Etiologic and outcome profiles in hypoactive and hyperactive subtypes of delirium.

The existence of hyperactive, hypoactive, or mixed clinical subtypes of delirium is widely accepted. But relationships between these motor profiles and etiology or outcome remain unclear. The aim of this study was to compare etiologic and outcome profiles in a case series of 183 elderly patients (mean age = 84.1 years, SD = 5.9) consecutively admitted into the geriatric wards of two French university hospitals or referred to a geriatric psychiatry consultation-liaison unit within a Swiss university hospital. All patients met DSM-III-R criteria for delirium and were classified into clinical subtypes according to the results of a previous factor analysis of scores on a 19-item checklist rating a wide range of delirium symptoms. The hyperactive subtype was more frequent (n = 85, 46.5%) than the unspecified (n = 50, 27.3%) and hypoactive subtypes (n = 48, 26.2%). There was no significant difference in terms of etiologic or outcome profile between clinical subtype groups. The presence of acute metabolic disorders, cardiovascular disease, and hyperthermia as etiologic factors was significantly associated with full recovery of the episode at 3 weeks follow-up, whereas probable preexisting dementia was significantly associated with partial recovery or failure to recover.

[Anatomoclinical and angiographic study of a case of disseminated thromboangiosis with predominant cerebral manifestations]. / Etude anatomoclinique et angiographique d'une observation de thromboangiose disséminée à manifestations cérebrales prédominantes

The authors describe the case of a patient of 22 with hypertension and livedo reticularis who, after presenting with a left brachial monoparesis became progressively demented over a period of five years and died at the age of 27 from a cerebro-meningeal haemorrhage. Angiographically, diffuse distal obliteration of the cerebral arteries was seen with deep networks of the moyamoya type involving the lenticulostriate arteries; similar changes were present in the upper left limb. Histopathological investigations showed obliterative thromboangiitis affecting not only the cerebrum, the brain stem and the cerebellum, but also the viscera. Analysis of this case and consideration of the theoretical possibilities leads the authors to urge that thromboangiosis together with its cerebral manifestations should be considered a nosological entity.

[Study of the reference values and nyctohemeral cycle of serum iron]. / Etude des valeurs de référence et du cycle nycthéméral du fer sérique.

Marked variations in the same individual of serum iron levels may be due to a circadian rhythm. We determined the reference values of serum iron in a population of blood donors who had no blood disease. The very wide reference interval found (0.47 to 1.75 mg/l in man and 0.36 to 1.66 mg/l in women) was due to physiological variations rather than analytical variations. We also demonstrated in individuals with a normal life rhythm, a circadian rhythm for iron with maximal levels in the morning (8 to 12) and minimal levels in the evening (8 p.m. to midnight) the ratio of these levels is usually between 1.5 and 2, but may reach much higher figures. On the other hand, the total fixation capacity varies little over 24 hours. In night workers, one may note a displacement of the cycle with a maximum towards 8 p.m. a minimum at 8 a.m. In diabetics, the circadian rhythm exists but with a lower amplitued than in healthy subjects. In a few cases a hemochromatosis, one may note disappearance of the cycle.

[Confusion syndromes in hospitalized aged patients: polymorphism of symptoms and course. Prospective study of 183 patients]. / Les syndromes confusionnels du sujet âgé hospitalisé: polymorphisme sémiologique et évolutif. Etude prospective de 183 patients.

