Outcomes associated with delirium in acutely hospitalized acquired immune deficiency syndrome patients

Uldall, Karina K.; Harris, Vicki; Lalonde, Bernadette

doi:10.1016/s0010-440x(00)90138-x

Cited by 15 publications

(14 citation statements)

References 18 publications

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“… 21 More recent studies have used delirium as a subtle indicator of higher morbidity and mortality in patients who have advanced to AIDS. 22 , 23 Hospitalized patients with AIDS were also found to have increased mortality if delirium complicated their hospital course. 22 Age appears to be an independent variable, as delirium may also occur in children with AIDS.…”

Section: Primary Psychiatric Conditions Associated With Cognitive Impmentioning

confidence: 99%

Cognitive impairment in patients with AIDS – prevalence and severity

Watkins¹,

Treisman²

2015

HIV

117

113

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The advent of highly active antiretroviral therapy has prolonged the life expectancy of HIV patients and decreased the number of adults who progress to AIDS and HIV-associated dementia. However, neurocognitive deficits remain a pronounced consequence of HIV/AIDS. HIV-1 infection targets the central nervous system in subcortical brain areas and leads to high rates of delirium, depression, opportunistic central nervous system infections, and dementia. Long-term HIV replication in the brain occurs in astrocytes and microglia, allowing the virus to hide from antiviral medication and later compromise neuronal function. The associated cognitive disturbance is linked to both viral activity and inflammatory and other mediators from these immune cells that lead to the damage associated with HIV-associated neurocognitive disorders, a general term given for these disturbances. We review the severity and prevalence of the neuropsychiatric complications of HIV including delirium, neurobehavioral impairments (depression), minor cognitive-motor dysfunction, and HIV-associated dementia.

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Section: Primary Psychiatric Conditions Associated With Cognitive Impmentioning

confidence: 99%

Cognitive impairment in patients with AIDS – prevalence and severity

Watkins¹,

Treisman²

2015

HIV

117

113

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“…HIV patients over age 50, regardless of duration of infection appear to be at greater risk for cognitive decline. Age and HIV seropositivity in general are predisposing factors for this altered mental status, which may be precipitated by normal aging, central nervous system infection, opportunistic infections, medications, fever, narcotics, benzodiazepines, and/or steroids (Uldall et al 2000a, b; Angelino and Treisman 2008). Older adults with HIV tend to generally have more progressive cognitive decline than younger HIV patients.…”

Section: Psychiatric Illnesses In Older Hiv Patientsmentioning

confidence: 99%

“…Delirium is traditionally associated with frail elderly patients and occurs frequently in patients with HIV/AIDS (Angelino and Treisman 2008). Hospitalized patients with HIV/AIDS often have high rates of delirium (Uldall et al 2000a, b; Uldall et al 2000a, b). One study found that 46 % of the AIDS patients at a skilled nursing facility had at least one episode of delirium (Uldall and Berghuis 1997).…”

Section: Psychiatric Illnesses In Older Hiv Patientsmentioning

confidence: 99%

Neuropsychiatric complications of aging with HIV

Watkins

Treisman

2012

J. Neurovirol.

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Persons over age 50 are not only aging with human immunodeficiency virus (HIV) infection but also represent a high proportion of new HIV infections. Neuropsychiatric symptoms, including depression, cognitive impairment, and substance abuse, are very common in individuals infected with HIV. However, there is little understanding of the relationship between these HIV-related comorbid conditions in newly infected elderly patients compared to uninfected elderly and those who have survived after 20 years of HIV/AIDS. We summarize the current theories and research that link aging and HIV with psychiatric illnesses and identify emerging areas for improved research, treatment, and patient care.

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“…The information that would most benefit healthcare providers is quantification of specific patient and hospital risk factors in well‐defined populations. We should not expect to find the same risk factors across groups of patients with acquired immunodeficiency syndrome, 27 older adults undergoing cardiac surgery, 15 terminally ill cancer patients, 28 and debilitated nursing home residents admitted to a medical ward. Not only do each these types of populations have measurably different demographic and physiological characteristics that probably contribute to the risk of delirium, they also experience widely different care plans in the hospital.…”

Section: Commentarymentioning

confidence: 99%

Delirium: Still Searching for Risk Factors and Effective Preventive Measures

Zeleznik

2001

J American Geriatrics Society

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BACKGROUND: Noting the outcomes of delirium reveals the importance of recognizing patients who are at the highest risk for delirium and developing prevention‐oriented systems of care. Outcomes found in prospective studies are falls,1 pressure ulcers,1 longer length of stay,1–5 long‐term cognitive deficits,2,6 and functional impairment.7–9 Many of these are used as indicators of quality geriatric care. The actual incidence rates of delirium depend on the characteristics of the cohort studied and whether it included all consecutive geriatric patients,1,10 emergency surgical patients,11–13 and elective surgery patients14–16 or specifically excluded patients with terminal illness2,7,17,18 or advanced dementia.4,16 Even for a given institution to determine its incidence rate is difficult. The frequency of use of the International Classification of Diseases, Ninth Revision, code for delirium at discharge is not an accurate measure because hospitals and physicians are not likely to use a code that does not add to hospital reimbursement under Medicare. Notably, there has never been a study of the cost of either the intensity of nursing care or additional diagnostic testing involved in the care of the delirious patient. Successful prevention depends on our ability to accurately identify those specific patients at risk for delirium and measure the relative contribution of the individual risk factors. This literature review addresses two systematic reviews by Cole et al., one on risk factors for delirium and the other on the effectiveness of preventive strategies. QUESTION: What are the risk factors for incident delirium in hospitalized geriatric patients? DATA SOURCES: A Medline search was performed using the terms “delirium,”“risk factors,” and “aged” for studies published in either French or English from 1966 through 1995. Current Contents and the bibliographies were also searched for relevant articles. STUDY SELECTION CRITERIA: One hundred one studies were identified in the search, of which 27 met the following inclusion criteria: prospective enrollment of patients age 50 and older, use of an accepted diagnostic criteria for delirium, and identification of at least one risk factor. No unpublished studies were included. DATA EXTRACTION: Each article was scored with an instrument specifically developed to assess validity of a study of risk factors. The criteria used were (1) adequate description of patient characteristics and recruitment process, (2) description of selection process of cases and controls, (3) adequate measure of and adjustment for confounding variables, (4) use of a systematic measure of risk factors, (5) blinded assessment of risk factors, (6) use of an operational definition of delirium, (7) adequate sample size, and (8) report of a measure of association with confidence intervals (CI). The mean quality score of the 27 studies was 9.3 out of total possible score of 16. A checklist was used to extract data from the articles. When original data were available in two or more studies, the unadjusted odds ra...

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Outcomes associated with delirium in acutely hospitalized acquired immune deficiency syndrome patients

Cited by 15 publications

References 18 publications

Cognitive impairment in patients with AIDS – prevalence and severity

Cognitive impairment in patients with AIDS – prevalence and severity

Neuropsychiatric complications of aging with HIV

Delirium: Still Searching for Risk Factors and Effective Preventive Measures

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Outcomes associated with delirium in acutely hospitalized acquired immune deficiency syndrome patients

Cited by 15 publications

References 18 publications

Cognitive impairment in patients with AIDS &ndash; prevalence and severity

Cognitive impairment in patients with AIDS &ndash; prevalence and severity

Neuropsychiatric complications of aging with HIV

Delirium: Still Searching for Risk Factors and Effective Preventive Measures

Contact Info

Product

Resources

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Cognitive impairment in patients with AIDS – prevalence and severity

Cognitive impairment in patients with AIDS – prevalence and severity