Impact of delirium on decision-making capacity after hematopoietic stem-cell transplantation.
BACKGROUND
Delirium is a common complication of myeloablative hematopoietic stem-cell transplantation (HSCT), yet no studies have explored the later effects of an episode of delirium in this setting on patients' decision-making capacity after the acute symptoms of delirium have resolved.


OBJECTIVE
The authors assessed the impact of delirium during the acute phase of myeloablative HSCT on later decision-making capacity.


METHODS
Decision-making capacity was assessed with the MacArthur Competence Assessment Tool in 19 patients before they received their first HSCT and at 30 and 80 days post-transplantation. Delirium was assessed 3 times per week with the Delirium Rating Scale and the Memorial Delirium Assessment Scale from 7 days pre-transplantation through 30 days post-transplantation.


RESULTS
Although there was little variance in the pre-treatment scores, with most patients showing very high or perfect scores on decision-making abilities, a multivariate regression model showed that delirium was predictive of a lower reasoning score at Day 30 post-transplantation.


CONCLUSIONS
Patients who experienced a delirium episode during the acute phase of HSCT were not likely to develop clinically meaningful impairments in decision-making capacity post-transplantation, although they evidenced minor impairment in their reasoning ability.
Zaubler
Thomas
T
Morristown Memorial Hospital, 100 Madison Ave., Morristown, NJ 07962, USA. thomas.zaubler@atlantichealth.org
Fann
Jesse R
JR
Roth-Roemer
Sari
S
Katon
Wayne J
WJ
Bustami
Rami
R
Syrjala
Karen L
KL
D000328:Adult; D003657:Decision Making; D003693:Delirium / Q000209:etiology* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000523:psychology*; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000523:psychology*; D008875:Middle Aged; D011446:Prospective Studies