Delirium and functionality: The impact of delirium on the level of functioning

Background and Objectives: Studies have shown showed that delirium affects the long-term functional status, however, the acute effect of delirium on functioning has been less documented. The purpose of this analysis was to examine the acute impact of delirium on the level of functioning. Methods: All patients were recruited at the Memorial Sloan Kettering Cancer Center (MSKCC). The Memorial Delirium Assessment Scale (MDAS) and Karnofsky scale of Performance Status (KPS) were recorded at baseline (T1), 2-3 days (T2) and 4-7 days (T3). A secondary analysis in respect to sociodemographic and medical variables, aspects of delirium, and level of functioning was performed. Results: Delirium severity at baseline did not affect the level of functioning, however, resolved delirium resulted in substantial functional recovery compared to persistent delirium at T2 (30.2 and 23.5) and T3 (35.1 and 26.2). Patients with persistent functional impairment were not different in age, pre-existing dementia or brain metastasis compared to those with functional recovery. However, brain cancer, terminal illness, hypoxia and multiple etiologies caused persistent functional decline. Although delirium severity was not different at baseline, delirium was more severe in the functionally-impaired at T2 and T3. Similarly, delirium resolution was inferior in these patients in contrast to the functionally-recovered at T2 (25% and 65.4%) and T3 (62.5% and 83.3%). On the contrary, the duration of delirium affected functional recovery; shorter delirium predicted faster functional recovery. Conclusions: Delirium caused an acute functional decline and appropriate management of delirium with antipsychotics reversed this decline. On the contrary, shorter duration of delirium was associated with faster functional recovery. Brain cancer, terminal illness, hypoxia, and multiple etiologies were confounders for persistent delirium and functional impairment. DOI: https://doi.org/10.4321/S0213-61632014000200002 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-108012 Published Version Originally published at: Boettger, Susanne; Breitbart, William; Jenewein, Josef; Boettger, Soenke (2014). Delirium and functionality: The impact of delirium on the level of functioning. European Journal of Psychiatry, 28(2):86-95. DOI: https://doi.org/10.4321/S0213-61632014000200002 Eur. J. Psychiat. Vol. 28, N.° 2, (86-95) 2014