Mohamad Faizal Nur Shairah, Tan Juen Kiem, Tan Michelle Maryanne, Khoo Ching Soong, Sahibulddin Siti Zaleha, Zolkafli Nursyazwana, Hod Rozita, Tan Hui Jan
Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia.
J Cent Nerv Syst Dis. 2024 Aug 16;16:11795735241274203. doi: 10.1177/11795735241274203. eCollection 2024.
Delirium is a prevalent yet underdiagnosed disorder characterized by acute cognitive impairment. Various screening tools are available, including the Confusion Assessment Method (CAM) and 4 A's test (4AT). However, the results of these assessments may vary among raters. Therefore, we investigated the objective use of electroencephalography (EEG) in delirium and its clinical associations and predictive value.
This cross-sectional observational study was conducted at Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan, Malaysia, from April 2021 to April 2023. This study included patients aged ≥18 years with a preliminary diagnosis of delirium. Demographic and clinical data were collected along with EEG recordings evaluated by certified neurologists to classify abnormalities and compare the associated factors between patients with delirium with or without EEG abnormalities.
One hundred and twenty patients were recruited, with 80.0% displaying EEG abnormalities, mostly generalized slowing (moderate to severe) and primarily generalized slowing (mild to severe), and were characterized by theta activity. Age was significantly associated with EEG abnormalities, with patients aged 75 and older demonstrating the highest incidence (88.2%). The CAM scores were strongly correlated with EEG abnormalities (r = 0.639, < 0.001) and was a predictor of EEG abnormalities ( < 0.012), indicating that EEG can complement clinical assessments for delirium. The Richmond Agitation and Sedation Scale (RASS) scores (r = -0.452, < 0.001) and Barthel index (BI) (r = -0.582, < 0.001) were negatively correlated with EEG abnormalities. Additionally, a longer hospitalization duration was associated with EEG abnormalities (r = 0.250, = 0.006) and emerged as a predictor of such changes ( = 0.030).
EEG abnormalities are prevalent in patients with delirium, particularly in elderly patients. CAM scores and the duration of hospitalization are valuable predictors of EEG abnormalities. EEG can be an objective tool for enhancing delirium diagnosis and prognosis, thereby facilitating timely interventions.
谵妄是一种常见但诊断不足的以急性认知障碍为特征的疾病。有多种筛查工具可供使用，包括意识错乱评估法（CAM）和4A测试（4AT）。然而，这些评估的结果在评估者之间可能存在差异。因此，我们研究了脑电图（EEG）在谵妄中的客观应用及其临床关联和预测价值。
这项横断面观察性研究于2021年4月至2023年4月在马来西亚国立大学敦库穆赫里兹医院进行。本研究纳入了年龄≥18岁且初步诊断为谵妄的患者。收集了人口统计学和临床数据以及由认证神经科医生评估的脑电图记录，以对异常进行分类，并比较有或无脑电图异常的谵妄患者之间的相关因素。
共招募了120名患者，其中80.0%表现出脑电图异常，主要是广泛性减慢（中度至重度）和主要为广泛性减慢（轻度至重度），并以θ波活动为特征。年龄与脑电图异常显著相关，75岁及以上患者的发病率最高（88.2%）。CAM评分与脑电图异常密切相关（r = 0.639，P < 0.001），并且是脑电图异常的一个预测指标（P < 0.012），这表明脑电图可以补充谵妄的临床评估。里士满躁动镇静量表（RASS）评分（r = -0.452，P < 0.001）和巴氏指数（BI）（r = -0.582，P < 0.001）与脑电图异常呈负相关。此外，住院时间延长与脑电图异常相关（r = 0.250，P = 0.006），并成为此类变化的一个预测指标（P = 0.030）。
脑电图异常在谵妄患者中很常见，尤其是在老年患者中。CAM评分和住院时间是脑电图异常的有价值的预测指标。脑电图可以作为一种客观工具来加强谵妄的诊断和预后，从而促进及时干预。
