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.
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.
Authors: David J Meagher; Alessandro Morandi; Sharon K Inouye; Wes Ely; Dimitrios Adamis; Alasdair J Maclullich; James L Rudolph; Karin Neufeld; Maeve Leonard; Giuseppe Bellelli; Daniel Davis; Andrew Teodorczuk; Stefan Kreisel; Christine Thomas; Wolfgang Hasemann; Suzanne Timmons; Niamh O'Regan; Sandeep Grover; Faiza Jabbar; Walter Cullen; Colum Dunne; Barbara Kamholz; Barbara C Van Munster; Sophia E De Rooij; Jos De Jonghe; Paula T Trzepacz Journal: BMC Med Date: 2014-09-30 Impact factor: 8.775
Authors: Daniel H J Davis; Stefan H Kreisel; Graciela Muniz Terrera; Andrew J Hall; Alessandro Morandi; Malaz Boustani; Karin J Neufeld; Hochang Benjamin Lee; Alasdair M J Maclullich; Carol Brayne Journal: Am J Geriatr Psychiatry Date: 2013-07-30 Impact factor: 4.105
Authors: Kevin Glynn; Frank McKenna; Kevin Lally; Muireann O'Donnell; Sandeep Grover; Subho Chakrabarti; Ajit Avasthi; Surendra K Mattoo; Akhilesh Sharma; Abhishek Gosh; Ruchita Shah; David Hickey; James Fitzgerald; Brid Davis; Niamh O'Regan; Dimitrious Adamis; Olugbenja Williams; Fahad Awan; C Dunne; Walter Cullen; Shane McInerney; John McFarland; Faiza Jabbar; Henry O'Connell; Paula T Trzepacz; Maeve Leonard; David Meagher Journal: BMJ Open Date: 2021-04-14 Impact factor: 2.692
Authors: Maeve Leonard; Shane McInerney; John McFarland; Candice Condon; Fahad Awan; Margaret O'Connor; Paul Reynolds; Anna Maria Meaney; Dimitrios Adamis; Colum Dunne; Walter Cullen; Paula T Trzepacz; David J Meagher Journal: BMJ Open Date: 2016-03-08 Impact factor: 2.692
Authors: David J Meagher; Henry O'Connell; Maeve Leonard; Olugbenga Williams; Fahad Awan; Chris Exton; Michael Tenorio; Margaret O'Connor; Colum P Dunne; Walter Cullen; John McFarland; Dimitrios Adamis Journal: World J Psychiatry Date: 2020-04-19
Authors: Alessandro Morandi; Jin H Han; David Meagher; Eduard Vasilevskis; Joaquim Cerejeira; Wolfgang Hasemann; Alasdair M J MacLullich; Giorgio Annoni; Marco Trabucchi; Giuseppe Bellelli Journal: J Am Med Dir Assoc Date: 2016-06-23 Impact factor: 4.669