Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 11;7(1):92.
doi: 10.1038/s41531-021-00234-2.

First delirium episode in Parkinson's disease and parkinsonism: incidence, predictors, and outcomes

Samantha Green  1 , Sarah L Perrott  1 , Andrew McCleary  2 , Isobel Sleeman  1 , Jodi Maple-Grødem  3   4 , Carl E Counsell  1 , Angus D Macleod  5
Affiliations

First delirium episode in Parkinson's disease and parkinsonism: incidence, predictors, and outcomes

Samantha Green et al. NPJ Parkinsons Dis. .

Abstract

To define the incidence, predictors and prognosis of the first hospital delirium episode in Parkinson's disease (PD) and atypical parkinsonism (AP), we identified the first hospital episode of delirium after diagnosis in the Parkinsonism Incidence in North-East Scotland (PINE) study, a prospective community-based incidence cohort of parkinsonism, using chart-based criteria to define delirium. Of 296 patients (189=PD, 107=AP [dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, vascular parkinsonism]), 152 developed delirium (PD = 98, AP = 54). Incidence of first hospital delirium episode per 100 person years was 8.1 (95% confidence interval [CI] 6.6-9.9) in PD and 18.5 (95% CI 13.9-24.7) in AP. Independent predictors of delirium were atypical parkinsonism (Hazard ratio [HR] vs PD = 2.83 [95% CI 1.60-5.03], age in PD but not in AP (HR for 10-year increase 2.29 [95% CI 1.74-3.02]), baseline MMSE (HR = 0.94 [95% CI 0.89-0.99]), APOE ε4 in PD (HR 2.16 [95% CI 1.15-4.08]), and MAPT H1/H1 in PD (HR 2.08 [95% CI 1.08-4.00]). Hazards of dementia and death after delirium vs before delirium were increased (dementia: HR = 6.93 [95% CI 4.18-11.48] in parkinsonism; death: HR = 3.76 [95% CI 2.65-5.35] in PD, 1.59 [95% CI 1.04-2.42] in AP). Delirium is a common non-motor feature of PD and AP and is associated with increased hazards of dementia and mortality. Whether interventions for early identification and treatment improve outcomes requires investigation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flowchart.
Flowchart of study participation with reasons for non-participation and exclusion from analysis.
Fig. 2
Fig. 2. Development of delirium.
Kaplan–Meier probabilities of survival free of delirium (first hospital episode) in PD and atypical parkinsonism.
Fig. 3
Fig. 3. Outcomes after delirium.
a Kaplan–Meier probabilities of dementia-free survival after delirium in PD and atypical parkinsonism in those without dementia at time of delirium. b Kaplan–Meier probabilities of survival after delirium in PD and atypical parkinsonism.
See this image and copyright information in PMC

References

    1. Barron EA, Holmes J. Delirium within the emergency care setting, occurrence and detection: a systematic review. Emerg. Med. J. 2013;30:263–268. doi: 10.1136/emermed-2011-200586. - DOI - PubMed
    1. Vardy ER, Teodorczuk A, Yarnall AJ. Review of delirium in patients with Parkinson’s disease. J. Neurol. 2015;262:2401–2410. doi: 10.1007/s00415-015-7760-1. - DOI - PubMed
    1. Klein C, Prokhorov T, Miniovitz A, Dobronevsky E, Rabey JM. Admission of Parkinsonian patients to a neurological ward in a community hospital. J. Neural Transm. 2009;116:1509. doi: 10.1007/s00702-009-0302-1. - DOI - PubMed
    1. Woodford H, Walker R. Emergency hospital admissions in idiopathic Parkinson’s disease. Mov. Disord. 2005;20:1104–1108. doi: 10.1002/mds.20485. - DOI - PubMed
    1. Lawson RA, Richardson SJ, Yarnall AJ, Burn DJ, Allan LM. Identifying delirium in Parkinson disease: a pilot study. Int J. Geriatr. Psychiatry. 2020;35:547–552. doi: 10.1002/gps.5270. - DOI - PMC - PubMed