Delirium other diagnostic studies
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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 maybe helpful for the diagnosis of delirium. EEG findings associated with delirium include 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.
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]
- Delirium has been known to be associated with a generalised slowing of background activity.[6][7]
- The relative power of the theta frequency and alpha frequencies was consistently different between delirium and non-delirium patients.
Lumbar puncture
- Routine LP does not provide any benefit in management of delirium. However,it maybe helpful in suspected meningitis when confusion is accompanied with:[8]
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) - ↑ Warshaw, G. (1993). "The effectiveness of lumbar puncture in the evaluation of delirium and fever in the hospitalized elderly". Archives of Family Medicine. 2 (3): 293–297. doi:10.1001/archfami.2.3.293. ISSN 1063-3987.