Advancing the Care of Delirium and Comorbid Dementia

A special issue of Geriatrics (ISSN 2308-3417).

Deadline for manuscript submissions: closed (15 November 2022) | Viewed by 24572

Special Issue Editors


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Guest Editor
1. Department of Rehabilitation and Aged Care Unit, Fondazione Teresa Camplani, Cremona, Italy
2. Geriatric Research Group, Brescia, Italy
Interests: delirium; rehabilitation; cognitive impairment; functional impairment

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Guest Editor
School of medicine and Surgery, University Milano-Bicocca, Milan, Italy
Interests: geriatric psychiatry; frontotemporal dementia; cognitive impairment; delirium

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Guest Editor
Neuroanesthesia and Neurocritical Care department of the Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
Interests: traumatic brain injury; brain oxygenation; sedation; ICP; delirium; mechanical ventilation
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Guest Editor
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
Interests: clinical research; patient safety; medical education

Special Issue Information

Dear Colleagues,

Postoperative delirium (POD) is an underdiagnosed adverse event related to surgical procedures. The incidence of delirium ranges from 11% to 51% .

POD is not only a postoperative complication itself, but it also contributes to the development of other undesired complications such as prolonged inpatient stay, longer-term cognitive impairment, and an increased risk of mortality.

Especially with the ageing population and the increasing frequency of surgery in elderly patients, the prevention of delirium and postoperative cognitive dysfunction is a challenge.

Despite the sometimes serious complications that can arise for patients and limited hospital resources, risk screening and prevention are still poorly standardized in routine practice.
In this Special Issue, we aim to provide an overview of how we recognize patients at risk of delirium at an early stage, how we can implement the better detection of delirium in our patients, and how we can take measures to prevent delirium in patients. We would like to discuss both the medical possibilities and the economic challenges.

Dr. Alessandro Morandi
Prof. Dr. Giuseppe Bellelli
Prof. Dr. Federico Bilotta
Prof. Dr. Maria Wittmann
Guest Editors

Manuscript Submission Information

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Keywords

  • postoperative delirium
  • cognitive dysfunction
  • preoperative prediction
  • neurocognitive testing

Published Papers (7 papers)

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Editorial

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3 pages, 193 KiB  
Editorial
Advancing the Care of Delirium and Comorbid Dementia
by Alessandro Morandi, Maria Wittmann, Federico Bilotta and Giuseppe Bellelli
Geriatrics 2022, 7(6), 132; https://doi.org/10.3390/geriatrics7060132 - 23 Nov 2022
Cited by 2 | Viewed by 1684
Abstract
Delirium is defined as an acute neuropsychiatric disorder characterized by a disturbance in attention and awareness, which develops over a short period of time, with additional disturbances in cognition which are not explained by a pre-existing cognitive impairment [...] Full article
(This article belongs to the Special Issue Advancing the Care of Delirium and Comorbid Dementia)

