Objective. To examine the phenomenological characteristics of delirium based on the Memorial Delirium Assessment Scale (MDAS) in order to explore the presence, severity of, and relationship between symptoms. Methods. An analysis of 100 cases of delirium recruited at Memorial Sloan Kettering Cancer Center (MSKCC) was performed. Sociodemographic and medical variables, the Memorial Delirium Assessment Scale (MDAS) subitems, and Karnofsky Performance Status scale (KPS) were analyzed of respect of the phenomenological characteristics and their interrelationship. Results. The most severe and frequent symptoms were recorded in the cognitive domain, psychomotor behavior, sleep-wake cycle, and disturbance of consciousness. Within the cognitive domain, concentration was the most severely affected task. The severity of impairment in most domains increased with delirium severity, whereas perceptual disturbances and delusions were independent of delirium severity. Advanced age and the prevalence of dementia increased with delirium severity in contrast to the functional status which declined. The presence of perceptual disturbances and delusions was independent of cognitive impairment and psychomotor abnormality, however, associated with the disturbances of consciousness and attention. Conclusion. Cognition, in particular concentration, was the most severely affected domain. Advanced age and the prevalence of dementia contributed to more severe delirium. Perceptual disturbances and delusions were independent of delirium severity; however, they were associated with disturbances of consciousness and attention. 1. Introduction Delirium is a neuropsychiatric disorder which is characterized by disturbances of consciousness, attention, cognition, and perception with an abrupt onset and fluctuating course and an underlying physiological etiology [1]. Further frequent symptoms of delirium include various mood changes, sleep-wake cycle disturbances, and psychomotor as well as language abnormalities [2]. The phenomenology of delirium has been examined in a number of studies. In a review [3], impairments in arousal have been recorded in 75% (48–82%), orientation in 76% (62–100%), attention in 65% (17–100%), memory in 84% (64–100%), thought process in 48% (2–68%), perception in 33% (20–78%), delusions in 27% (19–68%), psychomotor retardation in 59% (53–60%), psychomotor agitation in 44% (28–90%), and sleep-wake cycle in 53% (18–98%). The prevalence of perceptual disturbances and delusions was evaluated in further studies. Two studies revealed an approximately equal prevalence of
References
[1]
W. Breitbart, J. Franklin, J. Levenson, D. R. Martini, and P. Wang, “Practice guideline for the treatment of patients with delirium,” American Journal of Psychiatry, vol. 156, no. 5, supplement 1, pp. 1–20, 1999.
[2]
D. J. Meagher, D. O'Hanlon, E. O'Mahony, P. R. Casey, and P. T. Trzepacz, “Relationship between symptoms and motoric subtype of delirium,” Journal of Neuropsychiatry and Clinical Neurosciences, vol. 12, no. 1, pp. 51–56, 2000.
[3]
S. B. Turkeil, P. T. Trzepacz, and J. C. Tavaré, “Comparing symptoms of delirium in adults and children,” Psychosomatics, vol. 47, no. 4, pp. 320–324, 2006.
[4]
J. Cutting, “The phenomenology of acute organic psychosis. Comparison with acute schizophrenia,” British Journal of Psychiatry, vol. 151, pp. 324–332, 1987.
[5]
R. Webster and S. Holroyd, “Prevalence of psychotic symptoms in delirium,” Psychosomatics, vol. 41, no. 6, pp. 519–522, 2000.
[6]
F. Sirois, “Delirium: 100 cases,” Canadian Journal of Psychiatry, vol. 33, no. 5, pp. 375–378, 1988.
[7]
D. J. Meagher, M. Moran, B. Raju et al., “Phenomenology of delirium: assessment of 100 adult cases using standardised measures,” British Journal of Psychiatry, vol. 190, pp. 135–141, 2007.
[8]
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, Washington, DC, USA, 4th edition, 2000.
