brain, imaging, older patients, delirium, hospitalization, diagnosis
Background: Delirium is a common, serious and costly condition in older patients admitted to the hospital. This study describes the prevalence and results of brain imaging among a cohort of older hospitalized patients with and without delirium.
Purpose: Investigate the frequency and results of brain imaging in older patients with delirium as compared to those without delirium.
Methods: This was a cross-sectional study. Data were collected on hospitalized patients age 65 years or older who were admitted to 3 hospitals in Milwaukee, Wisconsin, during a 1-month period in the fall of 2013. Subjects were tested for delirium via the “Confusion Assessment Method” by researchers for another study. The collected data included demographics, presence of delirium, computed tomography (CT) and magnetic resonance imaging (MRI), and results of the imaging procedures. The imaging studies were done as a part of their medical care. The authors reviewed the radiologist’s final readings of the imaging studies. For all categorical variables, chi-squared/Fisher’s test was used with alpha of 0.05.
Results: A total of 92 patients were included in the study. Prevalence of delirium was 17.4%. Mean age was 77 years. Overall, 24% had a CT and 9% an MRI, with the most common abnormal finding being chronic microvascular changes (13%). CT scan was performed in 44% of patients with delirium and 20% of patients without delirium (P = 0.04). MRI was performed in zero patients with delirium and 11% without delirium (P = 0.34). When patients with delirium were compared with patients without delirium, respectively: normal imaging was described in 1 vs 2 patients (P = 0.70); cerebral atrophy in 3 vs 6 (P = 0.99); chronic microvascular changes in 2 vs 10 (P = 0.17); and acute hematoma (subdural or intraparenchymal) in 3 (43%) vs 0 (P = 0.02).
Conclusion: In this limited study, patients with delirium were noted to be more likely to have had a CT scan. Older patients with delirium had a variety of findings on brain imaging, some of which were more clinically relevant. No specific imaging changes were diagnostic for delirium.
Hasan LM, Khan A, Singh M, Malone ML. Brain imaging in older patients with delirium. J Patient Cent Res Rev. 2017;4:261.