Research

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11 pages, 747 KiB  
Article
Occurrence of Postoperative Delirium and the Use of Different Assessment Tools
by Andrea Kirfel, Diane Jossen, Jan Menzenbach, Andreas Mayr and Maria Wittmann
Geriatrics 2023, 8(1), 11; https://doi.org/10.3390/geriatrics8010011 - 11 Jan 2023
Viewed by 2466
Abstract
(1) Background: Postoperative delirium (POD) poses a high risk of worsening outcomes for patients and is also a burden for hospitals. The leading guidelines recommend standardized POD assessment and prevention. The aim of this subgroup analysis of the PRe-Operative Prediction of Postoperative DElirium [...] Read more.
(1) Background: Postoperative delirium (POD) poses a high risk of worsening outcomes for patients and is also a burden for hospitals. The leading guidelines recommend standardized POD assessment and prevention. The aim of this subgroup analysis of the PRe-Operative Prediction of Postoperative DElirium by Appropriate SCreening (PROPDESC) trial was to compare different delirium assessments and to analyse the frequency of POD on five postoperative days. (2) Methods: This prospective observational trial enrolled 1097 patients in a university hospital from 2018 until 2019. The following POD assessment tools were used for five consecutive days: Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method for normal ward (CAM), 4 A’s Test (4AT) and Delirium Observation Screening (DOS) scale. (3) Results: In a 5-day visit interval, most new POD developments occurred on the first and second postoperative day. A clear recommendation for a specific POD assessment tool based on our results cannot be given. (4) Conclusions: According to guidelines, a POD assessment should take place on the first five postoperative days, but of these, the first two are those of highest POD occurrence. The POD assessment tool used should at best include direct patient questioning and aspects of patient observation. Full article
(This article belongs to the Special Issue Advancing the Care of Delirium and Comorbid Dementia)
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11 pages, 387 KiB  
Article
The Impact of Perioperative and Predisposing Risk Factors on the Development of Postoperative Delirium and a Possible Gender Difference
by Maria Wittmann, Andrea Kirfel, Diane Jossen, Andreas Mayr and Jan Menzenbach
Geriatrics 2022, 7(3), 65; https://doi.org/10.3390/geriatrics7030065 - 14 Jun 2022
Cited by 8 | Viewed by 2938
Abstract
(1) Background: Postoperative delirium (POD) is an undesirable event especially for older patients after surgery. Perioperative risks for POD development are multiple, but gender differences are still poorly considered. In this observational study, predisposing and precipitating risk factors of POD and the possible [...] Read more.
(1) Background: Postoperative delirium (POD) is an undesirable event especially for older patients after surgery. Perioperative risks for POD development are multiple, but gender differences are still poorly considered. In this observational study, predisposing and precipitating risk factors of POD and the possible gender influence are distinguished. (2) Methods: This observational prospective trial enrolled 1097 patients in a tertiary hospital from September 2018 until October 2019. POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 ‘A’s Test (4AT) or Delirium Observation Screening (DOS) scale was positive on one of five assessment days. (3) Results: POD incidence was 23.5% and the mean age of study population was 72.3 ± 7.3 years. The multiple logistic regression model showed a significant impact of age (Odds Ratio (OR) 1.74; 95% Confidence Interval (CI): 1.37–2.22), American Society of Anesthesiologists (ASA) (OR 1.67; 95% CI: 1.25–2.26), surgery risk (OR 2.10; 95% CI: 1.52–2.95) and surgery duration (OR 1.17; 95% CI: 1.07–1.28), ventilation time (OR 1.64; 95% CI: 1.27–2.24), as well as the male sex (OR 1.74; 95% CI: 1.37–2.22) on POD risk. (4) Conclusions: Perioperative and predisposing risk factors had an impact on the development of POD. The influence of male sex should be considered in future research. Full article
(This article belongs to the Special Issue Advancing the Care of Delirium and Comorbid Dementia)
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Review

