First delirium episode in Parkinson’s disease and parkinsonism: incidence, predictors, and outcomes

Abstract

To define the incidence, predictors and prognosis of the first hospital delirium episode in Parkinson’s disease (PD) and atypical parkinsonism (AP), we identified the first hospital episode of delirium after diagnosis in the Parkinsonism Incidence in North-East Scotland (PINE) study, a prospective community-based incidence cohort of parkinsonism, using chart-based criteria to define delirium. Of 296 patients (189=PD, 107=AP [dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, vascular parkinsonism]), 152 developed delirium (PD = 98, AP = 54). Incidence of first hospital delirium episode per 100 person years was 8.1 (95% confidence interval [CI] 6.6–9.9) in PD and 18.5 (95% CI 13.9–24.7) in AP. Independent predictors of delirium were atypical parkinsonism (Hazard ratio [HR] vs PD = 2.83 [95% CI 1.60–5.03], age in PD but not in AP (HR for 10-year increase 2.29 [95% CI 1.74–3.02]), baseline MMSE (HR = 0.94 [95% CI 0.89–0.99]), APOE ε4 in PD (HR 2.16 [95% CI 1.15–4.08]), and MAPT H1/H1 in PD (HR 2.08 [95% CI 1.08–4.00]). Hazards of dementia and death after delirium vs before delirium were increased (dementia: HR = 6.93 [95% CI 4.18–11.48] in parkinsonism; death: HR = 3.76 [95% CI 2.65–5.35] in PD, 1.59 [95% CI 1.04–2.42] in AP). Delirium is a common non-motor feature of PD and AP and is associated with increased hazards of dementia and mortality. Whether interventions for early identification and treatment improve outcomes requires investigation.

Nomogram for Prediction of Postoperative Delirium after Deep Brain Stimulation of Subthalamic Nucleus in Parkinson’s Disease under General Anesthesia

“…Delirium is common in patients with PD and can occur in outpatient/inpatient settings and after surgery [ 6 ]. The general anesthesia has become an option for DBS anesthesia in recent years because of its sufficient comfort and safety.…”

“…Postoperative delirium is one of the common complications after DBS, with an incidence of 5.8%-40% [2][3][4]. It refers to an acute brain dysfunction mainly caused by the reduction of consciousness, cognitive impairment, and sensory disturbance due to various factors after operation [5,6]. Postoperative delirium can aggravate patients' cognitive dysfunction, prolong the length of stay and total length of stay in the intensive care unit and ward, increase readmission rates and mortality, seriously reduce the quality of life after discharge, and bring heavy mental and economic burden to medical staf, family members, and society [6][7][8].…”

Causal relationships between delirium and Parkinson’s Disease: a bidirectional two-sample Mendelian randomization study

“…Delirium is an acute state of confusion characterized by inattention, disorganized and incoherent thinking, and aberrant perceptual function 1,2 . Delirium is associated with an increased risk of falls, cognitive decline, morbidity and mortality 3,4 . Moreover, delirium is an important non-motor function that has received increasing attention in Parkinson's disease (PD) and other forms of Parkinsonism 4 .…”

“…Delirium is associated with an increased risk of falls, cognitive decline, morbidity and mortality 3,4 . Moreover, delirium is an important non-motor function that has received increasing attention in Parkinson's disease (PD) and other forms of Parkinsonism 4 . Delirium has been commonly associated with parkinsonism, surpassing its occurrence in the general aging population 4,5 .…”

“…Moreover, delirium is an important non-motor function that has received increasing attention in Parkinson's disease (PD) and other forms of Parkinsonism 4 . Delirium has been commonly associated with parkinsonism, surpassing its occurrence in the general aging population 4,5 . However, the existing research on delirium as a risk factor for PD remains limited, and there is a lack of studies investigating the prevalence of delirium speci cally in PD patients 6 .…”