Prognostic Significance of Delirium in Frail Older People

Pitkälä, Kaisu; Laurila, Jouko; Strandberg, Timo; Tilvis, Reijo S.

doi:10.1159/000082888

Cited by 133 publications

(87 citation statements)

References 49 publications

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“…However, the mean MMSE scores for CPS levels 2, 3, and 4 were similar (15 AE 7, 14 AE 6, 14 AE 8, respectively). These findings, based on descriptive analyses, were confirmed by ANOVA, showing an overall significant difference of mean MMSE score on levels of CPS score, (F [6,90] ¼ 14.3, p <0.0001). Posthoc testing revealed that the mean of the group with CPS score 0 was not significantly different from the mean of the group with CPS score 1, but significant differences in means were observed with the groups with CPS scores 2e6.…”

Section: Convergent Validity Of the Cps And Mmsesupporting

confidence: 54%

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Wellens

Flamaing

Tournoy

et al. 2013

The American Journal of Geriatric Psychiatry

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Objective: The Cognitive Performance Scale (CPS) is generated from five items of the interRAI/ Minimum Data Set instruments, a comprehensive geriatric assessment method. CPS was initially designed to assess cognition in residential care, where it has shown good psychometric performance. We evaluated the performance of the interRAI Acute Care in identifying cognitive impairment among patients hospitalized on acute geriatric wards. Methods: An observational study was conducted on two geriatric wards. Trained raters independently completed the interRAI Acute Care and the Mini-Mental State Examination (MMSE) in 97 inpatients (85 AE 5 years; 67% female). The level of agreement between CPS and MMSE was explored using comparisons of means, agreement coefficients, and diagnostic accuracy. Results: Cognitive impairment was present in 61% of the participants. Average MMSE scores were significantly different between groups with low CPS scores compared with those with high CPS scores (p <0.05). CPS explained only 48.8% of the variability in MMSE. Agreement in defining cognitively impaired subjects was moderate (percentage observed agreement, 68%; k ¼ 0.41). With MMSE score less than 24 as a gold standard, diagnostic accuracy of CPS was moderate (area under curve ¼ 0.73), with low sensitivity, but excellent specificity. When lowering the MMSE cutoff to less than 18 and focusing on patients with severe cognitive impairment, CPS agreement coefficients and sensitivity increased but specificity decreased. Using education-adjusted MMSE cutoffs did not substantially affect the results. Conclusion: CPS can be used for coarse triage between intact and severe cognitive impairment. Although promising results have been obtained in residential and community settings, our results suggest that CPS fails to differentiate across different levels of cognitive impairment in hospitalized geriatric patients. (Am J Geriatr Psychiatry 2013; 21:636e645)

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Section: Convergent Validity Of the Cps And Mmsesupporting

confidence: 54%

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Wellens

Flamaing

Tournoy

et al. 2013

The American Journal of Geriatric Psychiatry

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“…Delirium is a transient disorder of cognition and attention and is a common consequence of systemic infection in the elderly and demented (Elie et al, 1998). Episodes of delirium significantly increase the risk of dementia (Rockwood et al, 1999), shorten the time to permanent institutionalization (Pitkala et al, 2005), and are associated with long-term functional decline (Murray et al, 1993) and increased mortality (Rockwood et al, 1999). There is also epidemiological and clinical evidence that infections accelerate the progression of AD (Holmes et al, 2003;Dunn et al, 2005).…”

Section: Mechanisms and Implicationsmentioning

confidence: 99%

Central and Systemic Endotoxin Challenges Exacerbate the Local Inflammatory Response and Increase Neuronal Death during Chronic Neurodegeneration

Cunningham¹,

Wilcockson²,

Campion³

et al. 2005

J. Neurosci.

653

575

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The contribution of inflammation to the progression of neurodegenerative diseases such as Alzheimer's, Parkinson's, and prion diseases is poorly understood. Brain inflammation in animal models of these diseases is dominated by chronic microglial activation with minimal proinflammatory cytokine expression. However, these inflammatory cells are "primed" to produce exaggerated inflammatory responses to subsequent lipopolysaccharide (LPS) challenges. We show that, using the ME7 model of prion disease, intracerebral challenge with LPS results in dramatic interleukin-1␤ (IL-1␤) expression, neutrophil infiltration, and inducible nitric oxide synthase expression in the brain parenchyma of prion-diseased mice compared with the same challenge in normal mice. Systemic inflammation evoked by LPS also produced greater increases in proinflammatory cytokines, pentraxin 3, and inducible nitric oxide synthase transcription in priondiseased mice than in control mice and induced microglial expression of IL-1␤. These systemic challenges also increased neuronal apoptosis in the brains of ME7 animals. Thus, both central and peripheral inflammation can exacerbate local brain inflammation and neuronal death. The finding that a single acute systemic inflammatory event can induce neuronal death in the CNS has implications for therapy in neurodegenerative diseases.

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“…3 Moreover, from one-third to half of older adults discharged from hospitals failed to have their delirium symptoms identified or recognized. 4,5 It is well documented that patients with delirium have a greater risk of developing frailty and irreversible cognitive impairment, being institutionalized and premature death. [6][7][8] The literature shows that nonpharmacological nursing strategies are recommended as the gold standard for the prevention of delirium.…”

Section: Introductionmentioning

confidence: 99%

An observational study of community health care nurses’ knowledge about delirium

Akrour¹,

Verloo²

2017

NRR

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Background: Early detection of delirium among home-dwelling older patients is a substantial challenge for home health care providers. Despite an abundance of literature, recent studies still describe a widespread lack of knowledge about delirium and its underdetection in all types of health care settings. Aims and objectives: This study aimed to assess the knowledge of community health care nurses (CHNs) about delirium in the Switzerland's French-speaking region. Methods: A cross-sectional observational study involving 75 CHNs was conducted between February and July 2015. Data were collected using an autoadministered questionnaire based on the study by Malenfant and Voyer, exploring theoretical knowledge of delirium and its detection using clinical vignette case studies. Outcomes were analyzed using descriptive statistics. Results: Forty-eight CHNs participated in the study; nearly all of them (44; 94%) selected the correct definition of delirium, and most (36; 78%) knew its four principal diagnostic criteria. Only 16 (34%) participants selected the confusion assessment method (CAM) as the recommended best practice delirium detection tool. Only 19 (40%) and 23 (49%) participants were able to correctly identify hypoactive and hyperactive delirium, respectively, from the clinical vignette case studies. The average score of CHNs on the Malenfant and Voyer's questionnaire was 12.7 (SD 3.2). Conclusion: Participants showed moderate-to-low knowledge about delirium. The study identified a lack of knowledge on how to recognize the signs and symptoms of delirium and the absence of suitable delirium detection tools.

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Prognostic Significance of Delirium in Frail Older People

Cited by 133 publications

References 49 publications

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Central and Systemic Endotoxin Challenges Exacerbate the Local Inflammatory Response and Increase Neuronal Death during Chronic Neurodegeneration

An observational study of community health care nurses’ knowledge about delirium

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Prognostic Significance of Delirium in Frail Older People

Cited by 133 publications

References 49 publications

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Convergent Validity of the Cognitive Performance Scale of the interRAI Acute Care and the Mini-Mental State Examination

Central and Systemic Endotoxin Challenges Exacerbate the Local Inflammatory Response and Increase Neuronal Death during Chronic Neurodegeneration

An observational study of community health care nurses&rsquo; knowledge about delirium

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An observational study of community health care nurses’ knowledge about delirium