title: Screening methods for delirium: early diagnosis by means of objective quantification of motor activity patterns using wrist-actigraphy.
abstract: Delirium after cardiac surgery is a risk factor for adverse outcome and even death. Disturbance of motor activity is a core feature of delirium, but hypoactive delirium often remains unrecognized. We explored wrist-actigraphy as a tool to objectively quantify postoperative recovery of 24-h rest-activity patterns to improve the early recognition of delirium after surgery. Motor activity was recorded by wrist-actigraphy after cardiac surgery in 88 patients over 65 years of age. Patients were assessed daily by using the CAM-ICU. Our final analyses were based on 32 non-delirious patients and 38 patients who were delirious on the first day after surgery. The delirious patients showed lower mean activity levels during the first postoperative night (P<0.05), reduced restlessness during the first day (P<0.05), and a lower mean activity of the 5 h with lowest activity within the first 24 h (P=0.01), as compared to the non-delirious patients. Already at a very early stage after cardiac surgery, a difference in motor activity was observed between patients with and without a delirium. As an unobtrusive method, actigraphy has the potential to be a screening method that may lead to early diagnosis and treatment of delirium.
authors.affiliation: Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. r.osse@erasmusmc.nl
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: Osse
authors.forename: Joke H M
authors.initials: JH
authors.lastname: Tulen
authors.forename: Michiel W
authors.initials: MW
authors.lastname: Hengeveld
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
mesh_terms: D000054:Acceleration; D000368:Aged; D001696:Biomechanical Phenomena; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003693:Delirium / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D009043:Motor Activity; D011184:Postoperative Period; D011237:Predictive Value of Tests; D013997:Time Factors; D014953:Wrist / Q000503:physiopathology*