Delirium is more common and associated with worse outcomes in Parkinson's disease compared to older adult controls: results of two prospective longitudinal cohort studies

Florence Gerakios; Alison J Yarnall; Gemma Bate; Laura Wright; Daniel Davis; Blossom C M Stephan; Louise Robinson; Carol Brayne; Glenn Stebbins; John-Paul Taylor; David J Burn; Louise M Allan; Sarah J Richardson; Rachael A Lawson

doi:10.1093/ageing/afae046

Delirium is more common and associated with worse outcomes in Parkinson's disease compared to older adult controls: results of two prospective longitudinal cohort studies

Age Ageing. 2024 Mar 1;53(3):afae046. doi: 10.1093/ageing/afae046.

Authors

Florence Gerakios^{1

2}, Alison J Yarnall^{1

2

3}, Gemma Bate¹, Laura Wright¹, Daniel Davis⁴, Blossom C M Stephan^{5

6}, Louise Robinson⁷, Carol Brayne⁸, Glenn Stebbins⁹, John-Paul Taylor^{1

3}, David J Burn¹, Louise M Allan¹⁰, Sarah J Richardson^{1

3}, Rachael A Lawson^{1

3}

Affiliations

¹ Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
² Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.
³ NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK.
⁴ MRC Unit for Lifelong Health and Ageing, University College London, London, UK.
⁵ Institute of Mental Health, School of Medicine, Nottingham University, Nottingham, UK.
⁶ Dementia Centre of Excellence, EnAble Institute, Curtin University, Perth, Australia.
⁷ Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
⁸ Department of Psychiatry, University of Cambridge, Cambridge, UK.
⁹ Department of Neurological Sciences, Rush University Medical Center, Chicago, USA.
¹⁰ Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK.

Abstract

Background: Inpatient prevalence of Parkinson's disease (PD) delirium varies widely across the literature. Delirium in general older populations is associated with adverse outcomes, such as increased mortality, dementia, and institutionalisation. However, to date there are no comprehensive prospective studies in PD delirium. This study aimed to determine delirium prevalence in hospitalised PD participants and the association with adverse outcomes, compared to a control group of older adults without PD.

Methods: Participants were hospitalised inpatients from the 'Defining Delirium and its Impact in Parkinson's Disease' and the 'Delirium and Cognitive Impact in Dementia' studies comprising 121 PD participants and 199 older adult controls. Delirium was diagnosed prospectively using the Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria. Outcomes were determined by medical note reviews and/or home visits 12 months post hospital discharge.

Results: Delirium was identified in 66.9% of PD participants compared to 38.7% of controls (p < 0.001). In PD participants only, delirium was associated with a significantly higher risk of mortality (HR = 3.3 (95% confidence interval [CI] = 1.3-8.6), p = 0.014) and institutionalisation (OR = 10.7 (95% CI = 2.1-54.6), p = 0.004) 12 months post-discharge, compared to older adult controls. However, delirium was associated with an increased risk of developing dementia 12 months post-discharge in both PD participants (OR = 6.1 (95% CI = 1.3-29.5), p = 0.024) and in controls (OR = 13.4 (95% CI = 2.5-72.6), p = 0.003).

Conclusion: Delirium is common in hospitalised PD patients, affecting two thirds of patients, and is associated with increased mortality, institutionalisation, and dementia. Further research is essential to understand how to accurately identify, prevent and manage delirium in people with PD who are in hospital.

Keywords: Delirium; Institutionalisation; Mortality; Older people; Outcomes; Parkinson's disease.

MeSH terms

Aftercare
Aged
Delirium* / diagnosis
Delirium* / epidemiology
Delirium* / etiology
Dementia* / complications
Dementia* / diagnosis
Dementia* / epidemiology
Humans
Longitudinal Studies
Parkinson Disease* / complications
Parkinson Disease* / diagnosis
Parkinson Disease* / epidemiology
Patient Discharge
Prospective Studies

Abstract

MeSH terms

Grants and funding