Early Assessment of Delirium in Elderly Patients after Hip Surgery

OBJECTIVE: This study is intended to identify predictive factors of delirium, including risk factors and prodromal symptoms. METHODS: This study included sixty-five patients aged 65 years or older who had undergone hip surgery. Baseline assessments included age; gender; admission type (acute/elective); reason for surgery (fracture/replacement); C-reactive protein (CRP); Acute Physiology, Age, Chronic Health Evaluation (APACHE III); and the Mini-Mental State Examination (MMSE). The Korean version of the Delirium Rating Scale-Revised-98 (K-DRS-98) was used to assess prodromal symptoms daily before the onset of delirium. RESULTS: Almost 28% (n=18) of the 65 patients developed delirium after surgery. Delirium in elderly patients after hip surgery was observed more often in older patients and those with acute admission, hip fracture, higher APACHE III score, lower MMSE score, and higher CRP levels within early days after the operation. Sleep-wake cycle disturbances, thought process abnormalities, orientation, and long-term memory in symptom items of K-DRS-98 were showed significant difference on 4 days before delirium, lability of affect on 3 days before, perceptual disturbances and hallucination, and visuo-spatial ability on 2 days before, and delusion, motor agitation, and short-term memory on the day before the occurrence of delirium. CRP levels within 24 hours and 72 hours after hospitalization were significantly higher in the delirium group. CONCLUSION: Medical professionals must pay attention to behavioral, cognitive changes and risk factors in elderly patients undergoing hip surgery and to the prodromal phase of delirium. K-DRS-98 may help in identifying the prodromal symptoms of delirium in elderly patients after hip surgery.

Comparison of Efficacy and Side Effects between Aripiprazole and Haloperidol in the Treatment of Delirium

OBJECTIVES: To compare the efficacy and the safety of aripiprazole and haloperidol in the treatment of patients with delirium. METHODS: 26 patients with delirium were randomized to receive either aripiprazole or haloperidol and finally 20 patients were analyzed. We collected demographic and clinical data. The Korean Version of Delirium Rating Scale-revised-98 (K-DRS-98) and Korean Version of Drug Induced Extrapyramidal Symptom Scale (DIEPSS-K) were assessed. Blood samples were collected to analyze serum sodium ion concentration, plasma cortisol and prolactin level and pulse oximetry was used for measuring oxygen saturation. RESULTS: K-DRS-98 severity scores decreased in both groups significantly over the study period, but no statistically significant difference was observed between the two groups. No significant extrapyramidal syndromes were noted in both groups, but the use of haloperidol was associated with increased plasma prolactin level (From 24.0+/-28.1 ng/mL to 32.0+/-20.0 ng/mL, p=0.005). CONCLUSION: Aripiprazole is as effective as haloperidol in the treatment of delirium and aripiprazole may be safer than haloperidol in that haloperidol is associated with increased plasma prolactin level.

Comparison of the Efficacy between Risperidone and Quetiapine in Elderly Patients with Delirium

OBJECTIVES: Many studies showed that risperidone and olanzapine in the treatment of delirium were similar to haloperidol, in side effects were superior to that. Quetiapine is frequently used in delirious patients. However, the studies of quetiapine in the treatment of delirium are very few. This study was designed to compare the efficacy of risperidone and quetiapine in elderly patients with delirium. METHODS: We divided 2 groups (risperidone and quetiapine) of elderly patients with delirium. We compared the two groups of elderly patients with delirium by Korean Version of Delirium Rating Scale (K-DRS) and Korean Mini-Mental State Examination (K-MMSE) at baseline and 1 week later. RESULTS: Our results showed that risperidone and quetiapine were efficacious in the treatment of elderly patients with delirium according to using K-DRS and K-MMSE. There were no significant differences in the degree of effects in both drugs. CONCLUSION: We compared the efficacy of risperidone and quetiapine in the treatment of delirium. Quetiapine was as efficacious as risperidone in the treatment of the elderly patients with delirium. In future, the sample size need to be increased in the studies of delirium. And the evaluation of long-term side effects related to quetiapine need to be performed.

A Validation Study for the Korean Version of Delirium Rating Scale-Revised-98 (K-DRS-98) / 신경정신의학

OBJECTIVE: This study was conducted to develop and to validate the Korean version of Delirium Rating Scale-Revised-98 (K-DRS-98), which is a scale for diagnosing delirium and evaluating its severity. METHOD: After developing the K-DRS-98, 102 patients were rated by it among 4 diagnostic groups, such as delirium (N=25), dementia (N=27), schizophrenia (N=25) and others (N=25). To test for reliability, K-DRS-98 was independently administered by two psychiatrist. To test for validity, Korean version of Mini-Mental State Examination (MMSE-K) and Clinical Global Impression (CGI) were administered simultaneously. Statistical analysis was done with SPSS window version 12 package and statistical significance was p<0.05. RESULT: Internal consistencies (Cronbach alpha) of two raters were 0.867 and 0.858, respectively. Inter-rater reliability (kappa) was 0.893 for severity items of K-DRS-98 and kappa value of diagnosis items was 0.969. In Delirium group, Pearson correlation coefficients (gamma) of K-DRS-98 were -0.682 for MMSE-K and 0.667 for CGI. In comparison Delirium group with Others, ANOVA post hoc multiple comparison LSD was statistically significant (p<0.001). The cutoff score to diagnosis of delirium can be recommended 16 for severity items and 21.5 for total score, respectively. CONCLUSION: The K-DRS-98 was showed good reliability and validity for the assessment of delirium. The K-DRS-98 is an easy and useful tool for diagnosing delirium and assessing its severity.