Postoperative delirium in Parkinson’s disease patients following deep brain stimulation surgery

Carlson, Jonathan D.; Neumiller, Joshua J.; Swain, Lindy D.W.; Mark, Jamie; McLeod, Pam; Hirschauer, Jeff

doi:10.1016/j.jocn.2013.12.007

Cited by 42 publications

(53 citation statements)

References 13 publications

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“…There may be a dynamic relationship between the two, where frailty may be a risk factor for delirium, but delirium may be associated with cognitive decline and impeded physical recovery . Longer duration in hospital for patients with delirium in this study is consistent with studies both in older adults and in PD . This has an implication for increased health care costs.…”

Section: Discussionsupporting

confidence: 83%

“…Parkinson patients with delirium were significantly older, frailer, and had a longer stay in hospital compared with those without delirium. Increased age has been shown to be a risk factor for delirium in previous studies in PD . However, the link between frailty and delirium is not understood.…”

Section: Discussionmentioning

confidence: 94%

“…Increased age has been shown to be a risk factor for delirium in previous studies in PD. 6 However, the link between frailty and delirium is not understood. There may be a dynamic relationship between the two, where frailty may be a risk factor for delirium, but delirium may be associated with cognitive decline and impeded physical recovery.…”

Section: Discussionmentioning

confidence: 99%

“…4 This variability is in part due to different operationalised criteria used to identify delirium, although in some studies, delirium was poorly defined or not at all. Additionally, delirium in PD may be associated with increased hospital stay compared with those without delirium, 6 worsening motor symptoms, cognitive decline, and mortality. 7 There are currently no studies reporting prevention or management of delirium in PD.…”

mentioning

confidence: 99%

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Identifying delirium in Parkinson disease: A pilot study

Lawson

Richardson

Yarnall

et al. 2020

Int J Geriat Psychiatry

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Introduction People with Parkinson disease (PD) may be at increased risk of delirium and associated adverse outcomes. Delirium is an acute neuropsychiatric syndrome defined by confusion and inattention and is common in older adults. Previous studies may have underestimated the prevalence of delirium in PD because of overlapping symptoms, lack of awareness, and poorly defined criteria. We aimed to identify the prevalence and incidence of delirium in inpatients with PD. Measurements Participants were inpatients with PD admitted over a 4‐month period. Delirium prevalence was classified using a standardised assessment at a single visit on the basis of the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM‐5) criteria. To capture remaining time in hospital, incident delirium was diagnosed using detailed clinical vignettes and a validated consensus method. Results Forty‐four PD patients consented to take part in the study, accounting for 53 admissions. Delirium prevalence was 34.0% (n = 18); reviewing participants over the duration of their hospital stay identified 30 (56.6%) incident delirium cases. The admitting team screened 24.5% for delirium, and delirium was documented in eight (14.8%) patients' medical notes. Patients with delirium were significantly older, had higher frailty scores, and had a longer hospital stay (P < .05 for all). Conclusions Delirium is common in PD inpatients at admission and incidence increases during hospital stay, but delirium is commonly missed. Our results highlight the importance of screening for delirium throughout patients' stay in hospital. Future studies should consider frequent evaluation over the duration of hospital stay to identify emergent delirium during the admission.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Identifying delirium in Parkinson disease: A pilot study

Lawson

Richardson

Yarnall

et al. 2020

Int J Geriat Psychiatry

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“…In addition, and while not specifically covered in this review, neurosurgical patients are at risk of adverse outcomes common to all surgical patients (e.g., myocardial infarction, acute kidney injury) that themselves are associated with poor long-term outcomes. 4,5 Going forward, the outcomes that matter most to our patients need to be better defined, standardized, and incorporated into clinical trials. In this review, we discuss the importance of a spectrum of outcomes in neuroanesthesia and propose both short-and long-term outcomes on which to focus future research.…”

Section: Résumémentioning

confidence: 99%

Outcomes in neuroanesthesia: What matters most?

Flexman

Meng

Gelb

2015

Can J Anesth/J Can Anesth

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General Anesthesia vs Local Anesthesia in Microelectrode Recording–Guided Deep-Brain Stimulation for Parkinson Disease

et al. 2021

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IMPORTANCE It is unknown if there is a difference in outcome in asleep vs awake deep brain stimulation (DBS) of the subthalamic nucleus for advanced Parkinson disease. OBJECTIVE To determine the difference in adverse effects concerning cognition, mood, and behavior between awake and asleep DBS favoring the asleep arm of the study. DESIGN, SETTING, AND PARTICIPANTS This study was a single-center prospective randomized open-label blinded end point clinical trial. A total of 187 persons with Parkinson disease were referred for DBS between May 2015 to March 2019. Analysis took place from January 2016 to January 2020. The primary outcome follow-up visit was conducted 6 months after DBS. INTERVENTIONS Bilateral subthalamic nucleus DBS was performed while the patient was asleep (under general anesthesia) in 1 study arm and awake in the other study arm. Both arms of the study used a frame-based intraoperative microelectrode recording technique to refine final target placement of the DBS lead. MAIN OUTCOMES AND MEASURESThe primary outcome variable was the between-group difference in cognitive, mood, and behavioral adverse effects as measured by a composite score. The secondary outcomes included the Movement Disorders Society Unified Parkinson's Disease Rating Scale, the patient assessment of surgical burden and operative time.RESULTS A total of 110 patients were randomized to awake (local anesthesia; n = 56; mean [SD] age, 60.0 (7.4) years; 40 [71%] male) or to asleep (general anesthesia; n = 54; mean [SD] age, 61.3 [7.9] years; 38 [70%] male) DBS surgery. The 6-month follow-up visit was completed by 103 participants. The proportion of patients with adverse cognitive, mood, and behavioral effects on the composite score was 15 of 52 (29%) after awake and 11 of 51 (22%) after asleep DBS (odds ratio, 0.7 [95% CI, 0.3-1.7]). There was no difference in improvement in the off-medication Movement Disorders Society Unified Parkinson's Disease Rating Scale Motor Examination scores between groups (awake group: mean [SD], points; asleep group: mean [SD], points; mean difference, −2.0 [95% CI, −8.1 to 4.2]). Asleep surgery was experienced as less burdensome by patients and was 26 minutes shorter than awake surgery. CONCLUSIONS AND RELEVANCEThere was no difference in the primary outcome of asleep vs awake DBS. Future large randomized clinical trials should examine some of the newer asleep based DBS technologies because this study was limited to frame-based microelectrodeguided procedures.

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Postoperative delirium in Parkinson’s disease patients following deep brain stimulation surgery

Cited by 42 publications

References 13 publications

Identifying delirium in Parkinson disease: A pilot study

Identifying delirium in Parkinson disease: A pilot study

Outcomes in neuroanesthesia: What matters most?

General Anesthesia vs Local Anesthesia in Microelectrode Recording–Guided Deep-Brain Stimulation for Parkinson Disease

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