title: Severe, Persistent and Fatal Delirium in Psychogeriatric Patients Admitted to a Psychiatric Hospital.
abstract: OBJECTIVE
  Although delirium is generally regarded as a transient syndrome, persistence of delirium in patients with cognitive impairment - even with fatal outcome - has been reported as well. This study aims to describe the clinical features and neuropathological correlates of this type of delirium.
  
  
  METHODS
  Inclusion criteria for this case series were: (1) severe persistent delirium until death, (2) history of cognitive decline and (3) consent for brain autopsy. Medical records were examined in combination with collected clinical data and neuropathological findings.
  
  
  RESULTS
  In 15 patients, all living at home before admission, episodes with delirium lasted for 4.2 months on average. No distinct medical causes of persistent delirium could be identified. Pathological diagnoses included Alzheimer's disease and dementia with Lewy bodies as well as single cases of Creutzfeldt-Jakob disease and progressive supranuclear palsy.
  
  
  CONCLUSIONS
  Severe, persistent and fatal delirium in patients with cognitive impairment can occur relatively early in the disease trajectory and is associated with diverse neuropathologies.
authors.affiliation: Psychogeriatric Observation Unit, Institution for Mental Health Care 'Dijk en Duin', Parnassia Groep, Castricum, The Netherlands.
authors.forename: Ingrid S
authors.initials: IS
authors.lastname: Jans
authors.affiliation: Psychogeriatric Observation Unit, Institution for Mental Health Care 'Dijk en Duin', Parnassia Groep, Castricum, The Netherlands.
authors.forename: Letty
authors.initials: L
authors.lastname: Oudewortel
authors.affiliation: Psychogeriatric Observation Unit, Institution for Mental Health Care 'Dijk en Duin', Parnassia Groep, Castricum, The Netherlands.
authors.forename: Paulien M
authors.initials: PM
authors.lastname: Brandt
authors.affiliation: Psychogeriatric Observation Unit, Institution for Mental Health Care 'Dijk en Duin', Parnassia Groep, Castricum, The Netherlands ; Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: van Gool
keywords: Alzheimer's disease; Delusions; Dementia; Dementia with Lewy bodies; Hallucinations; Neuropathology; Persistent delirium; Severe delirium; Treatment