The Presence/Absence of an Awake-State Dominant EEG Rhythm in Delirious Patients Is Related to Different Symptoms of Delirium Evaluated by the Intensive Care Delirium Screening Checklist (ICDSC)

Abstract

(1) Background: Delirium is a serious condition in patients undergoing treatment for somatic diseases, leading to poor prognosis. However, the pathophysiology of delirium is not fully understood and should be clarified for its adequate treatment. This study analyzed the relationship between confusion symptoms in delirium and resting-state electroencephalogram (EEG) power spectrum (PS) profiles to investigate the heterogeneity. (2) Methods: The participants were 28 inpatients in a general hospital showing confusion symptoms with an Intensive Care Delirium Screening Checklist (ICDSC) score of 4 or above. EEG was measured at Pz in the daytime awake state for 100 s with the eyes open and 100 s with the eyes closed on the day of the ICDSC evaluation. PS analysis was conducted consecutively for each 10 s datum. (3) Results: Two resting EEG PS patterns were observed regarding the dominant rhythm: the presence or absence of a dominant rhythm, whereby the PS showed alpha or theta peaks in the former and no dominant rhythm in the latter. The patients showing a dominant EEG rhythm were frequently accompanied by hallucination or delusion (p = 0.039); conversely, those lacking a dominant rhythm tended to exhibit fluctuations in the delirium symptoms (p = 0.020). The other ICDSC scores did not differ between the participants with these two EEG patterns. (4) Discussion: The present study indicates that the presence and absence of a dominant EEG rhythm in delirious patients are related to different symptoms of delirium. Using EEG monitoring in the care of delirium will help characterize its heterogeneous pathophysiology, which requires multiple management strategies.

Keywords: Intensive Care Delirium Screening Checklist; delirium; dominant rhythm; electroencephalography; eyes opening and closing; hallucination or delusion; symptom fluctuation.

Figure 1

Different types of EEG power spectrum in sequential 10 s data at the parietal head position (Pz) in the eyes-open (Open) and -closed (Closed) conditions in two delirious patients. The data in the red line were inserted at the interval of 50 s. The arrow indicates the power spectrum peak at 8 Hz in a participant showing a dominant EEG rhythm (Dominant Rhythm (+)). No peak is present in the power spectrum of a participant without a dominant EEG rhythm (Dominant Rhythm (−)).

Figure 2

Total ICDSC scores of participants with (+) and without (−) dominant rhythm. Each filled circle indicates the individual data. The horizontal bar shows the average.

Figure 3

The numbers of participants scoring 1 or 0 for each ICDSC index: altered level of consciousness (Consciousness), inattention (Inattention), disorientation (Disorientation), hallucination or delusion (Delusion), psychomotor agitation or retardation (Psychomotor), inappropriate mood or speech (Inappropriate), sleep/wake cycle disturbance (Sleep/Awake), and symptom fluctuation (Fluctuation). The ICDSC score distribution (1 or 0) is shown as the number of participants with (black column) and without (white column) a dominant EEG rhythm. The differences were assessed using Fisher’s exact test. A significant difference (p < 0.05) is indicated as an asterisk at the right shoulder of the indices.