Delirium and dementia in acute medical admissions of elderly patients in Iceland

Kolbeinsson, H.; Jónsson, Ársæll

doi:10.1111/j.1600-0447.1993.tb03342.x

Cited by 78 publications

(69 citation statements)

References 33 publications

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“…[46][47][48] Generally speaking, patients with higher severities of illness are more likely to develop delirium, 41,58 and even higher doses are required to cause stupor and coma. Infections are probably the most common causes of delirium occurring in 16 to 67% of cases; 49,[52][53][54][60][61][62][63] urinary tract infection and pneumonia are common infectious etiologies. Other precipitants for delirium include electrolyte abnormalities such as hyponatremia, hypernatremia, hypercalcemia, and hypocalcemia, 58,64 organ failure, 58,64 Wernicke's encephalopathy, thyroid dysfunction, 65 central nervous system insults such as cerebrovascular accidents, intracerebral hemorrhage, epidural and subdural hematomas, and subarachnoid hemorrhage, 52,53,60,63 ethanol and benzodiazepine withdrawal, [66][67][68] dehydration, 41 and cardiovascular illnesses such as congestive heart failure, 53,54 and acute myocardial infarction.…”

Section: Precipitating Factors For Acute Brain Dysfunctionmentioning

confidence: 99%

“…[45][46][47][48] Dementia is the most consistently observed vulnerability factor for delirium regardless of clinical setting. 41,45,[49][50][51][52][53][54][55] A dose-response relationship seems to exist; as the severity of dementia worsens, the risk of developing delirium increases. 56 Similarly, low education attainment also increases the patient's susceptibility to developing delirium.…”

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Altered Mental Status in Older Emergency Department Patients

Wilber

2006

Emergency Medicine Clinics of North America

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SynopsisAltered mental status is a common chief complaint among older emergency department (ED) patients. Acute changes in mental status are more concerning and are usually secondary to delirium, stupor, and coma. These forms of acute brain dysfunction are commonly precipitated by an underlying medical illness that can be potentially life-threatening and are associated with a multitude of adverse outcomes. Though stupor and coma are easily identifiable, the clinical presentation of delirium can be subtle and is often missed without actively screening for it. For patients with acute brain dysfunction, the ED evaluation should focus on searching for the underlying etiology. Infection is one of the most common precipitants of delirium, but multiple etiologies may exist concurrently. Keywordsdelirium; coma; stupor emergency department; epidemiology; diagnosis; management IntroductionAltered mental status is a common chief complaint among older emergency department (ED) patients. Despite the frequency of this complaint, the term "altered mental status" is vague and has several synonyms such as confusion, not acting right, altered behavior, generalized weakness, lethargy, agitation, psychosis, disorientation, inappropriate behavior, inattention, and hallucination. 1 Such lack of standardized terminology not only hinders the assessment and appropriate management of patients with altered mental status, but also the advancement of knowledge through research.Altered mental status has varying time courses and degrees of severity. Acute changes in mental status are usually secondary to delirium, stupor, and coma, which are forms of acute brain dysfunction. These changes occur over a period of hours or days and are usually © 2012 Elsevier Inc. All rights reserved. Correspondence to: Jin H. Han, jin.h.han@vanderbilt.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript precipitated by an underlying medical illness that is potentially life threatening. Chronic alterations in mental status (e.g. dementia) occur over a period of months and years and are less likely to be precipitated by a life-threatening illness. 2 For these reasons, acute changes in mental status will be the focus of this review. Altered mental status is rarely caused by psychiatric illnesses such as depression or schizophrenia, and in elder patients, these should be diagnoses of exclusion. Acute brain dysfunction (delirium, stupor, and coma) and their underlying etiology should be ruled out prior to considering any psychiatric d...

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Section: Precipitating Factors For Acute Brain Dysfunctionmentioning

confidence: 99%

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confidence: 99%

Altered Mental Status in Older Emergency Department Patients

Wilber

2006

Emergency Medicine Clinics of North America

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“…The incidence of delirium in the elderly is known to be higher after hip fracture (range, 28%-61%) than after admission to a general internal medicine unit or an acute geriatric unit (range, 14%-42%) [6,10,12,17,25,39]. In nonorthopaedic fields, a chronic type of delirium, which is called prolonged delirium (defined here as lasting [ 4 weeks), is reported to exist and is known to be associated with greater mortality and poor functional recovery [4,21,22].…”

Section: Introductionmentioning

confidence: 99%

Frequency, Risk Factors, and Prognosis of Prolonged Delirium in Elderly Patients After Hip Fracture Surgery

