Advancing specificity in delirium: The delirium subtyping initiative

Alzheimer s & Dementia, Journal Year: 2023, Volume and Issue: 20(1), P. 183 - 194

Published: July 31, 2023

Delirium, a common syndrome with heterogeneous etiologies and clinical presentations, is associated poor long-term outcomes. Recording analyzing all delirium equally could be hindering the field's understanding of pathophysiology identification targeted treatments. Current subtyping methods reflect clinically evident features but likely do not account for underlying biology.

Language: Английский

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Persistierende Funktionsstörungen nach Delir

DNP – Die Neurologie & Psychiatrie, Journal Year: 2025, Volume and Issue: 26(2), P. 42 - 46

Published: April 1, 2025

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Delirium detection in the emergency department: A diagnostic accuracy meta‐analysis of history, physical examination, laboratory tests, and screening instruments

Academic Emergency Medicine, Journal Year: 2024, Volume and Issue: 31(10), P. 1014 - 1036

Published: May 16, 2024

Abstract Introduction Geriatric emergency department (ED) guidelines emphasize timely identification of delirium. This article updates previous diagnostic accuracy systematic reviews history, physical examination, laboratory testing, and ED screening instruments for the diagnosis delirium as well test–treatment thresholds screening. Methods We conducted a review to quantify approaches identify Studies were included if they described adults aged 60 or older evaluated in setting with an index test compared acceptable criterion standard Data extracted studies reviewed risk bias. When appropriate, we meta‐analysis estimated thresholds. Results Full‐text was performed on 55 27 current analysis. No identified exploring findings history While two reported clinicians accurately rule delirium, clinician gestalt is inadequate out report three that quantified 4 A's Test (4AT) (pooled positive likelihood ratio [LR+] 7.5, 95% confidence interval [CI] 2.7–20.7) negative [LR−] 0.18, CI 0.09–0.34) also Abbreviated Mental Test‐4 (AMT‐4) found pooled LR+ (4.3, 2.4–7.8) lower than observed 4AT, but LR− (0.22, 0.05–1) similar. Based one study Confusion Assessment Method Intensive Care Unit (CAM‐ICU) superior instrument The calculated threshold 2% treatment 11%. Conclusions quantitative examination virtually unexplored. 4AT has largest quantity ED‐based research. Other may more If goal then CAM‐ICU brief CAM modified are instruments, although these tools based single‐center studies. To Delirium Triage Screen study.

Language: Английский

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Assessment and report of individual symptoms in studies of delirium in postoperative populations: a systematic review

Age and Ageing, Journal Year: 2024, Volume and Issue: 53(4)

Published: April 1, 2024

Abstract Objectives Delirium is most often reported as present or absent. Patients with symptoms falling short of the diagnostic criteria for delirium fall into ‘no delirium’ ‘control’ groups. This binary classification neglects individual and may be hindering identification pathophysiology underlying delirium. systematic review investigates which are by studies postoperative in adults. Methods Medline, EMBASE Web Science databases were searched on 03 June 2021 06 April 2023. Two reviewers independently examined titles abstracts. Each paper was screened duplicate conflicting decisions settled consensus discussion. Data extracted, qualitatively synthesised narratively reported. All included quality assessed. Results These searches yielded 4,367 results. After title abstract screening, 694 full-text reviewed, 62 deemed eligible inclusion. details 11,377 patients including 2,049 In total, 78 differently described The inattention (N = 29), disorientation 27), psychomotor agitation/retardation 22), hallucination 22) memory impairment 18). Notably, agitation hallucinations not listed current Diagnostic Statistical Manual Mental Disorders-5-Text Revision definition. Conclusions this cover domains attention, awareness, other cognitive changes. There a lack standardisation terms, many recorded synonyms each other. provides library symptoms, used to inform future reporting.

Language: Английский

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Neurophysiological patterns reflecting vulnerability to delirium subtypes: a resting-state EEG and event-related potential study

Brain Communications, Journal Year: 2024, Volume and Issue: 6(5)

Published: Jan. 1, 2024

Abstract Delirium is a common and acute neurocognitive disorder in older adults associated with increased risk of dementia death. Understanding the interaction between brain vulnerability stressors key to delirium pathophysiology, but neurophysiology not well defined. This study aimed identify pre-operative resting-state EEG event-related potential markers incident its subtypes undergoing elective cardiac procedures. prospective observational included 58 participants (mean age = 75.6 years, SD 7.1; 46 male/12 female); COVID-19 restrictions limited recruitment. Baseline assessments were conducted weeks before procedures 4-min recording (2-min eyes open 2-min closed), 5-min frequency auditory oddball paradigm recording, cognitive depression examinations. Periodic peak power, bandwidth measures, aperiodic offsets exponents derived from data. Event-related potentials measured as mean component amplitudes (first positive component, first negative early third mismatch negativity) following standard deviant stimuli. Incident occurred 21 participants: 10 hypoactive, 6 mixed, 5 hyperactive. hyperactive was higher (P 0.045, d 1.0) closed 0.036, offsets. mixed significantly larger deviants 0.037, standards 0.025, 0.041, 0.9). Other statistically non-significant moderate-to-large effects observed relation all subtypes. We report evidence neurophysiological prior adults. Despite being underpowered due COVID-19–related recruitment impacts, these findings indicate dysfunction neural excitation/inhibition balance different warrant further investigation on scale.