[9]
W. Breitbart, B. Rosenfeld, A. Roth, M. J. Smith, K. Cohen, and S. Passik, “The memorial delirium assessment scale,” Journal of Pain and Symptom Management, vol. 13, no. 3, pp. 128–137, 1997.
[10]
J. Kazmierski, M. Kowman, M. Banach et al., “Clinical utility and use of DSM-IV and ICD-10 criteria and the memorial delirium assessment scale in establishing a diagnosis of delirium after cardiac surgery,” Psychosomatics, vol. 49, no. 1, pp. 73–76, 2008.
[11]
P. G. Lawlor, C. Nekolaichuk, and B. Gagnon, “Clinical utility, factor analysis, and further validation of the memorial delirium assessment scale in patients with advanced cancer: assessing delirium in advanced cancer,” Cancer, vol. 88, no. 12, pp. 2859–2867, 2000.
[12]
D. A. Karnofsky and J. H. Burchenal, “The clinical evaluation of chemotherapeutic agents in cancer,” in Evaluation of Chemotherapeutic Agents, C. M. Macleod, Ed., pp. 191–205, Columbia University Press, New York, NY, USA, 1949.
[13]
D. Meagher, M. Moran, B. Raju et al., “A new data-based motor subtype schema for delirium,” Journal of Neuropsychiatry and Clinical Neurosciences, vol. 20, no. 2, pp. 185–193, 2008.
[14]
D. J. Meagher, M. Moran, B. Raju et al., “Motor symptoms in 100 patients with delirium versus control subjects: comparison of subtyping methods,” Psychosomatics, vol. 49, no. 4, pp. 300–308, 2008.
[15]
T. G. Fong, R. N. Jones, P. Shi et al., “Delirium accelerates cognitive decline in alzheimer disease,” Neurology, vol. 72, no. 18, pp. 1570–1575, 2009.
[16]
T. Rahkonen, H. M?kel?, S. Paanila, P. Halonen, J. Sivenius, and R. Sulkava, “Delirium in elderly people without severe predisposing disorders: etiology and 1-year prognosis after discharge,” International Psychogeriatrics, vol. 12, no. 4, pp. 473–481, 2000.
[17]
D. K. Kiely, R. N. Jones, M. A. Bergmann, K. M. Murphy, E. J. Orav, and E. R. Marcantonio, “Association between delirium resolution and functional recovery among newly admitted postacute facility patients,” Journals of Gerontology A, vol. 61, no. 2, pp. 204–208, 2006.
[18]
J. McCusker, M. Cole, N. Dendukuri, é. Belzile, and F. Primeau, “Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study,” Canadian Medical Association Journal, vol. 165, no. 5, pp. 575–583, 2001.
[19]
J. McCusker, M. Cole, N. Dendukuri, L. Han, and é. Belzile, “The course of delirium in older medical inpatients: a prospective study,” Journal of General Internal Medicine, vol. 18, no. 9, pp. 696–704, 2003.
[20]
S. K. Inouye, “Delirium in hospitalized older patients,” Clinics in Geriatric Medicine, vol. 14, no. 4, pp. 745–764, 1998.
[21]
P. T. Trzepacz, B. H. Mulsant, M. A. Dew, R. Pasternak, R. A. Sweet, and G. S. Zubenko, “Is delirium different when it occurs in dementia? A study using the delirium rating scale,” Journal of Neuropsychiatry and Clinical Neurosciences, vol. 10, no. 2, pp. 199–204, 1998.
[22]
J. R. Fann, C. M. Alfano, B. E. Burington, S. Roth-Roemer, W. J. Katon, and K. L. Syrjala, “Clinical presentation of delirium in patients undergoing hematopoietic stem cell transplantation: delirium and distress symptoms and time course,” Cancer, vol. 103, no. 4, pp. 810–820, 2005.
[23]
S. E. Levkoff, B. Liptzin, D. A. Evans et al., “Progression and resolution of delirium in elderly patients hospitalized for acute care,” American Journal of Geriatric Psychiatry, vol. 2, no. 3, pp. 230–238, 1994.