Abstract
Introduction
Delirium is prevalent in patients with idiopathic Parkinson’s disease (iPD) who are admitted to hospital. The hypoactive subtype of delirium is associated with poorer outcomes in hospitalised patients The aim of this study was to evaluate different outcomes across delirium subtypes in unplanned hospital admissions in patients living with iPD
Methods
Data was collated prospectively on all patients with idiopathic Parkinson’s disease admitted to our hospital’s medical wards between 1st January 2019 and 30th March 2020. Electronic case-note review and in-person assessments were used to determine a diagnosis of delirium, the delirium subtype, and key outcomes including length of stay (LOS) and mortality. Data was analysed with respect to both index admissions and those readmitted during the study period.
Results
123 patients with iPD (male 52.8 %, mean age 77.9 years) accounted for 189 admissions. Delirium was present in 91/189 admissions (48%). There was no difference in Hoen & Yahr or Clinical Frailty Scale levels between groups with and without delirium. The prevalence of dementia was higher in the delirium group (48.3% vs 25.5%). Hypoactive delirium was the most common subtype (49.5%); hyperactive (13.2%), mixed (11%) and neutral (neither hypo- nor hyperactive) 26.4%. 12-month mortality in the index admissions was highest in the hypoactive subtype (57.1%). Median LOS (all admissions) was 11.5 days in patients with delirium vs 5.5 days in those without. A mixed delirium phenotype had longest LOS (mean 30.7 days) compared with other subtypes.
Conclusions
The hypoactive subtype of delirium predominates in hospitalised patients with iPD. Length of stay was longest in those experiencing a mixture of hyperactive and hypoactive subtypes, and mortality was highest in the hypoactive group. Healthcare settings need robust systems screening for delirium in Parkinson’s patients, with prevention and management processes to reduce morbidity and mortality in this complex group.