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2450 Delirium and catatonia: Age matters

Published online by Cambridge University Press:  21 November 2018

Jo E. Wilson
Affiliation:
Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
Richard Carlson
Affiliation:
Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
Maria C. Duggan
Affiliation:
Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, USA Veteran’s Affairs TN Valley, Geriatrics Research, Education and Clinical Center (GRECC)
Pratik Pandharipande
Affiliation:
Department of Anesthesiology and Critical Care
Timothy D. Girard
Affiliation:
Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Li Wang
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
Jennifer L. Thompson
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
Rameela Chandrasekhar
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
Andrew Francis
Affiliation:
Department of Psychiatry, Penn State Medical School, Hershey Medical Center, Hershey, PA, USA
Stephen E. Nicolson
Affiliation:
Department of Psychiatry, Beth Israel Deaconess Hospital-Plymouth, Plymouth, MA, USA
Robert S. Dittus
Affiliation:
Veteran’s Affairs TN Valley, Geriatrics Research, Education and Clinical Center (GRECC) Department of Medicine, The Center for Health Services Research, Division of Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
Stephan Heckers
Affiliation:
Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
E. W. Ely
Affiliation:
Veteran’s Affairs TN Valley, Geriatrics Research, Education and Clinical Center (GRECC) Department of Medicine, The Center for Health Services Research, Division of Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
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Abstract

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OBJECTIVES/SPECIFIC AIMS: Background: Delirium is a well described form of acute brain organ dysfunction characterized by decreased or increased movement, changes in attention and concentration as well as perceptual disturbances (i.e., hallucinations) and delusions. Catatonia, a neuropsychiatric syndrome traditionally described in patients with severe psychiatric illness, can present as phenotypically similar to delirium and is characterized by increased, decreased and/or abnormal movements, staring, rigidity, and mutism. Delirium and catatonia can co-occur in the setting of medical illness, but no studies have explored this relationship by age. Our objective was to assess whether advancing age and the presence of catatonia are associated with delirium. METHODS/STUDY POPULATION: Methods: We prospectively enrolled critically ill patients at a single institution who were on a ventilator or in shock and evaluated them daily for delirium using the Confusion Assessment for the ICU and for catatonia using the Bush Francis Catatonia Rating Scale. Measures of association (OR) were assessed with a simple logistic regression model with catatonia as the independent variable and delirium as the dependent variable. Effect measure modification by age was assessed using a Likelihood ratio test. RESULTS/ANTICIPATED RESULTS: Results: We enrolled 136 medical and surgical critically ill patients with 452 matched (concomitant) delirium and catatonia assessments. Median age was 59 years (IQR: 52–68). In our cohort of 136 patients, 58 patients (43%) had delirium only, 4 (3%) had catatonia only, 42 (31%) had both delirium and catatonia, and 32 (24%) had neither. Age was significantly associated with prevalent delirium (i.e., increasing age associated with decreased risk for delirium) (p=0.04) after adjusting for catatonia severity. Catatonia was significantly associated with prevalent delirium (p<0.0001) after adjusting for age. Peak delirium risk was for patients aged 55 years with 3 or more catatonic signs, who had 53.4 times the odds of delirium (95% CI: 16.06, 176.75) than those with no catatonic signs. Patients 70 years and older with 3 or more catatonia features had half this risk. DISCUSSION/SIGNIFICANCE OF IMPACT: Conclusions: Catatonia is significantly associated with prevalent delirium even after controlling for age. These data support an inverted U-shape risk of delirium after adjusting for catatonia. This relationship and its clinical ramifications need to be examined in a larger sample, including patients with dementia. Additionally, we need to assess which acute brain syndrome (delirium or catatonia) develops first.

Type
Basic/Translational Science/Team Science
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Association for Clinical and Translational Science 2018