Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
J Neurol. 2019 Dec;266(12):3065-3075. doi: 10.1007/s00415-019-09533-4. Epub 2019 Sep 13.
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.
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.
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).
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.
谵妄的诱发因素和促发因素是众所周知的；然而，它们在神经科患者中的相互作用和对谵妄的影响在很大程度上仍不清楚。因此，评估了这些因素在患有神经疾病的住院患者中的作用。
在这项前瞻性队列研究中，纳入了 1487 名神经科患者，其中 356 名患有谵妄，1131 名没有谵妄。使用多元回归分析、预测模型和聚类分析评估了与谵妄相关的相关神经学和医学相关簇，评估其与谵妄的关联。
该队列中谵妄的 1 年发生率为 23.9%。31%的中风患者、39.5%的癫痫患者和 58.4%的 ICH 患者发生谵妄。最相关的易患因素是物质使用障碍（OR 4.24，2.28-7.78，p<0.001）、高龄（OR 3.44，CI 2.40-4.92，p<0.001）和神经退行性疾病（OR 2.58，CI 1.47-4.54，p=0.001）。最相关的促发因素是脑膜炎（OR 21.52，CI 1.22-379.83，p=0.036）、急性肾功能衰竭（OR 10.01，CI 1.13-88.73，p=0.039）和颅内出血（OR 3.62，CI 2.08-6.30，p<0.001）。谵妄患者的住院时间延长了 6 天，院内死亡率更高，出院后更多地被送往疗养院和康复机构。谵妄的最佳预测因素是高龄与癫痫并存（58.3%，p<0.001），而年龄<65 岁且无癫痫和中风的患者很少发生谵妄（5.1%，p<0.001）。
谵妄在老年神经科患者中很常见，与预后不良相关。原发性脑部疾病最常引发神经科患者的谵妄。建议神经科医生在存在危险因素的情况下监测谵妄症状，以便及时进行诊断性检查和谵妄管理。
