Department of Internal Medicine, Geriatric Section, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Rejuvenation Res. 2011 Oct;14(5):483-90. doi: 10.1089/rej.2011.1181. Epub 2011 Sep 28.
Delirium is a frequent syndrome in elderly hospital patients. Symptoms typically show a fluctuating course during the day, with patients exhibiting disturbances of their sleep-wake rhythm. Delirium is frequently underdiagnosed, especially the so-called hypoactive subtype. Devices measuring 24-hr motor patterns could contribute to the recognition of delirium. The purpose of this paper is two-fold. First, the results of a pilot study are presented, in which 24-hr motor patterns of delirious patients are measured with a wrist-actigraph. Second, studies reporting 24-hr motor patterns in delirious patients are systematically reviewed.
The pilot study included 9 patients, 65 years or older, with a hip fracture in need of surgical repair. For the review, MEDLINE and Embase were searched for studies on motor activity assessment in delirious patients.
In the pilot study, the 24-hr activity rhythm was severely disturbed during delirium, and most actigraphic sleep parameter estimates indicated significantly worse sleep during delirious nights. The systematic search resulted in 10 papers. In 3 papers, the sleep-wake rhythm of delirious patients was significantly different from that of nondelirious patients. In 5 papers, delirious patients could be classified into delirium subtypes. In the 2 remaining papers, 24-hr motor patterns of delirium subtypes were not significantly different.
Activity patterns revealed differences between delirious and nondelirious patients and between the different subtypes, even in small samples of patients. Future studies, with preferably larger sample sizes, should confirm the potential of activity pattern measuring devices in the early detection of delirium.
谵妄是老年住院患者中常见的综合征。症状通常在白天呈波动变化，患者表现出睡眠-觉醒节律紊乱。谵妄常常被漏诊，尤其是所谓的低活动型亚型。测量 24 小时运动模式的设备有助于识别谵妄。本文的目的有两个。首先，介绍一项试点研究的结果，该研究使用腕动描记器测量谵妄患者的 24 小时运动模式。其次，系统回顾报告谵妄患者 24 小时运动模式的研究。
试点研究纳入 9 名年龄在 65 岁或以上、需要手术修复髋部骨折的患者。为了进行综述，在 MEDLINE 和 Embase 上搜索关于谵妄患者运动活动评估的研究。
在试点研究中，谵妄期间 24 小时活动节律严重紊乱，大多数动描记睡眠参数估计表明谵妄夜间睡眠明显较差。系统搜索得到 10 篇论文。在 3 篇论文中，谵妄患者的睡眠-觉醒节律与非谵妄患者明显不同。在 5 篇论文中，谵妄患者可以分为谵妄亚型。在另外 2 篇论文中，不同谵妄亚型的 24 小时运动模式没有显著差异。
即使在患者样本较小的情况下，活动模式也揭示了谵妄患者与非谵妄患者以及不同亚型之间的差异。未来的研究，最好有更大的样本量，应证实活动模式测量设备在早期发现谵妄方面的潜力。
