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Institute
for Aging Research study finds delirium
presentation predicts mortality
(Boston, Mass)—The way certain patients present in the
post-acute hospital setting with delirium, a
common, preventable but life-threatening
acute confusional state, predicts mortality,
according to a study conducted by the
Institute for Aging Research of Hebrew
SeniorLife.
Patients with severe, hypoactive delirium, characterized by
slowing or lack of movement and
unresponsiveness, have the worst six-month
survival rate of any class of the disease.
Those with mild, hypoactive delirium have a significantly
higher likelihood of dying than patients
with other, milder symptoms.
"The association of the delirium classes on mortality
depends on the presence or absence of
dementia," says lead author Frances Yang,
Ph.D., an assistant scientist at the
Institute for Aging Research and an
instructor in psychiatry at Brigham and
Women's Hospital and Harvard Medical School.
"Among patients who did not have dementia, it was delirium
severity rather than motoric subtype that
was associated with higher risk of mortality
at six months."
The study, published in the May/June issue of the journal
Psychosomatics, is the first to link
characteristics of delirium, called
subtypes, with disease severity.
The four subtypes of delirium are normal, hypoactive,
hyperactive (symptoms range from mild
restlessness to constant movement and
agitation) and mixed, which combines both
hypo- and hyperactive elements.
Using two standard assessment tools, researchers at the
Institute's Aging Brain Center examined
whether the classic psychomotor subtypes of
delirium are reflected by delirium severity.
In addition, they sought to determine if the subtypes were
able to predict mortality.
Dr. Yang's co-author, Edward Marcantonio, M.D., an
associate professor of medicine at Beth
Israel Deaconess Medical Center and Harvard
Medical School, and colleagues screened more
than 4,000 patients at eight Boston-area
skilled nursing facilities using the
Confusion Assessment Method and the Memorial
Delirium Assessment Scale, two standard
tools to detect delirium. More than 400 of
these patients were found to have delirium
and were followed over six months.
Delirium is an acute and relatively sudden—over hours or
days—decline in attention, perception and
cognition.
It is generally caused by severe physical illness, often in
the elderly, or any process that interferes
with the normal metabolism and function of
the brain.
An estimated 14 percent to 24 percent of patients admitted
to the hospital suffer from episodes of
delirium. A recent study by Aging Brain
Center investigators found that delirium
rapidly accelerates memory decline in
Alzheimer's disease patients.
"Our data reinforce the need to systematically assess
patients for delirium at post-acute care
admission, while considering dementia
status," says Dr. Yang.
"The findings demonstrate the importance of examining
psychomotor subtype and the severity of
delirium in predicting mortality."
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