Characterizing Delirium in a Parkinson’s Disease Population: Demographics, Common Etiologies and Co-Morbidities at a Single Institution
Phil Schmitt1, Megan Coghlan1, James Reid Johnson1, Jess Fulkerson1, Satya Alluri1, Victoria Holiday1, Peter Hedera1
1University of Louisville School of Medicine
Objective:
This study aims to evaluate factors associated with episodes of delirium in a large single-institution cohort of patients with Parkinson's Disease (PD).
Background:
Literature suggests patients with Parkinson’s Disease (PD) are at increased risk of delirium. Despite being at an apparent increased risk and worse health outcomes, there is a paucity of information on predictive factors for delirium in patients with PD.
Design/Methods:
This was a single-center, IRB-approved retrospective cohort study. Patients with ICD-10 diagnoses of Parkinson’s Disease in the University of Louisville Hospital system were identified via billing tracing. Patient records were reviewed for diagnoses of delirium/encephalopathy, or for neuropsychiatric episodes meeting the DSM-V criteria for delirium. Data at time of episode(s) was collected, including demographics, ICD-10 coding, medications, and neuropsychiatric co-morbidities at time of episode, and date of PD diagnosis.
Results:
40/625 (6.5%) pts with PD diagnosis met inclusion criteria for an episode of delirium, of which 18/40 (45%) carried an ICD-10 code of delirium or encephalopathy at time of episode. Average age of first episode was 70.72, mean 3.67 years following PD diagnosis. Average number of medications was 8.2, and average dose of PD medication in levodopa equivalents at first episode was 656.3 mg. Most common presenting symptoms of first episode were altered mental status (18%) and hallucinations (18%). Most common identifiable etiologies were medication changes (25%) and UTI/urosepsis (20%). 14/40 (35%) patients had pre-existing mood disorder and 9/40 (23%) had PD dementia. Zero patients had neurostimulators.
Conclusions:
In this retrospective study of a PD population, factors more associated with episodes of delirium include pre-existing mood disorder, PD dementia, UTI and medication changes. Many episodes did not include an ICD-10 code of delirium/encephalopathy in their diagnosis, reinforcing that delirium is under-diagnosed in patients with PD.