Brain Imaging in Older Patients With Delirium

Abstract

Background: Delirium is common, serious and costly condition in older patients admitted to the hospital. This study describes the prevalence and results of brain imaging among a cohort of older hospitalized patients with and without delirium. Research Question: To investigate the frequency and results of brain imaging in older patients with delirium as compared to those without delirium. Methods: This was a cross sectional study. Data was collected on hospitalized patients aged 65 year and older who were admitted to 3 hospitals in Milwaukee, WI during a one month period in the fall of 2013. Subjects were tested for delirium via the “Confusion Assessment Method” by researchers for another study. The collected data included demographics, presence of delirium, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and results of the imaging procedures. The imaging studies were done as a part of their medical care. The authors reviewed the radiologist's final readings of the imaging studies. For all category variables chi square/Fisher test was used with alpha 0.05. Results: A total of 92 patients were included in the study. The prevalence of delirium was 17.4%. The mean age was 77 years. Overall, 24% had a CT and 9% an MRI with the most common abnormal finding being chronic microvascular changes, 13%. CT scan was performed in 44% of patients with delirium and 20% of patients without delirium (p=0.041). MRI was performed in 0 patients with delirium and 11% without delirium (p=0.34). When patients with delirium were compared with patients without delirium: normal imaging was described in 1 vs.2 patients (p= 0.70); cerebral atrophy in 3 vs. 6 (p=0.99); chronic microvascular changes in 2 vs. 10 (p=0.17; acute hematoma (subdural or intraparenchymal) in 3 (43%) vs. 0 (p=0.02). Conclusion: In this limited study, patients with delirium were noted to be more likely to have had a CT scan. Older patients with delirium had a variety of findings on brain imaging, some of which were more clinically relevant. No specific imaging changes were diagnostic for delirium. There are some limitations to this study. Data was collected during a one month only and were limited to that available on ACE Tracker.