Using explicit criteria contained in the DSM III R, we collected in a prospective cohort study clinical features, outcome and risk factors from two cohorts of delirium in hospitalized elderly patients: 138 hospitalized in geriatric department and 45 patients admitted to an acute and comprehensive care hospital. The clinical features were assessed using a quantitative scale (developed by Derouesné). Delirium was unrecognized or misdiagnosed by physicians in 34% of the cases. The onset was known only two thirds of cases. The incidence of hyperactive type, prolonged hospital stay, poor outcomes (persistent delirium leading up to dementia) were highest in subjects admitted in comprehensive hospital. The etiology of delirium is complex and multifactorial. An underlying cause was identified in 80% of patients. The length or the worsening of delirium was significantly higher in patients with psychiatric or dementia comorbidity (OR: 0.2; IC 95%: 0.1-0.5). The prognosis was better in patients without psychoactive medications (OR: 0.2; IC 95%: 0.1-0.4) or with metabolic abnormalities or acute diseases and disorders (OR: 3.3; IC 95%: 1.5-7.6). The predisposing factors to the development of dementia were prior use of psychoactive medications and signs of prior cognitive impairment. This article suggests delirium in elderly patients is associated with several outcomes. The prognosis should be improved at admission by specific scale and an evaluation of predisposing and precipitating factors.

[Combined therapies in family practice and hospitals. A controlled clinical study of a population of 162 patients with criteria of age-related memory disorders]. / Thérapies combinées en médecine praticienne et hospitalière. Etude clinique contrôlée d'une population de 162 sujets répondant aux critères des troubles de la mémoire liés à l'âge (AAMI).

OBJECTIVES: To assess the combination of drug and cognitive therapy on age-associated memory impairment (AAMI). PATIENTS AND METHODS: A double-blind randomized trial was performed involving 162 patients with age-associated memory impairment selected and followed by their general practitioners. Two intervention methods-a drug and a cognitive therapy-were assessed in combination. Three randomized parallel groups of 54 patients each, aged 55 years and over, were followed and treated for 3 months. After a placebo washout period of 10 days, one group received 2.4 g of piracetam, another group, 4.8 g and the third, a placebo. RESULTS: A total of 135 patients, 45 in each group, completed the study. Combined therapy was most effective in patients whose baseline performance on memory tests was lowest. The best results were observed with piracetam combined with memory training. This result confirmed by the global impression of the principal investigator was in agreement with findings of previous double-blind placebo-controlled trials assessing the combined effect of drug treatment and memory training. CONCLUSION: This result confirmed by the global impression of the principal investigator was in agreement with findings of previous double-blind placebo-controlled trials assessing the combined effect of drug treatment and memory training.

Drug therapy and memory training programs: a double-blind randomized trial of general practice patients with age-associated memory impairment.

A double-blind randomized trial was performed involving 162 patients with age-associated memory impairment (AAMI) selected and followed by their general practitioners. Two intervention methods--a drug and a cognitive therapy--were assessed in combination. Three randomized parallel groups of 54 patients each, aged 55 years and over, were followed and treated for 3 months. After a placebo wash-out period of 10 days, one group received 2.4 g of piracetam, another group, 4.8g, and the third, a placebo. A total of 135 patients, 45 in each group, completed the study. Combined therapy was most effective in patients whose baseline performance on memory tests was lowest. The best results were observed with 4.8 g of piracetam, especially when training sessions began after 6 weeks of drug treatment. This result was confirmed by the global impression of the principal investigator.

Factor analysis supports the evidence of existing hyperactive and hypoactive subtypes of delirium.

OBJECTIVE: The aim of this study was to examine whether delirium has specific clinical subtypes. METHOD: One hundred and eighty-three elderly subjects meeting DSM-IIIR criteria for delirium were evaluated using a 19-item symptom check-list assessing different dimensions of delirium symptomatology. Exploratory factor analysis was conducted in order to examine which symptoms clustered. RESULTS: Factor analysis confirmed the existence of two different clusters of symptoms: first, symptoms of hyperalert/hyperactive features (agitation, hyper-reactivity, aggressiveness, hallucinations, delusions); and second, symptoms of hypoalert/hypoactive features (decreased reactivity, motor and speech retardation, facial inexpressiveness). CONCLUSION: This preliminary study seems to support the evidence of hypoactive and hyperactive subtypes of delirium, even though their aetiology and prognostic values need to be further examined.