Delirium other diagnostic studies: Difference between revisions
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* [[EEG]] changes in [[delirium]] are most prominent in the posterior regions. | * [[EEG]] changes in [[delirium]] are most prominent in the posterior regions. | ||
* [[Delirium]] shows slowing of background activity, however, slowing of background activity is also observed in deep [[sleep]] and [[dementia]]. | * [[Delirium]] shows slowing of background activity, however, slowing of background activity is also observed in deep [[sleep]] and [[dementia]]. | ||
*Typical and atypical [[antipsychotic]] may cause [[EEG]] abnormality. | *Typical and atypical [[antipsychotic]] may cause [[EEG]] abnormality.<ref name="YılmazErbaş2013">{{cite journal|last1=Yılmaz|first1=Mustafa|last2=Erbaş|first2=Oytun|title=The effects of typical and atypical antipsychotics on the electrical activity of the brain in a rat model|journal=Journal of Clinical and Experimental Investigations|volume=4|issue=3|year=2013|issn=13096621|doi=10.5799/ahinjs.01.2013.03.0284}}</ref> | ||
* One study observed an increase in the relative power of the theta and a decline in the relative power of the alpha frequency band, but this phenomenon seen to be absent when [[Parkinson]] is a co-morbid [[condition]] to [[delirium]].<ref name="CozacGschwandtner2016">{{cite journal|last1=Cozac|first1=Vitalii V.|last2=Gschwandtner|first2=Ute|last3=Hatz|first3=Florian|last4=Hardmeier|first4=Martin|last5=Rüegg|first5=Stephan|last6=Fuhr|first6=Peter|title=Quantitative EEG and Cognitive Decline in Parkinson’s Disease|journal=Parkinson's Disease|volume=2016|year=2016|pages=1–14|issn=2090-8083|doi=10.1155/2016/9060649}}</ref> | * One study observed an increase in the relative power of the theta and a decline in the relative power of the alpha frequency band, but this phenomenon seen to be absent when [[Parkinson]] is a co-morbid [[condition]] to [[delirium]].<ref name="CozacGschwandtner2016">{{cite journal|last1=Cozac|first1=Vitalii V.|last2=Gschwandtner|first2=Ute|last3=Hatz|first3=Florian|last4=Hardmeier|first4=Martin|last5=Rüegg|first5=Stephan|last6=Fuhr|first6=Peter|title=Quantitative EEG and Cognitive Decline in Parkinson’s Disease|journal=Parkinson's Disease|volume=2016|year=2016|pages=1–14|issn=2090-8083|doi=10.1155/2016/9060649}}</ref> | ||
* [[Delirium]] can also be identified from non [[delirium]] states by the following characteristics: | * [[Delirium]] can also be identified from non [[delirium]] states by the following characteristics: | ||
Revision as of 05:09, 22 April 2021
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Delirium Microchapters |
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Diagnosis |
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Treatment |
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Delirium On the Web |
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American Roentgen Ray Society Images of Delirium |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]
Overview
EEG and Lumbar puncture can be utilized in the management of delirium, however they are not always indicated.
Other Diagnostic Studies
- EEG
- Lumbar Puncture
EEG
- EEG shows diffuse slowing which is an indicator of delirium severity.[1]
- EEG is useful to differentiate delirium from following conditions:
- Conditions that can be identified on EEG include:
- metabolic encephalopathy or infectious encephalitis
- Focal intracranial lesion, or it's a global abnormality.
- Periodic discharges
- Triphasic waves
- lateralized rhythmic delta
- Low voltage/generalized attenuation
- Theta or delta generalized slowing
- The presence of either theta or delta generalized slowing correlated strongly with delirium severity regardless of arousal state (hyper- or hypoactive) and comorbidities.
- EEG changes in delirium are most prominent in the posterior regions.
- Delirium shows slowing of background activity, however, slowing of background activity is also observed in deep sleep and dementia.
- Typical and atypical antipsychotic may cause EEG abnormality.[3]
- One study observed an increase in the relative power of the theta and a decline in the relative power of the alpha frequency band, but this phenomenon seen to be absent when Parkinson is a co-morbid condition to delirium.[4]
- Delirium can also be identified from non delirium states by the following characteristics:
- Increase in the relative power of the delta frequency band
- Decrease in the peak frequency and significantly decreased bispectral index (BIS).[5]
Neurophysiology
- Electroencephalography (EEG) is an attractive mode of study in delirium as it has the ability to capture measures of global brain function.
- There are also opportunities to summarise temporal fluctuations as continuous recordings, compressed into power spectra (quantitative EEG, qEEG).
- Delirium has been known to be associated with a generalised slowing of background activity.[6][7]
- For most studies, the outcome of interest was the relative power measures, in order: alpha, theta, delta frequencies.
- The relative power of the theta frequency was consistently different between delirium and non-delirium patients.
- Similar findings were reported for alpha frequencies. In two studies, the relative power of all these bands was different within patients before and after delirium.
Lumbar puncture
- Routine LP does not provide any benefit in management of delirium. However,it maybe helpful in suspected meningitis when delirium is accompanied with:
- Meningism
- Headache and fever
References
- ↑ 1.0 1.1 Kimchi, Eyal Y.; Neelagiri, Anudeepthi; Whitt, Wade; Sagi, Avinash Rao; Ryan, Sophia L.; Gadbois, Greta; Groothuysen, Daniël; Westover, M. Brandon (2019). "Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes". Neurology. 93 (13): e1260–e1271. doi:10.1212/WNL.0000000000008164. ISSN 0028-3878.
- ↑ Thomas, C; Hestermann, U; Walther, S; Pfueller, U; Hack, M; Oster, P; Mundt, C; Weisbrod, M (2008). "Prolonged activation EEG differentiates dementia with and without delirium in frail elderly patients". Journal of Neurology, Neurosurgery & Psychiatry. 79 (2): 119–125. doi:10.1136/jnnp.2006.111732. ISSN 0022-3050.
- ↑ Yılmaz, Mustafa; Erbaş, Oytun (2013). "The effects of typical and atypical antipsychotics on the electrical activity of the brain in a rat model". Journal of Clinical and Experimental Investigations. 4 (3). doi:10.5799/ahinjs.01.2013.03.0284. ISSN 1309-6621.
- ↑ Cozac, Vitalii V.; Gschwandtner, Ute; Hatz, Florian; Hardmeier, Martin; Rüegg, Stephan; Fuhr, Peter (2016). "Quantitative EEG and Cognitive Decline in Parkinson's Disease". Parkinson's Disease. 2016: 1–14. doi:10.1155/2016/9060649. ISSN 2090-8083.
- ↑ "What are the opportunities f... [J Neuropsychiatry Clin Neurosci. 2012] - PubMed - NCBI".
- ↑ Engel, GL (2004 Fall). "Delirium, a syndrome of cerebral insufficiency. 1959". The Journal of neuropsychiatry and clinical neurosciences. 16 (4): 526–38. doi:10.1176/appi.neuropsych.16.4.526. PMID 15616182. Unknown parameter
|coauthors=ignored (help); Check date values in:|date=(help) - ↑ van der Kooi, AW (2012 Fall). "What are the opportunities for EEG-based monitoring of delirium in the ICU?". The Journal of neuropsychiatry and clinical neurosciences. 24 (4): 472–7. doi:10.1176/appi.neuropsych.11110347. PMID 23224454. Unknown parameter
|coauthors=ignored (help); Check date values in:|date=(help)