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Predisposing and precipitating factors for delirium in neurology: a prospective cohort study of 1487 patients

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Abstract

Introduction

Predisposing and precipitating factors for delirium are well known; however, their interaction and impact on delirium in neurological patients remains largely unknown. Therefore, those factors were evaluated in hospitalized patients with neurological disorders.

Methods

In this prospective cohort study, 1487 neurological patients were included, 356 patients with delirium and 1131 without delirium. Relevant neurological- and medical-related clusters were assessed with multiple regression analyses, prediction models, and cluster analysis evaluating their association with delirium.

Results

The 1-year incidence of delirium in this cohort was 23.9%. Delirium developed in 31% of patients with stroke, in 39.5% with epilepsy, and in 58.4% with ICH. The most relevant predisposing factors were substance-use disorders (OR 4.24, 2.28–7.78, p < 0.001), advanced age (OR 3.44, CI 2.40–4.92, p < 0.001), and neurodegenerative disorders (OR 2.58, CI 1.47–4.54, p = 0.001). The most relevant precipitating factors were meningitis (OR 21.52, CI 1.22–379.83, p = 0.036), acute renal failure (OR 10.01, CI 1.13–88.73, p = 0.039), and intracranial hemorrhage (OR 3.62, CI 2.08–6.30, p < 0.001). Delirious patients were hospitalized 6 days longer, had higher in-hospital mortality, and were discharged more often to nursing homes and rehabilitation. Best predictor for delirium was the coexistence of advanced age with epilepsy (58.3%, p < 0.001), while patients aged < 65 years without epilepsy and stroke rarely developed delirium (5.1%, p < 0.001).

Conclusions

Delirium is common in elder neurological patients and associated with worse outcome. Primary cerebral conditions most frequently precipitate delirium in neurology. Neurologists are advised to monitor symptoms of delirium in the presence of risk factors to enable both timely diagnostic work-up and management of delirium.

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Abbreviations

CCI:

Charlson comorbidity index

CNS:

Central nervous system

DOS:

Delirium Observation Screening Scale

ICH:

Intracerebral hemorrhage

ICU:

Intensive-care unit

LOS:

Length of stay

SU:

Stroke unit

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Authors and Affiliations

  1. Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland

    Carl Moritz Zipser, Roland von Känel & Soenke Boettger

  2. Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Carl Moritz Zipser

  3. Department of Hematology, University of Zurich, Zurich, Switzerland

    Jeremy Deuel

  4. Stem Cell Institute, University of Cambridge, Cambridge, UK

    Jeremy Deuel

  5. Institute of Nursing Science, University of Zurich, Zurich, Switzerland

    Jutta Ernst

  6. School of Health Professions, Zurich University of Applied Science, Technikumstrasse 81, 8401, Winterthur, Switzerland

    Maria Schubert

  7. Department of Neurology, University of Zurich, Zurich, Switzerland

    Michael Weller

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  1. Carl Moritz Zipser
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  2. Jeremy Deuel
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  3. Jutta Ernst
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  4. Maria Schubert
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Contributions

CMZ: design and conceptualized study; analyzed the data; drafted the manuscript for intellectual content. JD: major role in the analysis and of data and data bank management, and revised the manuscript for intellectual content. JE: interpreted the data; revised the manuscript for intellectual content. MS: Interpreted the data; revised the manuscript for intellectual content. MW: interpreted the data; revised the manuscript for intellectual content. RK: interpreted the data; revised the manuscript for intellectual content. SB: design and conceptualized study; analyzed the data; drafted the manuscript for intellectual content.

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Correspondence to Carl Moritz Zipser.

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Zipser, C.M., Deuel, J., Ernst, J. et al. Predisposing and precipitating factors for delirium in neurology: a prospective cohort study of 1487 patients. J Neurol 266, 3065–3075 (2019). https://doi.org/10.1007/s00415-019-09533-4

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