Objective: To establish documentation, assessment and diagnosis practices in the medical notes of inpatients with Parkinson’s disease (PD) and delirium.
Background: Delirium is a neuropsychiatric syndrome characterised by altered level of consciousness, confusion and impaired attention. Patients with PD may be at increased risk of developing delirium. The DETERMINE-PD study identified that delirium is common in PD inpatients, but delirium is commonly missed.
Method: The DETERMINE-PD pilot study assessed patients with PD admitted over a 4-month period. Incident delirium was diagnosed using detailed clinical vignettes complied from participants’ medical notes, study assessments in a single research visit and a collateral history from family or informal carers, and a validated consensus method. Inpatient medical notes of those with possible or probable delirium were reviewed for documentation of delirium symptoms, delirium diagnoses and discharge summaries were reviewed.
Results: Thirty (56.6%) admissions had possible or probable delirium during their inpatient stay. Delirium symptoms were documented in 21 (72.3%) admissions; 11(37.9%) patients had a delirium diagnosis documented. Diagnosis was more frequently made in older patients (p=0.027). There was no association between delirium and previous cognitive impairment (ꭓ2=1.0, p=0.79) or length of hospital stay (median= 8.0 vs 15.0 days, p=0.171). Time from documentation of symptoms to diagnosis ranged from within 24 hours to 7 days (mean 1.6±4.4 days). For 11 patients resolution of symptoms was documented and length of delirium ranged from 1-15 days (median 3 days), accounting for a median of 28.6% of their total hospital stay. Discharge summaries included diagnosis of delirium in 3 (11.5%) admissions and a relevant follow-up plan in 2 (7.7%).
Conclusion: Although delirium is common in PD patients, documentation of delirium is poor. Documentation of symptoms is more common, but this is still frequently failing to lead to a formal diagnosis. Our findings have identified the need to improve our knowledge on the incidence and prevalence of delirium in PD. This could reduce its impact on morbidity and mortality, and improved handover of this information could help identify patients at greater risk of dementia. Future work is required to develop education and screening tools on PD and delirium.
References: Lawson, Rachael & Richardson, Sarah & Yarnall, Alison & Burn, David & Allan, Louise. (2020). Identifying delirium in Parkinson disease: A pilot study. International Journal of Geriatric Psychiatry. 10.1002/gps.5270.
To cite this abstract in AMA style:
R. Cullinan, S. Richardson, A. Yarnall, D. Burn, L. Allan, R. Lawson. Identification and Documentation of Delirium in Parkinson’s Disease [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/identification-and-documentation-of-delirium-in-parkinsons-disease/. Accessed June 15, 2025.« Back to MDS Virtual Congress 2020
MDS Abstracts - https://www.mdsabstracts.org/abstract/identification-and-documentation-of-delirium-in-parkinsons-disease/