Institutional report - Cardiac general screening methods for delirium: Early diagnosis by means of objective quantification of motor activity patterns using wrist-actigraphy

Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Interactive Cardiovascular and Thoracic Surgery (Impact Factor: 1.16). 12/2008; 8(3):344-8; discussion 348. DOI: 10.1510/icvts.2008.192278
Source: PubMed


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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    • "The Delirium Rating Scale-Revised-98 (DRS-R-98) is the oldest and most traditional scale, created to measure the degree of delirium in patients. Among the scales that allow delirium stratification, the DRS-R-98 is one of the most well-known and frequently used in intensive care.(12,16,18) The DRS-R-98 consists of a scale with 16 items (3 of them used only at the moment of diagnosis and 13 used for stratification in successive evaluations). "
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