Language: Английский

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Pharmacologic Treatment Strategies for Delirium in Hospitalized Adults: Past, Present, and Future

Seminars in Neurology, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 23, 2024

Despite the use of multidomain prevention strategies, delirium still frequently occurs in hospitalized adults. With often associated with undesirable symptoms and deleterious outcomes, including cognitive decline, treatment is important. Risk-factor reduction protocolized multidomain, nonpharmacologic bundles remain mainstay treatment. There a current lack strong evidence to suggest any pharmacologic intervention treat will help resolve it faster, reduce its (other than agitation), facilitate hospital throughput, or improve post-hospital outcomes long-term function. exception dexmedetomidine as severe delirium-associated agitation ICU, practice guidelines do not recommend routine population. Future research should focus on identifying evaluating new interventions addressing key challenges gaps surrounding research.

Language: Английский

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Face and content validity of a mobile delirium screening tool adapted for use in the medical setting (eDIS‐MED): Welcome to the machine

Australasian Journal on Ageing, Journal Year: 2024, Volume and Issue: 43(2), P. 415 - 419

Published: Feb. 28, 2024

Abstract Objectives Following a user‐centred redesign and refinement process of an electronic delirium screening tool (eDIS‐MED), further accuracy assessment was performed prior to anticipated testing in the clinical setting. Methods Content validity each existing questions evaluated by expert group domains clarity, relevance importance. Questions with Validity Index (CVI) <0.80 were reviewed development for potential revision. Items CVI <0.70 discarded. Next, face entirety tests conducted readability measured. Results A panel five experts test battery comprising eDIS‐MED. The content endorsed 61 items. overall scale 0.92. Eighty‐eight per cent responses regard question relevancy, usefulness appropriateness positive. deemed fifth grade level very easy read. Conclusions revised shown be accurate according group. validation study is planned.

Language: Английский

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From Traditional Typing to Intelligent Insights: A Narrative Review of Directions Toward Targeted Therapies in Delirium

Critical Care Medicine, Journal Year: 2024, Volume and Issue: 52(8), P. 1285 - 1294

Published: July 15, 2024

Delirium is a heterogeneous syndrome characterized by an acute change in level of consciousness that associated with inattention and disorganized thinking. affects most critically ill patients poor patient-oriented outcomes such as increased mortality, longer ICU hospital length stay, worse long-term cognitive outcomes. The concept delirium its subtypes has existed since nearly the beginning recorded medical literature, yet robust therapies have to be identified. Analogous other critical illness syndromes, we suspect lack identified stems from patient heterogeneity prior subtyping efforts do not capture underlying etiology delirium. time come leverage machine learning approaches, supervised unsupervised clustering, identify clinical pathophysiological distinct clusters will likely respond differently various interventions. We use sedation example how precision can applied patients, highlighting fact while for some sedative drug may cause delirium, another cohort specific treatment. Finally, conclude proposition move away term rather focus on treatable traits allow tested.

Language: Английский

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Perioperative Management and Its Impact on Neurocognitive Disorders in the Postoperative Scenario

Springer eBooks, Journal Year: 2024, Volume and Issue: unknown, P. 1 - 28

Published: Jan. 1, 2024

Language: Английский

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Psychiatric Etiologies and Approaches in Altered Mental Status Presentations: Insights from Consultation Liaison Psychiatry

Seminars in Neurology, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 3, 2024

Consultation liaison psychiatrists are frequently asked to evaluate patients with altered mental status (AMS). Psychiatrists have unique perspectives and approaches care for confused patients, particularly optimizing facilitation of maintaining vigilance diagnostic overshadowing. also offer expertise in primary psychiatric illnesses that can overlap AMS, the most common etiology AMS is delirium. In this article, we provide a consultation psychiatrist perspective on related conditions addition Manic psychotic episodes secondary etiologies, some symptoms Catatonia, neuroleptic malignant syndrome, serotonin syndrome potentially fatal emergencies, require prompt index suspicion optimize clinical outcomes. Trauma sequelae, functional neurologic disorders, dissociative disorders present as puzzling cases care. Additionally, sometimes due substance intoxication withdrawal hospital. A nonstigmatizing approach evaluation management delirium ensure optimal patient experiences

Language: Английский

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