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Neuropsychiatric and cognitive profile of patients with DSM-IV delirium referred to an old age psychiatry consultation-liaison service

Published online by Cambridge University Press:  21 January 2011

Faiza Jabbar ,
Maeve Leonard ,
Karena Meehan ,
Margaret O'Connor ,
Con Cronin ,
Paul Reynolds ,
Anna Maria Meaney  and
David Meagher
Faiza Jabbar
Affiliation:
Psychiatry for Later Life Service, University College Hospital, Galway, Ireland
Maeve Leonard
Affiliation:
Department of Psychiatry, Midwestern Regional Hospital, Limerick, and University of Limerick Medical School, Limerick, Ireland
Karena Meehan
Affiliation:
Psychiatry for Later Life Service, University College Hospital, Galway, Ireland
Margaret O'Connor
Affiliation:
Department of Elderly Medicine, Midwestern Regional Hospital, Limerick, Ireland
Con Cronin
Affiliation:
St John's Hospital, Limerick, Ireland
Paul Reynolds
Affiliation:
Department of Psychiatry, Midwestern Regional Hospital, Limerick, and University of Limerick Medical School, Limerick, Ireland
Anna Maria Meaney
Affiliation:
Department of Psychiatry, Midwestern Regional Hospital, Limerick, and University of Limerick Medical School, Limerick, Ireland
David Meagher*
Affiliation:
Department of Psychiatry, Midwestern Regional Hospital, Limerick, and University of Limerick Medical School, Limerick, Ireland
*
Correspondence should be addressed to: Professor David Meagher, University of Limerick Medical School, Limerick, Ireland. Phone: +353-61-202700. Email: [email protected].
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Abstract

Background: The phenomenology of delirium is understudied, including how the symptom profile varies across populations. The aim of this study was to explore phenomenology occurring in patients with delirium referred to an old age psychiatry consultation-liaison setting and compare with delirium occurring in palliative care patients.

Methods: Consecutive cases of DSM-IV delirium were assessed with the Delirium Rating scale Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD).

Results: Eighty patients (mean age 79.3±7.7 years; mean DRS-R98 total score 21.7±4.9 and total CTD score 10.2±6.3) were included. Forty patients (50%) with comorbid dementia were older, had a longer duration of symptoms at referral, and more severe delirium due to greater cognitive impairments. Inattention (100%) was the most prominent cognitive disturbance, while sleep-wake cycle disturbance (98%), altered motor activity (97%), and thought process abnormality (96%) were the most frequent DRS-R98 non-cognitive features. Inattention was associated with severity of other cognitive disturbances on both the DRS-R98 and CTD, but not with DRS-R98 non-cognitive items. The phenomenological profile was similar to palliative care but with more severe delirium due to greater cognitive and non-cognitive disturbance.

Conclusion: Delirium is a complex neuropsychiatric syndrome with generalized cognitive impairment and disproportionate inattention. Sleep-wake cycle and motor-activity disturbances are also common. Comorbid dementia results in a similar phenomenological pattern but with greater cognitive impairment and later referral.