Lee

et al. 2011

Clinical Orthopaedics &Amp; Related Research

102

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Background Delirium in elderly patients after hip fracture surgery is believed to be a transient event, although it frequently lasts for more than 4 weeks. Questions/purposes We determined the incidence, risk factors, morbidity, and mortality of prolonged delirium in elderly patients after hip fracture surgery. Patients and Methods We evaluated 232 elderly patients (older than 65 years) (232 hips) who underwent hip fracture surgery for the development and duration of delirium and categorized them into three groups; nondelirium group, transient (B 4 weeks) delirium group, and prolonged ([ 4 weeks) delirium group. Patients underwent a global geriatric evaluation, which included postoperative complications, mortality, and functional and mental status evaluations. The three groups were compared with respect to these variables. Results Seventy patients (30.2%) had delirium develop, and among these, 14 (20%) had prolonged delirium with a total incidence of 6%. Multivariate analysis showed preinjury dementia was a risk factor of prolonged delirium. At the final followup, five (62.5%) of the eight patients who were ambulatory outdoors in the prolonged delirium group became housebound, whereas only 18 (16.4%) of the 110 patients who were ambulatory outdoors in the nondelirium group became housebound. Survival at 40 months was 81.0% (95% confidence interval, 72.6%-89.3%) in the nondelirium group and 63.6% (95% confidence interval, 35.2%-92.

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“…[1][2][3] It is especially common among patients with malignant disease, occurring in 25-40% of patients with malignancies 4 -6 and in 45-85% of those with advanced disease. [7][8][9][10] Delirium is associated with significantly increased morbidity, functional decline, and utilization of health care services.…”

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Delirium in patients undergoing hematopoietic stem cell transplantation

Fann

Roth-Roemer²,

Burington

et al. 2002

Cancer

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BACKGROUNDDelirium is common in patients with malignant disease and is associated with significant morbidity. Studies have not examined the epidemiology of delirium in patients undergoing hematopoietic stem cell transplantation (HSCT). The objectives of this study were to determine the prevalence, incidence, severity, and duration of delirium in the acute phase of HSCT and to determine the pretransplantation risk factors for the occurrence and severity of delirium during this period.METHODSNinety adult patients with malignancies who were admitted to the Fred Hutchinson Cancer Research Center for their first HSCT were assessed prospectively from 1 week pretransplantation to 30 days posttransplantation. Delirium occurrence using the Delirium Rating Scale (DRS) and severity using the Memorial Delirium Assessment Scale (MDAS) were assessed three times per week. Pretransplantation risk factors were assessed by patient self‐report, charts, and computerized records.RESULTSThe cumulative posttransplantation incidence of delirium events (DRS score > 12) was 66 (73%), and the incidence of delirium episodes (DRS score > 12 for 2 of 3 consecutive assessments) was 45 (50%). The mean ± standard deviation duration of delirium episodes was 4.8 ± 2.8 assessments (approximately 10 days). Pretransplantation risk factors for having a delirium episode were lower cognitive functioning (Trailmaking B test [a standardized test of visual conceptual and visuomotor tracking and cognitive flexibility]; P = 0.0008), higher blood urea nitrogen (P = 0.002), higher alkaline phosphatase (P = 0.008), lower physical functioning (SF‐12 [self report questionnaire that is a general measure of functioning]; P = 0.03), and higher magnesium (P = 0.03). Pretransplantation risk factors for higher delirium severity scores were higher creatinine (P < 0.0001), the presence of total body irradiation (P = 0.0001), higher magnesium (P = 0.0003), lower Mini‐Mental State Examination score (P = 0.002), malignancy diagnosis category (P = 0.002), female gender (P = 0.008), higher alkaline phosphatase (P = 0.02), older age (P = 0.03), and prior alcohol or drug abuse (P = 0.046).CONCLUSIONSHalf of patients who undergo HSCT experience a delirium episode during the 4 weeks posttransplantation. Pretransplantation risk factors can assist in identifying patients who are more likely to develop delirium posttransplantation. Cancer 2002;95:1971–81. © 2002 American Cancer Society.DOI 10.1002/cncr.10889

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Delirium and dementia in acute medical admissions of elderly patients in Iceland

Cited by 78 publications

References 33 publications

Altered Mental Status in Older Emergency Department Patients

Altered Mental Status in Older Emergency Department Patients

Frequency, Risk Factors, and Prognosis of Prolonged Delirium in Elderly Patients After Hip Fracture Surgery

Delirium in patients undergoing hematopoietic stem cell transplantation

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