Delirium in patients undergoing hematopoietic stem cell transplantation

Abstract

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

HHV-6 reactivation and its effect on delirium and cognitive functioning in hematopoietic cell transplantation recipients

“…12 It has good construct, discriminant, and criterion validity 13 and has been used previously in studies of HCT recipients. 14,15 The DRS has been used in children and was modified for patients 3 to 7 years old by including age-appropriate memory screening from the Children's Orientation and Amnesia Test. 16,17 In the few assessments (1%) for which some DRS items could not be scored, mostly because of severe illness, the completed items were averaged to assign scores to the missing items.…”

“…A delirium episode was defined as a DRS score more than 12 or delirium based on the DSM-IV checklist on at least 2 of 3 consecutive assessments. 14,[19][20][21] Neuropsychologic testing assessed the following domains: (1) Overall, 144 (49%) of 291 patients Ն 5 years old completed both baseline and follow-up neurocognitive testing. Of the 176 missed tests, 83 were the result of severe illness or death and 93 were refused or unable to be scheduled.…”

Opioid medications and longitudinal risk of delirium in hospitalized cancer patients

“…This term has been defined similarly and used in a recently published delirium study. 11 These delirium events would represent the smallest analyzable delirium unit (eg, each Nu-DESC delirium score for each 24-hour period) and, conceptually, would be equivalent to the statistical term recurrences mentioned above. This approach allowed us to include all observations for all patients as of the first manifestations of delirium, like previous work in delirium course studies.…”

Psychohematology. Attempt to Summarise

“…The authors identify risk factors of delirium in before transplantation period: low cognitive functioning, a high level of urea nitrogen, alkaline phosphatase, and magnesium salts in blood, lack of physical activity. In addition, a development of severe delirium during BMT, according to the authors, contribute to high levels of blood creatinine, past total irradiation, an extremely high rate of alkaline phosphatase, female gender, older age, and an abuse of alcohol or narcotic drugs [21] . High prevalence of psychoses, according to data cited in the article, can be explained by the prevalence of patients diagnosed with severe onco-hematological pathology (acute leukemia, lymphosarcoma), as well as a significant number of persons with drug / alcohol addiction and delirious disorders in the past history among them.…”

“…Thus, J. Fann et al (2002) showed signs of delirious clouding of consciousness in more than half (54%) of patients who underwent BMT. The authors identify risk factors of delirium in before transplantation period: low cognitive functioning, a high level of urea nitrogen, alkaline phosphatase, and magnesium salts in blood, lack of physical activity.…”