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

O'Regan, Niamh

Restricted to everyone for five years. Restriction lift date: 2021-06-13T10:49:06Z

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

dc.check.date	2021-06-13T10:49:06Z
dc.check.embargoformat	E-thesis on CORA only	en
dc.check.entireThesis	Entire Thesis Restricted
dc.check.info	Restricted to everyone for five years	en
dc.check.opt-out	No	en
dc.check.reason	This thesis is due for publication or the author is actively seeking to publish this material	en
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.contributor.funder	Health Research Board	en
dc.date.accessioned	2016-06-14T10:49:06Z
dc.date.issued	2015
dc.date.submitted	2015
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.description.status	Not peer reviewed	en
dc.description.version	Accepted Version
dc.format.mimetype	application/pdf	en
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	https://hdl.handle.net/10468/2734
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.thesis.opt-out	false
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
ucc.workflow.supervisor	s.timmons@ucc.ie