Giuseppe Bellelli1, Salvatore Speciale2, Sara Morghen2, Tiziana Torpilliesi2, Renato Turco2, Marco Trabucchi3. 1. Department of Rehabilitation and Aged Care, "Ancelle della Carità" Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. Electronic address: giuseppe.bellelli@ancelle.it. 2. Department of Rehabilitation and Aged Care, "Ancelle della Carità" Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy. 3. Geriatric Research Group, Brescia, Italy; University Tor Vergata, Rome, Italy.
Abstract
BACKGROUND: Although delirium is known as a mental disorder, recent evidence suggests that it is associated with short- and long-term impairment of functional status. OBJECTIVE: To evaluate whether a pattern of fluctuations in motor performance are a diagnostic sign of delirium. DESIGN: Case-controlled study with prospective evaluations of 4 groups of patients. SETTING: Department of Rehabilitation and Aged Care. METHODS: Fifteen patients with incident delirium alone (Del group) and 15 patients with incident delirium superimposed on dementia (DSD group) were compared with 15 patients with neither delirium nor dementia (No Del-No Dem group) and 15 patients with dementia but no delirium (Dem group), respectively. Eligibility criteria were age 65 years or older, ability on admission to maintain sitting position for at least 10 minutes, and absence of visual/hearing impairment or delirium on admission. All patients underwent a multidimensional assessment on admission and serial evaluations of motor performance using Trunk Control Test (TCT) and Tinetti scale. These assessments were fixed at 5 different times, coincident with admission (T(0)), predelirium (T(1)), onset of delirium (T(2)), resolution of delirium (T(3)), and discharge (T(4)). RESULTS: Patients in the Dem, DSD, and Del groups were significantly more impaired at T(0) in cognitive and functional status and motor performance compared with No Del-No Dem patients. At T(1) all groups improved, although in different ways. At T(2) only in the Del and DSD groups, but not in the others, there was a pattern of decline in TCT and Tinetti scores (P < .0005 at t test for pair comparison for both tests) and a specular pattern of improvement at T(3) (P < .0005 at t test for pair comparison for both tests). Patients in the Del and DSD groups had the poorest attentive and executive performances at T(2), which significantly improved at T(3). In No Del-No Dem and Dem groups, attentive and executive functions did not change from T(2) to T(3.) CONCLUSION: Patients with delirium exhibit a pattern of fluctuating motor performance that is chronologically related with the onset and the end of delirium, ie, they decline when delirium develops and improve when delirium ends. This pattern seems to be typical of delirium, as it is appreciable in subjects with dementia developing delirium but not in patients with dementia alone. A fluctuation of motor performance should be considered a diagnostic sign of delirium.
BACKGROUND: Although delirium is known as a mental disorder, recent evidence suggests that it is associated with short- and long-term impairment of functional status. OBJECTIVE: To evaluate whether a pattern of fluctuations in motor performance are a diagnostic sign of delirium. DESIGN: Case-controlled study with prospective evaluations of 4 groups of patients. SETTING: Department of Rehabilitation and Aged Care. METHODS: Fifteen patients with incident delirium alone (Del group) and 15 patients with incident delirium superimposed on dementia (DSD group) were compared with 15 patients with neither delirium nor dementia (No Del-No Dem group) and 15 patients with dementia but no delirium (Dem group), respectively. Eligibility criteria were age 65 years or older, ability on admission to maintain sitting position for at least 10 minutes, and absence of visual/hearing impairment or delirium on admission. All patients underwent a multidimensional assessment on admission and serial evaluations of motor performance using Trunk Control Test (TCT) and Tinetti scale. These assessments were fixed at 5 different times, coincident with admission (T(0)), predelirium (T(1)), onset of delirium (T(2)), resolution of delirium (T(3)), and discharge (T(4)). RESULTS:Patients in the Dem, DSD, and Del groups were significantly more impaired at T(0) in cognitive and functional status and motor performance compared with No Del-No Dem patients. At T(1) all groups improved, although in different ways. At T(2) only in the Del and DSD groups, but not in the others, there was a pattern of decline in TCT and Tinetti scores (P < .0005 at t test for pair comparison for both tests) and a specular pattern of improvement at T(3) (P < .0005 at t test for pair comparison for both tests). Patients in the Del and DSD groups had the poorest attentive and executive performances at T(2), which significantly improved at T(3). In No Del-No Dem and Dem groups, attentive and executive functions did not change from T(2) to T(3.) CONCLUSION:Patients with delirium exhibit a pattern of fluctuating motor performance that is chronologically related with the onset and the end of delirium, ie, they decline when delirium develops and improve when delirium ends. This pattern seems to be typical of delirium, as it is appreciable in subjects with dementia developing delirium but not in patients with dementia alone. A fluctuation of motor performance should be considered a diagnostic sign of delirium.
Authors: Alessandro Morandi; Elena Lucchi; Renato Turco; Sara Morghen; Fabio Guerini; Rossana Santi; Simona Gentile; David Meagher; Philippe Voyer; Donna Fick; Eva M Schmitt; Sharon K Inouye; Marco Trabucchi; Giuseppe Bellelli Journal: J Psychosom Res Date: 2015-08-08 Impact factor: 3.006
Authors: Sarinnapha M Vasunilashorn; Dena Schulman-Green; Douglas Tommet; Tamara G Fong; Tammy T Hshieh; Edward R Marcantonio; Eran D Metzger; Eva M Schmitt; Patricia A Tabloski; Thomas G Travison; Yun Gou; Benjamin Helfand; Sharon K Inouye; Richard N Jones Journal: Dement Geriatr Cogn Disord Date: 2020-06-17 Impact factor: 2.959
Authors: Alessandro Morandi; Elena Lucchi; Renato Turco; Sara Morghen; Fabio Guerini; Rossana Santi; Simona Gentile; David Meagher; Philippe Voyer; Donna M Fick; Eva M Schmitt; Sharon K Inouye; Marco Trabucchi; Giuseppe Bellelli Journal: J Psychosom Res Date: 2015-08-09 Impact factor: 3.006
Authors: Alessandro Morandi; Daniel Davis; Giuseppe Bellelli; Rakesh C Arora; Gideon A Caplan; Barbara Kamholz; Ann Kolanowski; Donna Marie Fick; Stefan Kreisel; Alasdair MacLullich; David Meagher; Karen Neufeld; Pratik P Pandharipande; Sarah Richardson; Arjen J C Slooter; John P Taylor; Christine Thomas; Zoë Tieges; Andrew Teodorczuk; Philippe Voyer; James L Rudolph Journal: J Am Med Dir Assoc Date: 2016-09-16 Impact factor: 4.669
Authors: Alessandro Morandi; Jessica McCurley; Eduard E Vasilevskis; Donna M Fick; Giuseppe Bellelli; Patricia Lee; James C Jackson; Susan D Shenkin; John Schnelle; Sharon K Inouye; E Wesley Ely; Wesley E Ely; Alasdair MacLullich Journal: J Am Geriatr Soc Date: 2012-10-05 Impact factor: 5.562
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