Abstract
Delirium is a common neurocognitive disorder in hospital settings, characterised by fluctuating impairments in attention and arousal following an acute precipitant. Electroencephalography (EEG) is a useful method to understand delirium pathophysiology. We performed a systematic review to investigate associations between delirium and EEG measures recorded prior, during, and after delirium. A total of 1,655 articles were identified using PsycINFO, Embase and MEDLINE, 31 of which satisfied inclusion criteria. Methodological quality assessment was undertaken, resulting in a mean quality score of 4 out of a maximum of 5. Qualitative synthesis revealed EEG slowing and reduced functional connectivity discriminated between those with and without delirium (i.e. EEG during delirium); the opposite pattern was apparent in children, with cortical hyperexcitability. EEG appears to have utility in differentiating those with and without delirium, but delirium vulnerability and the long-term effects on brain function require further investigation. Findings provide empirical support for the theory that delirium is a disorder of reduced functional brain integration.
Highlights
Delirium is a neurocognitive disorder characterised by an acute and fluctuating disturbance in attention, awareness, and cognition due to a physiological condition (American Psychiatric Association, 2013)
1598 unique articles were screened, with 31 articles eventually included. Key characteristics of these papers, including delirium and EEG measures and sample sizes are provided in Tables 1–3, summarised relative to the timepoint that EEG was measured
Searches were conducted in PsychINFO, MEDLINE and Embase on the 9th of January 2019, using the terms: (EEG OR PSG OR electroencephalography OR polysomnography OR ‘‘evoked potential” OR ‘‘evoked-potential” OR event related potentials (ERPs) OR ‘‘event-related potential” OR ‘‘event related potential”) AND deliri*
Summary
Delirium is a neurocognitive disorder characterised by an acute and fluctuating disturbance in attention, awareness, and cognition due to a physiological condition (American Psychiatric Association, 2013). Delirium is commonly observed in acute care settings and is most prevalent in older adults. One in four older adults develop delirium after a cardiac procedure (Tilley et al, 2018; Greaves et al, 2019), and approximately 15% in general hospital settings (Welch et al, 2019). Delirium is associated with serious outcomes including cognitive decline (Bickel et al, 2008; Davis et al, 2017), higher mortality (Kiely et al, 2009), and incident dementia (Davis et al, 2012). How EEG measures associate with delirium across these time-points are the focus of this review (see Fig. 1)
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