Keywords

deliriumphenomenologydementia
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 7 , September 2011 , pp. 1167 - 1174
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Adamis, D., Morrison, C., Treloar, A., MacDonald, A. J. and Martin, F. C. (2005). The performance of the clock Drawing Test in elderly medical inpatients: does it have utility in the identification of delirium. Journal of Geriatric Psychiatry and Neurology, 18, 129–133.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: American Psychiatric Association.Google Scholar
Francis, J., Martin, D. and Kapoor, W. N. (1996). A prospective study of delirium in hospitalized elderly. JAMA, 263, 1097–1101.CrossRefGoogle Scholar
Franco, J., Trzepacz, P., Mejia, M. and Ochoa, S. (2009). Factor analysis of the Colombian translation of the Delirium Rating Scale-Revised-98. Psychosomatics, 50, 255–262.Google Scholar
Gupta, N., de Jonghe, J., Schieveld, J., Leonard, M. and Meagher, D. (2008). Delirium phenomenology: what can we learn from the symptoms of delirium? Journal of Psychosomatic Research, 65, 215–222.CrossRefGoogle ScholarPubMed
Hart, R. P., Levenson, J. L., Sessler, C. N., Best, A. M., Schwartz, S. M. and Rutherford, L. E. (1996). Validation of a cognitive test for delirium in medical ICU patients. Psychosomatics, 37, 533–546.CrossRefGoogle ScholarPubMed
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method, a new method for the detection of delirium. Annals of Internal Medicine, 113, 941–948.CrossRefGoogle Scholar
Inouye, S. K., Rushing, J. T., Foreman, M. D., Palmer, R. M. and Pompei, P. (1998). Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. Journal of General and Internal Medicine, 13, 234–242.CrossRefGoogle ScholarPubMed
Jorm, A. F. (2004). The Informant Questionnaire on cognitive decline in the elderly (IQCODE): a review. International Psychogeriatrics, 16, 275–293CrossRefGoogle ScholarPubMed
Kennedy, R. E., Nakase-Thompson, R., Nick, T. G. and Shere, M. (2003). Use of the Cognitive Test for Delirium in patients with traumatic brain injury. Psychosomatics, 44, 283–289.CrossRefGoogle ScholarPubMed
Levkoff, S. E. et al. (1992). Delirium: the occurrence and persistence of symptoms among elderly hospitalized patients. Archives of Internal Medicine, 152, 334–340.CrossRefGoogle ScholarPubMed
Lipowski, Z. J. (1991). Delirium: how its concept has developed. International Psychogeriatrics, 3, 115–120.CrossRefGoogle ScholarPubMed
MacLullich, A. M. J., Beaglehole, A., Hall, R. J. and Meagher, D. J. (2009). Delirium and long-term cognitive impairment. International Review of Psychiatry, 21, 30–42.CrossRefGoogle ScholarPubMed
McCusker, J., Cole, M. G., Abrahamowicz, M., Primeau, F. and Belzile, E. (2002). Delirium predicts 12-month mortality. Archives of Internal Medicine, 162, 457–463.CrossRefGoogle ScholarPubMed
Meagher, D. (2009). Motor subtypes of delirium: past, present, and future. International Review of Psychiatry, 21, 59–73.CrossRefGoogle ScholarPubMed
Meagher, D. (2010). Impact of an educational workshop upon attitudes towards pharmacotherapy for delirium. International Psychogeriatrics 22, 938–946.CrossRefGoogle ScholarPubMed
Meagher, D. J. and Trzepacz, P. T. (2009). Delirium. In Geddes, J., Lopez-Ibor, J. J. and Andreasen, N. (eds.), Oxford Textbook of Psychiatr.y (Chapter 4.1.1.) Oxford: Oxford University Press.Google Scholar
Meagher, D. J. et al. (2007). Phenomenology of 100 consecutive adult cases of delirium. British Journal of Psychiatry, 190, 135–141.Google Scholar
Meagher, D., MacLullich, A. M. J. and Laurila, J. (2008). Defining delirium for the International Classification of Diseases. Journal of Psychosomatic Research, 65, 207–214.Google Scholar
O'Keeffe, S. and Lavan, J. (1997). The prognostic significance of delirium in older hospital patients. Journal of the American Geriatrics Society, 45, 174–178.Google Scholar
Rockwood, K. (1993). The occurrence and duration of symptoms in elderly patients with delirium. Journal of Gerontological Medical Science, 48, M162–M166.CrossRefGoogle ScholarPubMed
Rockwood, K., Cosway, S., Carver, D., Jarrett, P., Stadnyk, K. and Fisk, J. (1999). The risk of dementia and death after delirium. Age and Ageing, 28, 551–556.CrossRefGoogle ScholarPubMed
Trzepacz, P. and Meagher, D. (2007). Neuropsychiatric aspects of delirium. In Yudofsky, S. and Hales, R. (eds.), American Psychiatric Association Textbook of Neuropsychiatry (5th edition). Washington, DC: American Psychiatric Publishing Press.Google Scholar
Trzepacz, P. T., Mulsant, B. H., Dew, M. A., Pasternak, R., Sweet, R. A. and Zubenko, G. S. (1998). Is delirium different when it occurs in dementia? A study using the Delirium Rating Scale. Journal of Neuropsychiatry and Clinical Neuroscience, 10, 199–204.CrossRefGoogle ScholarPubMed
Trzepacz, P. T., Mittal, D., Torres, R., Kanary, K., Norton, J. and Jimerson, N. (2001). Validation of the Delirium Rating Scale-Revised-98 (DRS-R-98). Journal of Neuropsychiatry and Clinical Neuroscience, 13, 229–242.CrossRefGoogle Scholar
World Medical Association (2004). Declaration of Helsinki: Ethical Principles for medical research Involving Human Subjects. Available at: http://www.wma.net/e/policy/pdf/17c.pdf.Google Scholar