Early symptoms in the prodromal phase of delirium: a prospective cohort study in elderly patients undergoing hip surgery.
OBJECTIVE
The authors investigated prodromal delirium symptoms in elderly patients undergoing hip surgery.


METHODS
This was a prospective cohort study in the setting of a large medical school-affiliated general hospital in Alkmaar, The Netherlands. Participants were patients undergoing hip surgery aged 70 and older at risk for delirium. Before surgery, patients were randomized to low-dose prophylactic haloperidol treatment or placebo. Daily assessments were based on patient interviews with the Mini-Mental State Examination and Digit Span test. The Delirium Rating Scale-Revised (DRS-R-98) was used to measure early symptoms during the prodromal phase before the onset of delirium.


RESULTS
Data of 66 patients with delirium were compared with those of 35 at-risk patients who did not develop delirium: 14 of 66 patients (21%) had delirium on the day of surgery or early the day after, 32 of 66 (48%) on the second day, 14 of 66 on the third, and six of 66 (9%) on the fourth. The average DRS-R-98 total scores on day -4 to day -1 before delirium were 1.9 for the comparison group patients and 5.0, 4.3, 5.8, and 10.7 for patients with postoperative delirium. Multivariate analysis showed that the early symptoms memory impairments, incoherence, disorientation, and underlying somatic illness predict delirium.


CONCLUSIONS
Most elderly patients undergoing hip surgery with postoperative delirium already have early symptoms in the prodromal phase of delirium. These findings are potentially useful for screening purposes and for optimizing prevention strategies targeted at reducing the incidence of postoperative delirium.
de Jonghe
Jos F M
JF
Department of Clinical Psychology, Medical Center Alkmaar, Alkmaar, The Netherlands. j.de.jonghe@mca.nl
Kalisvaart
Kees J
KJ
Dijkstra
Marty
M
van Dis
Huib
H
Vreeswijk
Ralph
R
Kat
Martin G
MG
Eikelenboom
Piet
P
van der Ploeg
Tjeerd
T
van Gool
Willem A
WA
D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis* / Q000188:drug therapy; D004311:Double-Blind Method; D042241:Early Diagnosis; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D011183:Postoperative Complications / Q000175:diagnosis* / Q000188:drug therapy; D011292:Premedication; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors
D014150:Antipsychotic Agents; D006220:Haloperidol