Screening methods for delirium: early diagnosis by means of objective quantification of motor activity patterns using wrist-actigraphy.
ABSTRACT Delirium after cardiac surgery is a risk factor for adverse outcome and even death. Disturbance of motor activity is a core feature of delirium, but hypoactive delirium often remains unrecognized. We explored wrist-actigraphy as a tool to objectively quantify postoperative recovery of 24-h rest-activity patterns to improve the early recognition of delirium after surgery. Motor activity was recorded by wrist-actigraphy after cardiac surgery in 88 patients over 65 years of age. Patients were assessed daily by using the CAM-ICU. Our final analyses were based on 32 non-delirious patients and 38 patients who were delirious on the first day after surgery. The delirious patients showed lower mean activity levels during the first postoperative night (P<0.05), reduced restlessness during the first day (P<0.05), and a lower mean activity of the 5 h with lowest activity within the first 24 h (P=0.01), as compared to the non-delirious patients. Already at a very early stage after cardiac surgery, a difference in motor activity was observed between patients with and without a delirium. As an unobtrusive method, actigraphy has the potential to be a screening method that may lead to early diagnosis and treatment of delirium.
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ABSTRACT: To identify scales that can establish a quantitative assessment of delirium symptoms in critically ill patients through a systematic review. Studies that evaluated delirium stratification scales in patients hospitalized in intensive care units were selected in a search performed in the MedLine database. Validation studies of these scales and their target patient populations were analyzed, and we identified the examiner and the signs and symptoms evaluated. In addition, the duration of the application and the sensitivity and specificity of each scale were assessed. Six scales were identified: the Delirium Detection Score, the Cognitive Test of Delirium, the Memorial Delirium Assessment Scale, the Intensive Care Delirium Screening Checklist, The Neelon and Champagne Confusion Scale and the Delirium Rating Scale-Revised-98. The scales identified allow the stratification and monitoring of critically ill patients with delirium. Among the six scales, the most studied and best suited for use in the intensive care units was the Intensive Care Delirium Screening.06/2013; 25(2):148-154. DOI:10.5935/0103-507X.20130026
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ABSTRACT: Actigraphic data during simulated participant movements were evaluated to differentiate among patient behavior states. Arm and leg actigraphic data were collected on 30 volunteers who simulated 3 behavioral states (calm, restless, agitated) for 10 minutes; counts of observed participant movements (head, torso, extremities) were documented. The mean age of participants was 34.7 years, and 60% were female. Average movement was significantly different among the states (P < .0001; calm [mean = .48], restless [mean = 2.16], agitated [mean = 3.75]). Mean actigraphic measures were significantly different among states for both arm (P < .0001; calm [mean = 6.8], restless [mean = 28.5], agitated [mean = 52.6]) and leg (P < .0001; calm [mean = 3.5], restless [mean = 18.7], agitated [mean = 37.7]). Distinct levels of behavioral states were successfully simulated. Actigraphic data can provide an objective indicator of patient activity over a variety of behavioral states, and these data may offer a standard for comparison among these states.Heart & lung: the journal of critical care 05/2011; 40(3):e52-9. DOI:10.1016/j.hrtlng.2009.12.013 · 1.32 Impact Factor
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ABSTRACT: Delirium is a complex neuropsychiatric syndrome that impacts adversely upon patient outcomes and healthcare outcomes. Delirium occurs in approximately one in five hospitalised patients and is especially common in the elderly and patients who are highly morbid and/or have pre-existing cognitive impairment. However, efforts to improve management of delirium are hindered by gaps in our knowledge and issues that reflect a disparity between existing knowledge and real-world practice. This review focuses on evidence that can assist in prevention, earlier detection and more timely and effective pharmacological and non-pharmacological management of emergent cases and their aftermath. It points towards a new approach to delirium care, encompassing laboratory and clinical aspects and health services realignment supported by health managers prioritising delirium on the healthcare change agenda. Key areas for future research and service organisation are outlined in a plan for improved delirium care across the range of healthcare settings and patient populations in which it occurs.Journal of neurology, neurosurgery, and psychiatry 01/2013; 85(2). DOI:10.1136/jnnp-2012-304334 · 5.58 Impact Factor