Advancing specificity in delirium: The delirium subtyping initiative
Bowman, Emily M L; Brummel, Nathan E; Caplan, Gideon A; Cunningham, Colm; Evered, Lis A; Fiest, Kirsten M; Girard, Timothy D; Jackson, Thomas A; LaHue, Sara C; Lindroth, Heidi L; Maclullich, Alasdair M J; McAuley, Daniel F; Oh, Esther S; Oldham, Mark A; Page, Valerie J; Pandharipande, Pratik P; Potter, Kelly M; Sinha, Pratik; Slooter, Arjen J C; Sweeney, Aoife M; Tieges, Zoë; Van Dellen, Edwin; Wilcox, Mary Elizabeth; Zetterberg, Henrik; Cunningham, Emma L
(2024) Alzheimer's & Dementia, volume 20, issue 1, pp. 183 - 194
(Article)
Abstract
BACKGROUND: Delirium, a common syndrome with heterogeneous etiologies and clinical presentations, is associated with poor long-term outcomes. Recording and analyzing all delirium equally could be hindering the field's understanding of pathophysiology and identification of targeted treatments. Current delirium subtyping methods reflect clinically evident features but likely do not account for
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underlying biology. METHODS: The Delirium Subtyping Initiative (DSI) held three sessions with an international panel of 25 experts. RESULTS: Meeting participants suggest further characterization of delirium features to complement the existing Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision diagnostic criteria. These should span the range of delirium-spectrum syndromes and be measured consistently across studies. Clinical features should be recorded in conjunction with biospecimen collection, where feasible, in a standardized way, to determine temporal associations of biology coincident with clinical fluctuations. DISCUSSION: The DSI made recommendations spanning the breadth of delirium research including clinical features, study planning, data collection, and data analysis for characterization of candidate delirium subtypes. HIGHLIGHTS: Delirium features must be clearly defined, standardized, and operationalized. Large datasets incorporating both clinical and biomarker variables should be analyzed together. Delirium screening should incorporate communication and reasoning.
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Keywords: acute encephalopathy, biomarkers, clinical features, cognitive change, delirium, endotype, subphenotype, subtype, Clinical Neurology, Geriatrics and Gerontology, Psychiatry and Mental health, Cellular and Molecular Neuroscience, Health Policy, Developmental Neuroscience, Epidemiology, Journal Article
ISSN: 1552-5260
Publisher: John Wiley & Sons, Ltd.
Note: Funding Information: T.D.G. receives research funding from Ceribell and served previously on an advisory board for Lungpacer Medical Inc. S.C.L. receives funding from the National Institute on Aging (R03AG074035), Larry L. Hillblom Foundation (A137420), UCSF Claude D. Pepper Older Americans Independence Center funded by National Institute on Aging (P30 AG044281), and the Bakar Aging Research Institute. She also receives royalties from Oxford University Press. H.L.L. receives funding from the National Institute on Aging (K23AG076662). E.S.O. receives funding from the National Institute on Aging and National Institutes of Health (R01AG076525, R01AG057725). K.M.P. receives funding from the National Heart, Lung, and Blood Institute (T32HL007820). H.Z. has served on scientific advisory boards and/or as a consultant for Abbvie, Acumen, Alector, Alzinova, ALZPath, Annexon, Apellis, Artery Therapeutics, AZTherapies, CogRx, Denali, Eisai, Nervgen, Novo Nordisk, Optoceutics, Passage Bio, Pinteon Therapeutics, Prothena, Red Abbey Labs, reMYND, Roche, Samumed, Siemens Healthineers, Triplet Therapeutics, and Wave; has given lectures in symposia sponsored by Cellectricon, Fujirebio, Alzecure, Biogen, and Roche; and is a co‐founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program (outside submitted work). All other authors have no disclosures. Author disclosures are available in the supporting information . Publisher Copyright: © 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.
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