الفهرس 
Delirium and its subtypesOnly 14 pages are availabe for public view
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Abstract
Delirium is associated with adverse outcomes including more prolonged hospitalisation, institutionalisation , increased mortality and cognitive impairement. This study aimed to assess cognitive decline in different delirium subtypes (hyperactive, hypoactive, mixed and no subtype) and the possible relationship between level of serum S100B, delirium subtypes
and cognitive decline. Another aim was added involving assessment of outcome for 17 delirious patients at 1 month. This study enrolled 35 delirious patients. Their age range between
18-40 years old and both sexes were included. They experienced delirium due to neoplasm (extracranial), traumatic brain injury (TBI) and post hip replacement surgery. 2 control groups, group (B) comprised 10 patients diseased but without delirium and group (C) comprised 10 normal healthy subjects. All participants were evaluated through the questionnaire included data regarding demographic characteristics, mode and history of illness, current medications, clinical findings and laboratory investigations. Patients fulfilled the criteria for diagnosis of delirium according to DSMIVTR, Delirium Symptom Interview (DSI) for screening and assess severity of delirium, Cognitive Test for Delirium (CTD) to assess 5 neuropsychological domains (orientation, attention, memory, comprehension and vigilance), The Delirium Motor Subtypes Scale (DMSS) for rating delirium into hyperactive, hypoactive, mixed and no
subtype, Trail Making Test Parts A and B (TMT) Part A to measure
psychomotor speed and attention. Part B assess switching attention
and finally serum biomarker S100B was measured in the venous blood
samples were drawn in the morning.
The main findings of the present study were as follow:
• Socio-demographic data
The study showed no statistically significant difference between
delirium patients, diseased patients without delirium and normal healthy
subjects regarding age, gender, level of education, marital status and
occupation.
• Mode of delirium onset
In the current study, there was a significant difference between the
mode of delirium onset regarding different etiological groups (post hip
replacement surgery, traumatic brain injury and neoplasm).
•Pattern of delirium symptoms in delirium subtypes
In the present study, the severity of delirium showed no significant
difference across 4 subtype groups. Sleep–wake cycle disturbance
occurred in 92% of patients followed by disturbance of consciousness
and disorientation occured in 81% of patients, incoherent speech
occurred in 77% of the patients, fluctuating behavior occurred in 68% of
the patients, level of psychomotor activity occurred in 62% of the patients
while perceptual disturbance occured in 46% of patients.
• Pattern of cognitive dysfunction in delirium subtypes
The level of cognitive dysfunction in delirious patients was
significantly higher than the level of cognitive dysfunction in the 2
control groups. The level of cognitive dysfunction was not significantly
different across 4 subtype groups. Attention impairement occurred in
(96%) of patients followed by impaired vigilance occurred in (92%) of
patients, disorientation occurred in (80%), memory impairement
occurred in (78%) of the patients, and less affected domains was
comprehension occurred in (77% ) of the patients. Attention impairement
showed no significant difference across 4 subtype groups. The
impairement of switching attention was significantly difference between
delirious patients and other 2 control groups but was not significantly
different across 4 delirium subtypes.
• Level of serum S100B in all participants
In the present study, the level of serum S100B was significantly
higher in delirious patients than the 2 control groups but was not
significant different across 4 delirium subtypes. The cut-off point of
serum level of S100B ≥ 0.13 ug/l which may predict the development of
delirium in patients with traumatic brain injury, post hip replacement
surgery and neoplasm (extracranial).
The level of serum S100B was not related to the degree of delirium
severity nor to the degree of cognitive dysfunction in delirious patients.
The level of serum S100B was not significantly different across
etiological groups of delirium.
• Outcome of delirium at 1 month
Full recovery from delirium occurred in 66.7% from no subtype
group followed by 33.3% from hyperactive group and no patients from
mixed or hypoactive groups achieved full recovery. No recovery
occurred in 66.7% of patients in hypoactive group and 33.3% in
hyperactive group. The number of died patients was 3 patients from
hypoactive group only. There was a significant improvement of delirium
severity with better cognitive functions and attention at 1 month of
follow up period.
• Risk factors for delirium
The high level of serum S100B, high score of Delirium Symptom
Interview (DSI), the severity of cognitive impairement, the level of
impairement of attention and psychomotor speed and the level of
Summary.