Category: Epidemiology
Objective: To explore (i) the incidence of, (ii) the risk factors for, and (iii) the outcomes after, the first hospital episode of delirium in both PD and atypical parkinsonism.
Background: The incidence, predictors and prognosis of delirium in PD and atypical parkinsonism are unclear.
Method: We studied delirium in the Parkinsonism Incidence in North-East Scotland (PINE) study, a prospective, community‐based incidence cohort of parkinsonism. Retrospective case note review identified the first hospital episode of delirium after parkinsonism diagnosis using a chart-based delirium definition.
Results: Of 296 patients (189 with Parkinson’s disease [PD], 107 with atypical parkinsonism [dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, vascular parkinsonism]), 152 developed delirium (PD=98, atypical parkinsonism=54) over median follow-up of 12 years. The incidence rate of first hospital delirium episode per 100 person years was 8.1 (95%CI 6.6-9.9) in PD and 18.5 (95%CI 13.9-24.7) in atypical parkinsonism. Predictors of delirium were atypical parkinsonism (HR vs PD=2.80, 95%CI 1.56-5.05), age (in PD but not atypical parkinsonism [HR=2.24, 95%CI 1.70-2.94]), baseline MMSE (HR=0.95, 95%CI 0.91-0.99). Development of dementia increased hazards of delirium (HR=1.89, 95%CI 1.25-2.84). In PD, APOE ε4 (HR 2.16, 95%CI 1.15-4.08) and MAPT H1/H1 (HR 2.08, 95%CI 1.08-4.00) predicted delirium. Median time from delirium to dementia was 2.8 years in PD and 1.8 years in atypical parkinsonism. Hazards of dementia after delirium vs before delirium were increased (HR=6.9, 95%CI 4.18-11.4). Median time from delirium to death was 2.0 years. Hazards of death after delirium vs before delirium were increased in PD (HR=3.89, 95%CI 2.72-5.55) and in atypical parkinsonism (HR=2.19, 95%CI 1.23-3.91).
Conclusion: Delirium is common in PD and atypical parkinsonism and is associated with increased dementia and mortality risk. Whether interventions for early identification and treatment improve outcomes requires investigation.
To cite this abstract in AMA style:
S. Green, A. McCleary, I. Sleeman, J. Maple-Grødem, C. Counsell, A. Macleod. The incidence, predictors, and outcomes of delirium in Parkinson’s disease and atypical parkinsonism [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/the-incidence-predictors-and-outcomes-of-delirium-in-parkinsons-disease-and-atypical-parkinsonism/. Accessed June 15, 2025.« Back to MDS Virtual Congress 2020
MDS Abstracts - https://www.mdsabstracts.org/abstract/the-incidence-predictors-and-outcomes-of-delirium-in-parkinsons-disease-and-atypical-parkinsonism/