Frequency Of Delirium In Patients Research Articles

Inpatient Delirium in Guillain-Barré Syndrome: Frequency and Clinical Characteristics in a Mexican Hospital

BackgroundDelirium has a prevalence of 14%-56% in hospitalized patients. Risk factors include advanced age, invasive mechanical ventilation (IMV), and prolonged intensive care unit stay. Neuropsychiatric symptoms have been reported to be related to autoimmune responses secondary to Guillain-Barré syndrome (GBS) with direct involvement of the central nervous system (CNS) or to delirium. There are few reports of the frequency of delirium in patients with Guillain-Barré syndrome (GBS).ObjectiveTo describe the frequency of and the characteristics associated with delirium in patients with GBS.Material and methodsA single-center, cross-sectional study was conducted in patients with GBS diagnosis between 2015 and 2019. The diagnosis of delirium was made using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. We compared patients with and without delirium. We performed both univariate and multivariate analyses to identify factors associated with delirium.ResultsA total of 154 patients with GBS were included, of which 20 (12.9%) fulfilled the DSM-5 criteria for delirium. The mean age was 48 ± 18.2 years, the median Medical Research Council (MRC) sum score was 29.3 ± 21.9 points, 65% had bulbar cranial nerve involvement, 80% presented autonomic dysfunction, 85% had ICU stay, and 90% had mechanical ventilation requirement. In the multivariate analysis, the following were the independent factors for the development of delirium: age ≥ 60 (odds ratio (OR): 5.7; 95% confidence interval (CI): 1.3-23.5), time from symptom onset to admission ≤ 3 days (OR: 4.3; 95% CI: 1.1-16.8), autonomic dysfunction (OR: 13.1; 95% CI: 3-56), and intensive care unit stay (OR: 9.5; 95% CI: 2.1-42.6).ConclusionDelirium is not frequent in patients with Guillain-Barré syndrome. Patients with advanced age, rapid motor progression, bulbar cranial nerve involvement, prolonged intensive care unit stay, and mechanical ventilation need are more likely to present delirium.

Does nicotine replacement therapy affect the frequency of delirium in patients after isolated myocardial revascularization?

Aim. Among cardiac patients, active smokers are not a rarity. Smoking causes a strong addiction and smoking cessation leads to the development of a withdrawal syndrome. Due to forced smoking cessation before surgery, nicotine abstinence may become one of the reasons for the development of delirium in the immediate postoperative period. The study was designed to assess the efficacy of nicotine replacement therapy in the prevention of delirium in smoking patients after isolated myocardial revascularization surgery. Methods. From January 2014 to December 2014, 968 patients underwent isolated myocardial revascularization. Four hundred and twenty-eight of the above patients with the length of smoking of more than 10 years were included in the study. Nicotine replacement therapy in the smoking patients consisted of two sequential applications of nicotine patches. The first application was put in the operating room before induction into anesthesia, the second one—after 16 hours in the intensive care unit. The control group of smoking patients, in whom nicotine replacement therapy was not implemented, was formed by the selection method according to the match index with the first group. To form the group, the following criteria were used: sex, age, body mass index, length of smoking, EuroSCORE, left ventricular ejection fraction, concomitant diseases, off-pump coronary artery bypass grafting.Results. In the immediate postoperative period the patients of both groups had episodes of delirium and agitation. Delirium developed less frequently in the group of patients receiving nicotine replacement therapy (34.7% vs 55.1%, p = 0.05). The average time of mechanical ventilation for patients with nicotine replacement therapy (3 h 35 min) was less than that for patients without nicotine replacement therapy (4 h 10 min). At the same time the groups did not differ from each other by the duration of their stay in intensive care unit, which was only one day.Conclusion. Since smoking is a risk factor for the development of delirium, implementation of nicotine replacement therapy in smoking patients who underwent isolated myocardial revascularization can reduce not only the frequency of delirium in the early postoperative period, but also the duration of the ventilator support and the percentage of complications associated with it. Received 10 August 2017. Revised 13 December 2017. Accepted 25 December 2017. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: M.E. Evdokimov, A.A. Gornostaev, V.V. BazylevData collection and analysis: M.E. Evdokimov, A.A. Gornostaev, A.A. Schegolkov, A.V. Bulygin, E.A. Malyarova Statistical data analysis: A.A. Schegolkov, A.V. BulyginDrafting the article: I.S. Fomina, A.A. Schegolkov, A.V. Bulygin, E.A. MalyarovaCritical revision of the article: M.E. Evdokimov, A.A. Gornostaev, V.V. Bazylev Final approval of the version to be published: V.V. Bazylev, M.E. Evdokimov, A.A. Gornostaev, I.S. Fomina, A.A. Schegolkov, A.V. Bulygin, E.A. Malyarova

Prevalence of delirium among outpatients with dementia

Delirium and dementia are highly interrelated. However, few comprehensive epidemiological studies have examined this altered state of consciousness superimposed on dementia. We investigated the frequency of delirium in patients with dementia, its prevalence in patients with each dementia type, and its association with cerebrovascular disease (CVD) in patients with neurodegenerative dementias. We studied 261 consecutive outpatients in the memory clinic of a psychiatric hospital between April 2010 and September 2011. All patients underwent routine laboratory tests and computed tomography (CT), and their Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Physical Self-Maintenance Scale (PSMS), and Delirium Rating Scale - Revised 98 scores were recorded. The diagnosis of delirium was based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. CVD was detected by CT. Among the 206 patients with dementia, delirium was present in 40 (19.4%). The proportion of patients who experienced episodes of delirium was 14.7% in the Alzheimer's disease, 34.4% in the vascular dementia, 31.8% in the dementia with Lewy bodies, and none in frontotemporal lobar degeneration. Delirium was frequently observed in patients with dementia and CVD. The NPI total and agitation subscale scores were significantly higher in dementia patients with delirium than in those without delirium. PSMS scores were significantly lower for patients with delirium than for patients without delirium. The frequency of delirium varies with each dementia type. In addition, delirium decreases activities of daily living, exaggerates behavioral and psychological symptoms dementia, and is associated with CVD in patients with neurodegenerative dementias.