Delir – eine interdisziplinäre Herausforderung

Kappenschneider, Tobias; Meyer, M.; Maderbacher, Günther; Parik, Lukas; Leiß, Franziska; Quintana, Loreto Pulido; Grifka, Joachim

doi:10.1007/s00132-021-04209-2

Cited by 8 publications

(4 citation statements)

References 68 publications

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“…Interestingly, we observed comparable rates of delirium during hospitalization in patients with stroke mimics, when compared to patients with confirmed strokes, underlining the importance of conducting delirium risk assessments in SU or ICU patients regardless of the specific diagnosis. The primary limitation of our study is the likely underdiagnosis of hypoactive delirium and the differentiation of pre-stroke cognitive decline, delirium and stroke-related cognitive deterioration independent from delirium, which is however a common limitation encountered in delirium assessments and applies to our study as well (3,32,33). Furthermore, the CAM-ICU has its weaknesses when applied in stroke patients and is not exactly equivalent to delirium assessment according to DSM-5 criteria (34, 35).…”

Section: Discussionmentioning

confidence: 96%

The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters

Wischmann,

Kremer,

Hinske

et al. 2023

Front. Neurol.

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Background and objectivePost-stroke delirium (PSD) is a common complication in acute stroke patients, and guidelines recommend routine screening and various preventive and treatment measures. However, there is a substantial lack of standardized approaches in diagnostic and therapeutic management of PSD. Here, we aimed to develop a new pragmatic and easily assessable screening tool to predict PSD based on early parameters, which are already integral to acute stroke diagnostics.MethodsWe enrolled acute stroke patients admitted to our stroke unit or intensive care unit and developed the scoring system using retrospective single-center patient data. The Confusion Assessment Method for the Intensive Care Unit was used for prospective score validation. Logistic regression models were employed to analyze the association of early clinical and paraclinical parameters with PSD development.ResultsN = 525 patients (median age: 76 years; 45.7% female) were enrolled, with 29.7% developing PSD during hospitalization. The resulting score comprises 6 items, including medical history, clinical examination findings, and non-contrast computed tomography results at admission. Scores range from −15 to +15 points, with higher values indicating a higher likelihood of PSD, ranging from 4% to 79%. The accuracy was 0.85, and the area under the curve was 0.89.ConclusionThe new RAPID (Risk Assessment and PredIction of Delirium in acute stroke patients)-score shows high accuracy in predicting PSD among acute stroke patients and offers precise odds of PSD for each corresponding score value, utilizing routine early clinical and paraclinical parameters. It can identify high-risk populations for clinical study interventions and may be suitable to guide prophylactic PSD measures.

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Section: Discussionmentioning

confidence: 96%

The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters

Wischmann,

Kremer,

Hinske

et al. 2023

Front. Neurol.

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“…Antipsychotics are the most common medications used in treating delirium, with haloperidol the drug of choice [12]. Antipsychotics are not proven to be helpful in randomized clinical trials (RCTs) and do not increase the number of days alive without delirium or coma in terminally ill patients [13,14]. Non-pharmacologic interventions are effective but are not cost-effective and take time to bear results [12].…”

Section: Introductionmentioning

confidence: 99%

Use of Methylphenidate for Hypoactive Delirium: A Comprehensive Systematic Review

Bachu,

Kotapati,

Kainth

et al. 2023

Psychoactives

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Background: Delirium is a complex neuropsychiatric syndrome common in all medical settings. An acute change in cognition characterizes a disturbance of consciousness, usually resulting from an underlying medical condition or withdrawal from medications or drugs. Three different subtypes of delirium have been identified based on the motor symptoms exhibited by the patient: hyperactive, hypoactive, and mixed. This study aims to review the use of methylphenidate for treating hypoactive delirium. Methods: The review was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We performed a literature search of PubMed, MEDLINE, Cochrane, and clinical trial registries from 1990 to 15 March 2023. Results: A total of 115 articles were identified. After removing duplicates, 68 abstracts were reviewed by all the authors. Then, 13 full-text articles were assessed for eligibility. Three articles were deemed eligible for the systematic review. These included one prospective clinical study, one case series, and one case report. The total number of participants was 17, with multiple comorbidities. Most studies reported using methylphenidate for hypoactive delirium in terminally ill patients. All reviewed studies reported symptomatic benefits in individuals with hypoactive delirium. Conclusions: Methylphenidate may be beneficial in treating hypoactive delirium in terminally ill patients. Clinical trials are needed to assess the safety and efficacy of methylphenidate in Hypoactive delirium.

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“…Causes of this mortality include pulmonary embolism, heart failure, and infections 2 . Further complicating matters, the geriatric population faces additional challenges such as comorbidities, polypharmacy, malnutrition, sarcopenia, immobility, and cognitive impairments, among others 4 . These changing demographics necessitate a comprehensive approach to patient care.…”

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confidence: 99%

“…Prior work has focused on the development of orthogeriatric teams to execute strategies of optimizing outcomes in trauma and joint replacement patients 2,4,8 . Pioli et al conceptualized the orthogeriatric care model as not just a multidisciplinary activity but rather a radical alternative to the traditional model 9 .…”

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confidence: 99%

Dementia and Hip Fractures

Zabawa,

Choubey,

Drake

et al. 2023

JBJS Reviews

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» The elderly population is the fastest growing demographic, and the number of dementia cases in the United States is expected to double to 10 million by 2050.» Patients with dementia are at 3× higher risk of hip fractures and have higher morbidity and mortality after hip fractures.» Hip fracture patients with dementia benefit from early analgesia and timely surgical fixation of fracture.» Early and intensive inpatient rehabilitation is associated with improved postoperative outcomes in patients with dementia.» Coordination of care within a “orthogeriatric” team decreases mortality, and fracture liaison services show potential for improving long-term outcomes in hip fracture patients with dementia.

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Delir – eine interdisziplinäre Herausforderung

Cited by 8 publications

References 68 publications

The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters

The RAPID-score: Risk Assessment and PredIction of Delirium in acute stroke patients based on very early clinical parameters

Use of Methylphenidate for Hypoactive Delirium: A Comprehensive Systematic Review

Dementia and Hip Fractures

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