Early detection of delirium in older medical inpatients: prodrome, predictors and motor subtyping

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dc.contributor.advisor Timmons, Suzanne en
dc.contributor.advisor Meagher, David en
dc.contributor.advisor Molloy, D. William en
dc.contributor.author O'Regan, Niamh
dc.date.accessioned 2016-06-14T10:49:06Z
dc.date.issued 2015
dc.date.submitted 2015
dc.identifier.citation O'Regan, N. 2015. Early detection of delirium in older medical inpatients: prodrome, predictors and motor subtyping. PhD Thesis, University College Cork. en
dc.identifier.endpage 409 en
dc.identifier.uri http://hdl.handle.net/10468/2734
dc.description.abstract Background Delirium is highly prevalent, especially in older patients. It independently leads to adverse outcomes, but remains under-detected, particularly hypoactive forms. Although early identification and intervention is important, delirium prevention is key to improving outcomes. The delirium prodrome concept has been mooted for decades, but remains poorly characterised. Greater understanding of this prodrome would promote prompt identification of delirium-prone patients, and facilitate improved strategies for delirium prevention and management. Methods Medical inpatients of ≥70 years were screened for prevalent delirium using the Revised Delirium Rating Scale (DRS--‐R98). Those without prevalent delirium were assessed daily for delirium development, prodromal features and motor subtype. Survival analysis models identified which prodromal features predicted the emergence of incident delirium in the cohort in the first week of admission. The Delirium Motor Subtype Scale-4 was used to ascertain motor subtype. Results Of 555 patients approached, 191 patients were included in the prospective study. The median age was 80 (IQR 10) and 101 (52.9%) were male. Sixty-one patients developed incident delirium within a week of admission. Several prodromal features predicted delirium emergence in the cohort. Firstly, using a novel Prodromal Checklist based on the existing literature, and controlling for confounders, seven predictive behavioural features were identified in the prodromal period (for example, increasing confusion; and being easily distractible). Additionally, using serial cognitive tests and the DRS-R98 daily, multiple cognitive and other core delirium features were detected in the prodrome (for example inattention; and sleep-wake cycle disturbance). Examining longitudinal motor subtypes in delirium cases, subtypes were found to be predominantly stable over time, the most prevalent being hypoactive subtype (62.3%). Discussion This thesis explored multiple aspects of delirium in older medical inpatients, with particular focus on the characterisation of the delirium prodrome. These findings should help to inform future delirium educational programmes, and detection and prevention strategies. en
dc.description.sponsorship Health Research Board (HPF/2011/24) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher University College Cork en
dc.rights © 2015, Niamh O'Regan. en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/ en
dc.subject Delirium en
dc.subject Cognition en
dc.subject Prodromal symptoms en
dc.subject Early diagnosis en
dc.subject Motor activity en
dc.subject Psychomotor performance en
dc.subject Sensitivity and specificity en
dc.subject Risk factors en
dc.title Early detection of delirium in older medical inpatients: prodrome, predictors and motor subtyping en
dc.type Doctoral thesis en
dc.type.qualificationlevel Doctoral en
dc.type.qualificationname PhD (Medicine and Health) en
dc.internal.availability Full text not available en
dc.check.info Restricted to everyone for five years en
dc.check.date 2021-06-13T10:49:06Z
dc.description.version Accepted Version
dc.contributor.funder Health Research Board en
dc.description.status Not peer reviewed en
dc.internal.school Medicine en
dc.check.reason This thesis is due for publication or the author is actively seeking to publish this material en
dc.check.opt-out No en
dc.thesis.opt-out false
dc.check.entireThesis Entire Thesis Restricted
dc.check.embargoformat E-thesis on CORA only en
ucc.workflow.supervisor s.timmons@ucc.ie
dc.internal.conferring Summer 2016 en

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© 2015, Niamh O'Regan. Except where otherwise noted, this item's license is described as © 2015, Niamh O'Regan.
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