Advanced Age Is Associated With Catatonia in Critical Illness: Results From the Delirium and Catatonia Prospective Cohort Investigation.

Jennifer Connell,Nathan E Brummel,Robert S Dittus,Pratik Pandharipande,Jo Ellen Wilson,Stephan Heckers,E Wes Ely,Mayur B Patel,Simon N Vandekar,Ahra Kim

doi:10.3389/fpsyt.2021.673166

Abstract

Introduction: Catatonia, characterized by motor, behavioral and affective abnormalities, frequently co-occurs with delirium during critical illness. Advanced age is a known risk factor for development of delirium. However, the association between age and catatonia has not been described. We aim to describe the occurrence of catatonia, delirium, and coma by age group in a critically ill, adult population.Design: Convenience cohort, nested within two clinical trials and two observational cohort studies.Setting: Intensive care units in an academic medical center in Nashville, TN.Patients: 378 critically ill adult patients on mechanical ventilation and/or vasopressors.Measurements and Main Results: Patients were assessed for catatonia, delirium, and coma by independent and blinded personnel, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method for the Intensive Care Unit (ICU) and the Richmond Agitation and Sedation Scale. Of 378 patients, 23% met diagnostic criteria for catatonia, 66% experienced delirium, and 52% experienced coma during the period of observation. There was no relationship found between age and catatonia severity or age and presence of specific catatonia items. The prevalence of catatonia was strongly associated with age in the setting of critical illness (p < 0.05). Delirium and comas' association with age was limited to the setting of catatonia.Conclusion: Given the significant relationship between age and catatonia independent of coma and delirium status, these data demonstrate catatonia's association with advanced age in the setting of critical illness. Future studies can explore the causative factors for this association and further elucidate the risk factors for acute brain dysfunction across the age spectrum.

Highlights

Catatonia, characterized by motor, behavioral and affective abnormalities, frequently co-occurs with delirium during critical illness
In this study we aim to understand whether the occurrence of catatonia, delirium and coma differ by age group in a critically ill adult population
Patients were separated into quartiles of age: 18–46 (N = 90), >46–58 (N = 99), >58–66 (N = 90), and > 66 years (N = 99)

Summary

Introduction

Catatonia, characterized by motor, behavioral and affective abnormalities, frequently co-occurs with delirium during critical illness. A psychomotor syndrome with motor, behavioral and affective abnormalities, was previously thought to represent a subtype of schizophrenia [1]. It is more likely a sign of other clinical diagnoses, including mood disorders, medical including neurologic conditions, and critical illness. Predisposing risk factors for the development of catatonia are not well-described, but may include genetic variants relating to neuronal structure as well as alterations in activation and connectivity of cerebral motor circuits [7]. Much work is still needed to study this topic more substantially

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