A systematic review of studies reporting on neuropsychological and functional domains used for assessment of recovery from delirium in acute hospital patients

• Published in: International journal of geriatric psychiatry 2023-06, Vol.38 (6), p.e5943-n/a
• Main Authors: McCartney, Haruno, Noble, Erin, MacLullich, Alasdair M. J., Davis, Daniel H. J., Evans, Jonathan, Shenkin, Susan D., Muniz‐Terrera, Graciela, Sandeman, Daisy, Tieges, Zoë
• Format: Article
• Language: English
• Subjects: 4AT; Arousal; Clinical trials; Cognition; Delirium; delirium assessment; delirium recovery; functional recovery; Geriatric psychiatry; Longitudinal studies; neuropsychological domains; Neuropsychology; Patients; Recovery of function; repeat assessment; Systematic review
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.5943

Objectives Assessing for recovery in delirium is essential in guiding ongoing investigation and treatment. Yet, there is little scrutiny and no research or clinical consensus on how recovery should be measured. We reviewed studies which used tests of neuropsychological domains and functional ability to track recovery of delirium longitudinally in acute hospital settings. Methods/Design We systematically searched databases (MEDLINE, PsycInfo, CINAHL, Embase, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials), from inception to October 14th, 2022. Inclusion criteria were: adult acute hospital patients (≥18 years) diagnosed with delirium by a validated tool; 1+ repeat assessment using an assessment tool measuring domains of delirium/functional recovery ≤7 days from baseline. Two reviewers independently screened articles, performed data extraction, and assessed risk of bias. A narrative data synthesis was completed. Results From 6533 screened citations, we included 39 papers (reporting 32 studies), with 2370 participants with delirium. Studies reported 21 tools with an average of four repeat assessments including baseline (range 2–10 assessments within ≤7 days), measuring 15 specific domains. General cognition, functional ability, arousal, attention and psychotic features were most commonly assessed for longitudinal change. Risk of bias was moderate to high for most studies. Conclusions There was no standard approach for tracking change in specific domains of delirium. The methodological heterogeneity of studies was too high to draw firm conclusions on the effectiveness of assessment tools to measure delirium recovery. This highlights the need for standardised methods for assessing recovery from delirium. Key points Assessing for recovery is an essential part of delirium care, to guide clinicians' ongoing investigation and treatment and to provide accurate information to patients and carers. It is unclear what assessment tools are used to measure delirium recovery on a longitudinal basis, specifically which neuropsychological and functional domains should be assessed. A total of 21 assessment tools measuring 15 different symptom domains of delirium were used in the included studies, however, there was no standard approach for tracking change in these domains over time. The symptom domains most frequently assessed for longitudinal change in the included studies were general cognition, functional ability, arousal, attention and psychotic feature