients were given a loading dose of either placebo or clonidine; 75 mug every 3(rd) hour up to a maximum of 4 doses to reach steady state and further 75 mug twice daily until delirium free for 2 days, discharge or a maximum of 7 days of treatment. The primary endpoint was the trajectory of the Memorial Delirium Assessment Scale (MDAS) for the 7 days of treatment. Presence of delirium according to the DSM-5 criteria and severity measured by MDAS were assessed daily until discharge or a maximum of 7 days after end of treatment. RESULTS: Due to slower enrolment than anticipated, the study was halted early. Ten patients in each group were studied. The low recruitment rate was mainly due to the presence of multiple patient exclusion criteria for patient safety. There was no significant difference between the treatment group in the primary endpoint comparing the trajectory of MDAS for the 7 days of treatment using mixed linear models with log-transformation, (p=0.60). The treatment group did not have increased adverse effects. CONCLUSIONS: No effect of clonidine for delirium was found, though the study was under-powered. Further studies in less frail populations are now required.
    • PubMed ID
  • Delirium and Alzheimer disease: A proposed model for shared pathophysiology. 2019 Fong, T. G. Vasunilashorn, S. M. Libermann, T. Marcantonio, E. R. Inouye, S. K.. Int J Geriatr Psychiatry,
    • Title

      Delirium and Alzheimer disease: A proposed model for shared pathophysiology.

    • Authors
      Fong, T. G. Vasunilashorn, S. M. Libermann, T. Marcantonio, E. R. Inouye, S. K.
    • Year
      2019
    • Journal
      Int J Geriatr Psychiatry
    • URL
    • Abstract
    • PubMed ID
  • Development and validation of a dynamic delirium prediction rule in patients admitted to the Intensive Care Units (DYNAMIC-ICU): A prospective cohort study. 2019 Fan, H. Ji, M. Huang, J. Yue, P. Yang, X. Wang, C. Ying, W.. International journal of nursing studies, (94-73)
    • Title

      Development and validation of a dynamic delirium prediction rule in patients admitted to the Intensive Care Units (DYNAMIC-ICU): A prospective cohort study.

    • Authors
      Fan, H. Ji, M. Huang, J. Yue, P. Yang, X. Wang, C. Ying, W.
    • Year
      2019
    • Journal
      International journal of nursing studies
    • URL
    • Abstract
      BACKGROUND: Delirium is one of the most common cognitive complications among patients admitted to the intensive care units (ICU). OBJECTIVE: To develop and validate a DYNAmic deliriuM predICtion rule for ICU patients (DYNAMIC-ICU) and to stratify patients into different risk levels among patients in various types of ICUs. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: A total of 560 (median age of 66 years, 62.5% male) consecutively enrolled patients from four ICUs were included in the study. The patients were randomly assigned into either the derivation (n = 336, 60%) or the validation (n = 224, 40%) cohort by stratified randomization based on delirium/non-delirium and types of ICU. METHODS: The simplified Chinese version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to assess delirium until patients were discharged from the ICUs. Potential predisposing, disease-related, and iatrogenic and environmental risk factors as well as data on patients' outcomes were collected prospectively. RESULTS: Of the enrolled patients, 20.2% and 20.5% developed delirium in the derivation and validation cohorts, respectively. Predisposing factors (history of chronic diseases, hearing deficits), disease-related factors (infection, higher APACHE II scores at admission), and iatrogenic and environmental factors (the use of sedatives and analgesics, indwelling catheter, and sleep disturbance) were identified as independent predictors of delirium. Points were assigned to each predictor according to their odds ratio to create a prediction rule which was internally validated based on total scores and by bootstrapping (AUCs of 0.907 [95% CI 0. 871 -0.944], 0.888 [95% CI 0.845-0.932], and 0.874 [95% CI 0.828-0.920]), respectively. The total score of the DYNAMIC-ICU ranged from 0 to 33 and patients were divided into low risk (0-9), moderate risk (10-17), high risk (18-33) groups in developing delirium according to their total score with incidence of delirium at 2.8%, 16.8% and 75.9% in the derivation group, respectively. The DYNAMIC-ICU and its performance of risk level stratification were further validated in the validation cohort (AUC = 0.900 [95% CI 0.858-0.941]). The all-cause mortality was increased and the length of hospital stay was prolonged dramatically with the increase of delirium risk levels in both derivation (p = 0.034, p < 0.001) and validation cohorts (p < 0.001, p < 0.001). CONCLUSIONS: Seven predictors for ICU delirium were identified to create DYNAMIC-ICU, which could well stratify ICU patients into three different delirium risk levels, tailor risk level changes, and predict in-hospital outcomes by a dynamic assessment approach.
    • PubMed ID
  • Delirium and cognitive impairment among older patients in Norwegian emergency departments. 2019 Evensen, S. Saltvedt, I. Ranhoff, A. H. Myrstad, M. Myrstad, C. Mellingsaeter, M. Wang-Hansen, M. S. Neerland, B. E.. Tidsskr Nor Laegeforen, 139:6
    • Title

      Delirium and cognitive impairment among older patients in Norwegian emergency departments.

    • Authors
      Evensen, S. Saltvedt, I. Ranhoff, A. H. Myrstad, M. Myrstad, C. Mellingsaeter, M. Wang-Hansen, M. S. Neerland, B. E.
    • Year
      2019
    • Journal
      Tidsskr Nor Laegeforen
    • URL
    • Abstract
      BACKGROUND: Delirium is common and underdiagnosed among patients in hospitals, and is associated with complications, increased mortality, onset of dementia and need for nursing home care. Cognitive impairment from other causes is also common among hospitalised elderly people and is a key risk factor for delirium. Since no relevant prevalence studies have been undertaken in Norwegian hospitals, we investigated the prevalence of delirium among elderly patients in Norwegian emergency departments on World Delirium Awareness Day, 14 March 2018. MATERIAL AND METHOD: We included patients >/= 75 years who arrived in ten Norwegian emergency departments between 08:00 and 22:00 on that day. We identified delirium and cognitive impairment using the '4AT' screening tool and registered the patients' age and gender and the hospital and department to which they were admitted (internal medicine, surgery, orthopaedics, 'other'). RESULTS: Of 118 included patients, 20 (17 per cent) showed signs of delirium and 36 (30 per cent) showed signs of other forms of cognitive impairment. All hospitals and all categories of departments received patients with signs of delirium and cognitive impairment. INTERPRETATION: Delirium and other forms of cognitive impairment are both common among elderly patients in Norwegian emergency departments. Our results indicate that all hospital departments who treat elderly patients frequently observe these issues. All departments should therefore have routines to identify and deal with patients who suffer from delirium and cognitive impairment.
    • PubMed ID
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