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11 pages, 408 KiB  
Review
Innovative Non-Pharmacological Management of Delirium in Persons with Dementia: New Frontiers for Physiotherapy and Occupational Therapy?
by Christian Pozzi, Verena C. Tatzer, Cornelia Strasser-Gugerell, Stefano Cavalli, Alessandro Morandi and Giuseppe Bellelli
Geriatrics 2023, 8(2), 28; https://doi.org/10.3390/geriatrics8020028 - 22 Feb 2023
Cited by 5 | Viewed by 7245
Abstract
Background: Delirium and dementia are two of the most common geriatric syndromes, which requires innovative rehabilitation approaches. Aim: We aimed at determining which occupational therapy and physiotherapy interventions are applied with older people with delirium and dementia in different care settings. We also [...] Read more.
Background: Delirium and dementia are two of the most common geriatric syndromes, which requires innovative rehabilitation approaches. Aim: We aimed at determining which occupational therapy and physiotherapy interventions are applied with older people with delirium and dementia in different care settings. We also identified the assessment tools that were used. Materials and methods: We conducted a literature search for scientific articles published from 2012 to 2022 (PubMed, MEDLINE, AMED and CINAHL) with adults aged >65 years including experimental study designs with randomized or non-randomized intervention, exploratory studies, pilot studies, quasi-experimental studies, case series and/or clinical cases. Studies that did not use interventions that could be classified as occupational therapy or physiotherapy were excluded. Results: After applying the exclusion criteria, 9 articles were selected. The most widely used assessment to define dementia was the MMSE (N = 5; 55.5%), whereas the CAM (N = 2; 22.2%), CAM-ICU (N = 2; 22.2%) and RASS (N = 3; 33.3%) were the most widely used to define delirium. The rehabilitation interventions that were most frequently performed were early mobilization, inclusion of the caregiver during treatment, modification of the environment to encourage orientation and autonomy, the interprofessional systemic approach and engaging persons in meaningful activities. Conclusions: Despite the growing evidence on its effectiveness, the role of physiotherapy and occupational therapy interventions in the prevention and treatment of people with dementia and delirium is still emerging. More research is needed to investigate if effective occupational therapy programs known to reduce the behavioral and psychological symptoms in people with dementia are also useful for treating delirium and specifically delirium superimposed on dementia. Regarding physiotherapy, it is crucial to know about the amount and timing of intervention required. Further studies are needed including older adults with delirium superimposed on dementia to define the role of the interprofessional geriatric rehabilitation team. Full article
(This article belongs to the Special Issue Advancing the Care of Delirium and Comorbid Dementia)
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15 pages, 288 KiB  
Review
Recognition of Delirium Superimposed on Dementia: Is There an Ideal Tool?
by Priyanka Shrestha and Donna M. Fick
Geriatrics 2023, 8(1), 22; https://doi.org/10.3390/geriatrics8010022 - 2 Feb 2023
Cited by 8 | Viewed by 3350
Abstract
Delirium in persons with dementia (DSD) is a common occurrence. Over the past three decades, several tools have been developed and validated to diagnose delirium, yet there is still a shortage of tools recommended in persons with dementia and there is a lack [...] Read more.
Delirium in persons with dementia (DSD) is a common occurrence. Over the past three decades, several tools have been developed and validated to diagnose delirium, yet there is still a shortage of tools recommended in persons with dementia and there is a lack of sufficient research on the accuracy of performance of such tools in this growing population. The purpose of this article is to (1) conduct a clinical review of the detection of DSD across settings of care by formal health care professionals and informal family members and care partners; (2) identify barriers and facilitators to detection and highlight delirium tools that have been tested in person with dementia; and (3) make recommendations for future research, practice, and policy. Given this review, an “ideal” tool for DSD would point to tools being brief, easy to integrate into the EMR, and accurate with at least 90% accuracy given the poor outcomes associated with delirium and DSD. Knowing the baseline and communication between family members and healthcare professionals should be a top priority for education, research, and health systems policy. More work is needed in better understanding DSD and optimizing and standardizing feature assessment, especially the acute change feature at the bedside for DSD. Full article
(This article belongs to the Special Issue Advancing the Care of Delirium and Comorbid Dementia)
10 pages, 255 KiB  
Review
Is There a Role for Medication in Managing Delirium with Dementia?
by Elizabeth L. Sampson, Frederick Graham and Andrew Teodorczuk
Geriatrics 2022, 7(5), 114; https://doi.org/10.3390/geriatrics7050114 - 7 Oct 2022
Cited by 3 | Viewed by 2552
Abstract
People with dementia are more likely to develop delirium. We conducted a brief literature search and give a pragmatic overview of the key issues. Making rational and safe prescribing decisions is highly influenced by organisational culture and embedded staff practices. Comprehensive assessment for [...] Read more.
People with dementia are more likely to develop delirium. We conducted a brief literature search and give a pragmatic overview of the key issues. Making rational and safe prescribing decisions is highly influenced by organisational culture and embedded staff practices. Comprehensive assessment for unmet physical, psychological, and social needs is an important intervention in itself. Taking a broad overview of possible pharmacological interventions should include stopping inappropriate medications and prescribing for key drivers of the underlying causes of delirium. Prescribing psychotropic medications may be indicated where there is significant distress or risk to the person with dementia and risk to those around them. It is vital to consider the dementia subtype and, where possible, involve family and friend carers in the decision-making process. Medications should be prescribed at the lowest possible dose for the least amount of time after carefully weighing risks versus benefits and documenting these. While these cases are challenging for staff and families, it can be rewarding to improve the quality of life and lessen distress for the person with dementia. There are also opportunities for informing family and friend carers, educating the wider multidisciplinary team, and promoting organisational change. Full article
(This article belongs to the Special Issue Advancing the Care of Delirium and Comorbid Dementia)

Other

19 pages, 2521 KiB  
Systematic Review
Preoperative Risk Factors Associated with Increased Incidence of Postoperative Delirium: Systematic Review of Qualified Clinical Studies
by Vlasios Karageorgos, Lior Mevorach, Melissa Silvetti and Federico Bilotta
Geriatrics 2023, 8(1), 24; https://doi.org/10.3390/geriatrics8010024 - 7 Feb 2023
Cited by 2 | Viewed by 3202
Abstract
Postoperative delirium (POD) is an acute alteration of mental state, characterized by reduced awareness and attention, occurring up to five postoperative days after recovery from anesthesia. Several original studies and reviews have identified possible perioperative POD risk factors; however, there is no comprehensive [...] Read more.
Postoperative delirium (POD) is an acute alteration of mental state, characterized by reduced awareness and attention, occurring up to five postoperative days after recovery from anesthesia. Several original studies and reviews have identified possible perioperative POD risk factors; however, there is no comprehensive review of the preoperative risk factors in patients diagnosed with POD using only validated diagnostic scales. The aim of this systematic review was to report the preoperative risk factors associated with an increased incidence of POD in patients undergoing non-cardiac and non-brain surgery. The reviewed studies included original research papers that used at least one validated diagnostic scale to identify POD occurrence for more than 24 h. A total of 6475 references were retrieved from the database search, with only 260 of them being suitable for further review. Out of the 260 reviewed studies, only 165 that used a validated POD scale reported one or more preoperative risk factors. Forty-one risk factors were identified, with various levels of statistical significance. The extracted risk factors could serve as a preoperative POD risk assessment workup. Future studies dedicated to the further evaluation of the specific preoperative risk factors’ contributions to POD could help with the development of a weighted screening tool. Full article
(This article belongs to the Special Issue Advancing the Care of Delirium and Comorbid Dementia)
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