Connell Jennifer, Kim Ahra, Brummel Nathan E, Patel Mayur B, Vandekar Simon N, Pandharipande Pratik, Dittus Robert S, Heckers Stephan, Ely E Wes, Wilson Jo Ellen
Critical Illness, Brain Dysfunction, and Survivorship Center, Center for Health Services Research, Nashville, TN, United States.
Vanderbilt University School of Medicine, Nashville, TN, United States.
Front Psychiatry. 2021 Nov 19;12:673166. doi: 10.3389/fpsyt.2021.673166. eCollection 2021.
Catatonia, characterized by motor, behavioral and affective abnormalities, frequently co-occurs with delirium during critical illness. Advanced age is a known risk factor for development of delirium. However, the association between age and catatonia has not been described. We aim to describe the occurrence of catatonia, delirium, and coma by age group in a critically ill, adult population. Convenience cohort, nested within two clinical trials and two observational cohort studies. Intensive care units in an academic medical center in Nashville, TN. 378 critically ill adult patients on mechanical ventilation and/or vasopressors. Patients were assessed for catatonia, delirium, and coma by independent and blinded personnel, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method for the Intensive Care Unit (ICU) and the Richmond Agitation and Sedation Scale. Of 378 patients, 23% met diagnostic criteria for catatonia, 66% experienced delirium, and 52% experienced coma during the period of observation. There was no relationship found between age and catatonia severity or age and presence of specific catatonia items. The prevalence of catatonia was strongly associated with age in the setting of critical illness ( < 0.05). Delirium and comas' association with age was limited to the setting of catatonia. Given the significant relationship between age and catatonia independent of coma and delirium status, these data demonstrate catatonia's association with advanced age in the setting of critical illness. Future studies can explore the causative factors for this association and further elucidate the risk factors for acute brain dysfunction across the age spectrum.
紧张症以运动、行为和情感异常为特征，在危重病期间常与谵妄同时出现。高龄是已知的谵妄发生风险因素。然而，年龄与紧张症之间的关联尚未得到描述。我们旨在描述危重病成年人群中按年龄组划分的紧张症、谵妄和昏迷的发生情况。便利队列，嵌套于两项临床试验和两项观察性队列研究中。田纳西州纳什维尔市一家学术医疗中心的重症监护病房。378名接受机械通气和/或血管加压药治疗的危重病成年患者。由独立且不知情的人员使用布什·弗朗西斯紧张症评定量表、重症监护病房（ICU）意识模糊评估方法和里士满躁动镇静量表对患者进行紧张症、谵妄和昏迷评估。在378名患者中，23%符合紧张症诊断标准，66%经历过谵妄，52%在观察期间经历过昏迷。未发现年龄与紧张症严重程度或年龄与特定紧张症项目的存在之间存在关联。在危重病情况下，紧张症的患病率与年龄密切相关（<0.05）。谵妄和昏迷与年龄的关联仅限于紧张症情况。鉴于年龄与紧张症之间存在独立于昏迷和谵妄状态的显著关系，这些数据表明在危重病情况下紧张症与高龄有关。未来的研究可以探索这种关联的致病因素，并进一步阐明全年龄范围内急性脑功能障碍的风险因素。
