Identifying delirium in Parkinson disease: A pilot study

Abstract

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.

Frailty in Parkinson’s disease: A systematic review and meta-analysis

“…The majority (25/30) enrolled community-dwelling participants and 5 enrolled inpatients. [13] , [14] , [15] , [16] Study sizes ranged from 8 to 5,308 participants with PD. Sixteen studies were set in Europe, 6 in North America, 6 in Asia, 1 in Australia and 1 was a multisite international study.…”

“…Fifteen studies employed the frailty phenotype method [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] and 9 studies employed the clinical frailty scale [13] , [14] , [15] , [31] , [32] , [33] , [34] , [35] , [36] . Four studies employed the frailty index, or cumulative deficit model [19] , [27] , [37] , [38] .…”

“…In a Taiwanese study of 76 patients with PD, frailty phenotype was associated with worse scores on neuropsychological assessments of attention, executive function, memory, speech, language, and visuospatial function [25] . A U.K. inpatient study found that PD patients who developed delirium were more likely to be frail [14] .…”

A Pragmatic Approach to the Perioperative Management of Parkinson’s Disease

“…59 Delirium has an association with length of hospitalization, motor severity of PD, and older age. 59,60 A study that investigated the non-motor correlates of postoperative delirium in PD patients undergoing spinal surgeries reported hyposmia and rapid eye movement sleep behavior disorder (RBD) as independent risk factors for delirium. 61 As delirium can substantially worsen the overall outcome of PD patients, it needs effective prevention strategies (described in the preoperative section) and prompt management.…”

Analysis of the Incidence and Risk factors of Postoperative Delirium in Patients with Degenerative Cervical Myelopathy

“…7,8 A few studies on POD after spinal surgery have been conducted and identi ed various associated factors, including age, baseline comorbidities, preoperative cognition, neurological diseases, and operation duration. [9][10][11][12] However, these studies included all spinal surgery patients with no consideration for factors related to the prevalence of delirium, whose occurrence varies according to the type and method of spinal surgery. Thus, these studies provide no descriptions of whether the degree of delirium would vary according to the severity of the disease, the surgical levels, or the speci c surgical method.…”