First delirium episode in Parkinson’s disease and parkinsonism: incidence, predictors, and outcomes
Abstract To define the incidence, predictors and prognosis of the first hospital delirium episode in Parkinson’s disease (PD) and atypical parkinsonism (AP), we identified the first hospital episode of delirium after diagnosis in the Parkinsonism Incidence in North-East Scotland (PINE) study, a pros...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2021-10-01
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| Series: | npj Parkinson's Disease |
| Online Access: | https://doi.org/10.1038/s41531-021-00234-2 |
| _version_ | 1797428967772258304 |
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| author | Samantha Green Sarah L. Perrott Andrew McCleary Isobel Sleeman Jodi Maple-Grødem Carl E. Counsell Angus D. Macleod |
| author_facet | Samantha Green Sarah L. Perrott Andrew McCleary Isobel Sleeman Jodi Maple-Grødem Carl E. Counsell Angus D. Macleod |
| author_sort | Samantha Green |
| collection | DOAJ |
| description | Abstract To define the incidence, predictors and prognosis of the first hospital delirium episode in Parkinson’s disease (PD) and atypical parkinsonism (AP), we identified the first hospital episode of delirium after diagnosis in the Parkinsonism Incidence in North-East Scotland (PINE) study, a prospective community-based incidence cohort of parkinsonism, using chart-based criteria to define delirium. Of 296 patients (189=PD, 107=AP [dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, vascular parkinsonism]), 152 developed delirium (PD = 98, AP = 54). Incidence of first hospital delirium episode per 100 person years was 8.1 (95% confidence interval [CI] 6.6–9.9) in PD and 18.5 (95% CI 13.9–24.7) in AP. Independent predictors of delirium were atypical parkinsonism (Hazard ratio [HR] vs PD = 2.83 [95% CI 1.60–5.03], age in PD but not in AP (HR for 10-year increase 2.29 [95% CI 1.74–3.02]), baseline MMSE (HR = 0.94 [95% CI 0.89–0.99]), APOE ε4 in PD (HR 2.16 [95% CI 1.15–4.08]), and MAPT H1/H1 in PD (HR 2.08 [95% CI 1.08–4.00]). Hazards of dementia and death after delirium vs before delirium were increased (dementia: HR = 6.93 [95% CI 4.18–11.48] in parkinsonism; death: HR = 3.76 [95% CI 2.65–5.35] in PD, 1.59 [95% CI 1.04–2.42] in AP). Delirium is a common non-motor feature of PD and AP and is associated with increased hazards of dementia and mortality. Whether interventions for early identification and treatment improve outcomes requires investigation. |
| first_indexed | 2024-03-09T09:06:24Z |
| format | Article |
| id | doaj.art-c5297eda790349019248e6acd7096bd3 |
| institution | Directory Open Access Journal |
| issn | 2373-8057 |
| language | English |
| last_indexed | 2024-03-09T09:06:24Z |
| publishDate | 2021-10-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Parkinson's Disease |
| spelling | doaj.art-c5297eda790349019248e6acd7096bd32023-12-02T10:23:35ZengNature Portfolionpj Parkinson's Disease2373-80572021-10-01711910.1038/s41531-021-00234-2First delirium episode in Parkinson’s disease and parkinsonism: incidence, predictors, and outcomesSamantha Green0Sarah L. Perrott1Andrew McCleary2Isobel Sleeman3Jodi Maple-Grødem4Carl E. Counsell5Angus D. Macleod6Division of Applied Health Sciences, University of AberdeenDivision of Applied Health Sciences, University of AberdeenNinewells HospitalDivision of Applied Health Sciences, University of AberdeenThe Norwegian Centre for Movement Disorders, Stavanger University HospitalDivision of Applied Health Sciences, University of AberdeenDivision of Applied Health Sciences, University of AberdeenAbstract To define the incidence, predictors and prognosis of the first hospital delirium episode in Parkinson’s disease (PD) and atypical parkinsonism (AP), we identified the first hospital episode of delirium after diagnosis in the Parkinsonism Incidence in North-East Scotland (PINE) study, a prospective community-based incidence cohort of parkinsonism, using chart-based criteria to define delirium. Of 296 patients (189=PD, 107=AP [dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, vascular parkinsonism]), 152 developed delirium (PD = 98, AP = 54). Incidence of first hospital delirium episode per 100 person years was 8.1 (95% confidence interval [CI] 6.6–9.9) in PD and 18.5 (95% CI 13.9–24.7) in AP. Independent predictors of delirium were atypical parkinsonism (Hazard ratio [HR] vs PD = 2.83 [95% CI 1.60–5.03], age in PD but not in AP (HR for 10-year increase 2.29 [95% CI 1.74–3.02]), baseline MMSE (HR = 0.94 [95% CI 0.89–0.99]), APOE ε4 in PD (HR 2.16 [95% CI 1.15–4.08]), and MAPT H1/H1 in PD (HR 2.08 [95% CI 1.08–4.00]). Hazards of dementia and death after delirium vs before delirium were increased (dementia: HR = 6.93 [95% CI 4.18–11.48] in parkinsonism; death: HR = 3.76 [95% CI 2.65–5.35] in PD, 1.59 [95% CI 1.04–2.42] in AP). Delirium is a common non-motor feature of PD and AP and is associated with increased hazards of dementia and mortality. Whether interventions for early identification and treatment improve outcomes requires investigation.https://doi.org/10.1038/s41531-021-00234-2 |
| spellingShingle | Samantha Green Sarah L. Perrott Andrew McCleary Isobel Sleeman Jodi Maple-Grødem Carl E. Counsell Angus D. Macleod First delirium episode in Parkinson’s disease and parkinsonism: incidence, predictors, and outcomes npj Parkinson's Disease |
| title | First delirium episode in Parkinson’s disease and parkinsonism: incidence, predictors, and outcomes |
| title_full | First delirium episode in Parkinson’s disease and parkinsonism: incidence, predictors, and outcomes |
| title_fullStr | First delirium episode in Parkinson’s disease and parkinsonism: incidence, predictors, and outcomes |
| title_full_unstemmed | First delirium episode in Parkinson’s disease and parkinsonism: incidence, predictors, and outcomes |
| title_short | First delirium episode in Parkinson’s disease and parkinsonism: incidence, predictors, and outcomes |
| title_sort | first delirium episode in parkinson s disease and parkinsonism incidence predictors and outcomes |
| url | https://doi.org/10.1038/s41531-021-00234-2 |
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