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A longitudinal study of delirium phenomenology indicates widespread neural dysfunction

Published online by Cambridge University Press:  04 November 2013

Maeve Leonard ,
Dimitrios Adamis ,
Jean Saunders ,
Paula Trzepacz  and
David Meagher
Maeve Leonard
Affiliation:
Department of Adult Psychiatry, University Hospital Limerick, Limerick, Ireland Milford Hospice Palliative Care Centre, Limerick, Ireland University of Limerick Medical School, Limerick, Ireland
Dimitrios Adamis*
Affiliation:
University of Limerick Medical School, Limerick, Ireland Research and Academic Institute of Athens, Athens, Greece Sligo Mental Health Services, Sligo, Ireland
Jean Saunders
Affiliation:
Statistical Consulting Unit, University of Limerick, Limerick, Ireland
Paula Trzepacz
Affiliation:
Tufts University School of Medicine, Medford, Massachusetts Indiana University School of Medicine, Indianapolis, Indiana Lilly Research Laboratories, Indianapolis, Indiana
David Meagher
Affiliation:
Department of Adult Psychiatry, University Hospital Limerick, Limerick, Ireland Milford Hospice Palliative Care Centre, Limerick, Ireland University of Limerick Medical School, Limerick, Ireland
*
Address correspondence and reprint requests to: Dimitrios Adamis, University of Limerick Medical School, Limerick, Ireland. E-mail: [email protected]
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Abstract

Objectives:

Delirium affects all higher cortical functions supporting complex information processing consistent with widespread neural network impairment. We evaluated the relative prominence of delirium symptoms throughout episodes to assess whether impaired consciousness is selectively affecting certain brain functions at different timepoints.

Methods:

Twice-weekly assessments of 100 consecutive patients with DSM-IV delirium in a palliative care unit used the Delirium Rating Scale Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD). A mixed-effects model was employed to estimate changes in severity of individual symptoms over time.

Results:

Mean age = 7 0.2 ± 10.5 years, 51% were male, and 27 had a comorbid dementia. A total of 323 assessments (range 2–9 per case) were conducted, but up to 6 are reported herein. Frequency and severity of individual DRS-R98 symptoms was very consistent over time even though the majority of patients (80%) experienced fluctuation in symptom severity over the course of hours or minutes. Over time, DRS-R98 items for attention (88–100%), sleep–wake cycle disturbance (90–100%), and any motor disturbance (87–100%), and CTD attention and vigilance were most frequently and consistently impaired. Mixed-effects regression modeling identified only very small magnitudes of change in individual symptoms over time, including the three core domains.

Significance of results:

Attention is disproportionately impaired during the entire episode of delirium, consistent with thalamic dysfunction underlying both an impaired state of consciousness and well-known EEG slowing. All individual symptoms and three core domains remain relatively stable despite small fluctuations in symptom severity for a given day, which supports a consistent state of impaired higher cortical functions throughout an episode of delirium.

Keywords

DeliriumPhenomenologyLongitudinal assessmentCourseCore domains
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 2 , April 2015 , pp. 187 - 196
Copyright
Copyright © Cambridge University Press 2013 

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