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Delirium etiology subtypes and their effect on six-month function and cognition in older emergency department patients

Published online by Cambridge University Press:  19 July 2018

Jamie Cirbus ,
Alasdair M. J. MacLullich ,
Christopher Noel ,
E. Wesley Ely ,
Rameela Chandrasekhar  and
Jin H. Han
Jamie Cirbus
Affiliation:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Alasdair M. J. MacLullich
Affiliation:
Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
Christopher Noel
Affiliation:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
E. Wesley Ely
Affiliation:
Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, Tennessee, USA Center for Quality Aging, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Rameela Chandrasekhar
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Jin H. Han*
Affiliation:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care Center, Nashville, Tennessee, USA Center for Quality Aging, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA
*
Correspondence should be addressed to: Jin H. Han, MD, Vanderbilt University Medical Center, Department of Emergency Medicine, 703 Oxford House, Nashville, Tennessee 37232-4700, USA. Phone: +615-936-0087; Fax: +615-936-1316. Email: Jin.h.han@vanderbilt.edu.
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Abstract

Background:

Delirium is heterogeneous and can vary by etiology.

Objectives:

We sought to determine how delirium subtyped by etiology affected six-month function and cognition.

Design:

Prospective cohort study.

Setting:

Tertiary care, academic medical center.

Participants:

A total of 228 hospitalized patients > 65 years old were admitted from the emergency department (ED).

Measurements:

The modified Brief Confusion Assessment Method was used to determine delirium in the ED. Delirium etiology was determined by three trained physician reviewers using a Delirium Etiology checklist. Pre-illness and six-month function and cognition were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire and the short-form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Multiple linear regression was performed to determine if delirium etiology subtypes were associated with six-month function and cognition adjusted for baseline OARS ADL and IQCODE. Two-factor interactions were incorporated to determine pre-illness function or cognition-modified relationships between delirium subtypes and six-month function and cognition.

Results:

In patients with poorer pre-illness function only, delirium secondary to metabolic disturbance (β coefficient = −2.9 points, 95%CI: −0.3 to −5.6) and organ dysfunction (β coefficient = −4.3 points, 95%CI: −7.2 to −1.4) was significantly associated with poorer six-month function. In patients with intact cognition only, delirium secondary to central nervous system insults was significantly associated with poorer cognition (β coefficient = 0.69, 95%CI: 0.19 to 1.20).

Conclusions:

Delirium is heterogeneous and different etiologies may have different prognostic implications. Furthermore, the effect of these delirium etiologies on outcome may be dependent on the patient's pre-illness functional status and cognition.

Keywords

deliriumetiologysubtypeslong-term functionlong-term cognition
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 2: Issue Theme: Positive Psychiatry II , February 2019 , pp. 267 - 276
Copyright
Copyright © International Psychogeriatric Association 2018 

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Footnotes

This abstract was presented at the Society of Academic Emergency Medicine 2017 Annual Meeting at Orlando, FL.

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