Advancing specificity in delirium: the delirium subtyping initiative

Emily M. L. Bowman; Nathan E. Brummel; Gideon A. Caplan; Colm Cunningham; Lis A. Evered; Kirsten M. Fiest; Timothy D. Girard; Thomas A. Jackson; Sara C. LaHue; Heidi L. Lindroth; Alasdair M. J. Maclullich; Daniel F. McAuley; Esther S. Oh; Mark A. Oldham; Valerie J. Page; Pratik P. Pandharipande; Kelly M. Potter; Pratik Sinha; Arjen J. C. Slooter; Aoife M. Sweeney; Zoe Tieges; Edwin Van Dellen; M. Elizabeth Wilcox; Henrik Zetterberg; Emma L. Cunningham

doi:10.1002/alz.13419

Advancing specificity in delirium: the delirium subtyping initiative

Emily M. L. Bowman^*, Nathan E. Brummel, Gideon A. Caplan, Colm Cunningham, Lis A. Evered, Kirsten M. Fiest, Timothy D. Girard, Thomas A. Jackson, Sara C. LaHue, Heidi L. Lindroth, Alasdair M. J. Maclullich, Daniel F. McAuley, Esther S. Oh, Mark A. Oldham, Valerie J. Page, Pratik P. Pandharipande, Kelly M. Potter, Pratik Sinha, Arjen J. C. Slooter, Aoife M. SweeneyZoe Tieges, Edwin Van Dellen, M. Elizabeth Wilcox, Henrik Zetterberg, Emma L. Cunningham

^*Corresponding author for this work

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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 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.

Original language	English
Pages (from-to)	183-194
Number of pages	12
Journal	Alzheimer's & Dementia: The Journal of the Alzheimer's Association
Volume	20
Issue number	1
Early online date	31 Jul 2023
DOIs	https://doi.org/10.1002/alz.13419
Publication status	Published - Jan 2024

Keywords

delirium
subtype
subphenotype
endotype
acute encephalopathy
clinical features
biomarkers
cognitive change

ASJC Scopus subject areas

Clinical Neurology
Geriatrics and Gerontology
Psychiatry and Mental health
Cellular and Molecular Neuroscience
Health Policy
Developmental Neuroscience
Epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Documents and Links

10.1002/alz.13419

Final published versionFinal published version, 690 KBLicence: CC BY-NC-ND

Cite this

Bowman, E. M. L., Brummel, N. E., Caplan, G. A., Cunningham, C., Evered, L. A., Fiest, K. M., Girard, T. D., Jackson, T. A., LaHue, S. C., Lindroth, H. L., Maclullich, A. M. J., McAuley, D. F., Oh, E. S., Oldham, M. A., Page, V. J., Pandharipande, P. P., Potter, K. M., Sinha, P., Slooter, A. J. C., ... Cunningham, E. L. (2024). Advancing specificity in delirium: the delirium subtyping initiative. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 20(1), 183-194. https://doi.org/10.1002/alz.13419

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title = "Advancing specificity in delirium: the delirium subtyping initiative",

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 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.",

keywords = "delirium, subtype, subphenotype, endotype, acute encephalopathy, clinical features, biomarkers, cognitive change",

author = "Bowman, {Emily M. L.} and Brummel, {Nathan E.} and Caplan, {Gideon A.} and Colm Cunningham and Evered, {Lis A.} and Fiest, {Kirsten M.} and Girard, {Timothy D.} and Jackson, {Thomas A.} and LaHue, {Sara C.} and Lindroth, {Heidi L.} and Maclullich, {Alasdair M. J.} and McAuley, {Daniel F.} and Oh, {Esther S.} and Oldham, {Mark A.} and Page, {Valerie J.} and Pandharipande, {Pratik P.} and Potter, {Kelly M.} and Pratik Sinha and Slooter, {Arjen J. C.} and Sweeney, {Aoife M.} and Zoe Tieges and {Van Dellen}, Edwin and Wilcox, {M. Elizabeth} and Henrik Zetterberg and Cunningham, {Emma L.}",

year = "2024",

month = jan,

doi = "10.1002/alz.13419",

language = "English",

volume = "20",

pages = "183--194",

journal = "Alzheimer's & Dementia: The Journal of the Alzheimer's Association",

issn = "1552-5260",

publisher = "John Wiley and Sons Inc.",

number = "1",

}

Bowman, EML, Brummel, NE, Caplan, GA, Cunningham, C, Evered, LA, Fiest, KM, Girard, TD, Jackson, TA, LaHue, SC, Lindroth, HL, Maclullich, AMJ, McAuley, DF, Oh, ES, Oldham, MA, Page, VJ, Pandharipande, PP, Potter, KM, Sinha, P, Slooter, AJC, Sweeney, AM, Tieges, Z, Van Dellen, E, Wilcox, ME, Zetterberg, H & Cunningham, EL 2024, 'Advancing specificity in delirium: the delirium subtyping initiative', Alzheimer's & Dementia: The Journal of the Alzheimer's Association, vol. 20, no. 1, pp. 183-194. https://doi.org/10.1002/alz.13419

TY - JOUR

T1 - Advancing specificity in delirium: the delirium subtyping initiative

AU - Bowman, Emily M. L.

AU - Brummel, Nathan E.

AU - Caplan, Gideon A.

AU - Cunningham, Colm

AU - Evered, Lis A.

AU - Fiest, Kirsten M.

AU - Girard, Timothy D.

AU - Jackson, Thomas A.

AU - LaHue, Sara C.

AU - Lindroth, Heidi L.

AU - Maclullich, Alasdair M. J.

AU - McAuley, Daniel F.

AU - Oh, Esther S.

AU - Oldham, Mark A.

AU - Page, Valerie J.

AU - Pandharipande, Pratik P.

AU - Potter, Kelly M.

AU - Sinha, Pratik

AU - Slooter, Arjen J. C.

AU - Sweeney, Aoife M.

AU - Tieges, Zoe

AU - Van Dellen, Edwin

AU - Wilcox, M. Elizabeth

AU - Zetterberg, Henrik

AU - Cunningham, Emma L.

PY - 2024/1

Y1 - 2024/1

N2 - 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 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.

AB - 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 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.

KW - delirium

KW - subtype

KW - subphenotype

KW - endotype

KW - acute encephalopathy

KW - clinical features

KW - biomarkers

KW - cognitive change

U2 - 10.1002/alz.13419

DO - 10.1002/alz.13419

M3 - Article

C2 - 37522255

SN - 1552-5260

VL - 20

SP - 183

EP - 194

JO - Alzheimer's & Dementia: The Journal of the Alzheimer's Association

JF - Alzheimer's & Dementia: The Journal of the Alzheimer's Association

IS - 1

ER -

Advancing specificity in delirium: the delirium subtyping initiative

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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