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Postoperative Delirium

A recent study looked at postoperative delirium in the Parkinson's population and the results are important to keep in mind when there is a planned or unplanned hospital visit. Postoperative delirium is when a patient becomes very confused and disoriented following an operation. Delirium is NOT the same as dementia, as dementia will come on gradually and impact one's memory and cognitive function. Delirium, on the other hand, shows the following abrupt symptoms:

Reduced awareness of surrounds possibly resulting in

  1. trouble focusing on conversations

  2. being easily distracted

  3. being withdrawn

  4. getting stuck on an idea instead of responding to questions

Poor thinking skills which may appear as

  1. not knowing where they are, who they are, or why they are in the hospital

  2. trouble with speech or recalling words

  3. trouble understanding speech

  4. trouble writing or reading

  5. rambling when attempting to talk

Behavior and emotional changes that may include

  1. anxiety

  2. fear

  3. short temper

  4. lack of interest

  5. quick changes in mood

  6. personality changes

  7. slowed movement

The study examined if delirium is more common the those with PD. Let's see what they found.

35,743 people with PD who underwent a procedure were included in this study. An equal amount of people without PD were also included. The groups were matched according to age, sex, health conditions other than PD, and dementia. It is important to note that the most common surgeries were hip and knee replacements as this is a more common orthopedic procedure that lots of people with and without PD elect.

Postoperative delirium was documented for 4.2% of the patients with Parkinson's, while in those without Parkinson's 2.3% were diagnosed with delirium. While those percentages seem low, statistical models demonstrated that the risk of this complication was increased by 88% in people with Parkinson’s. In fact, the researched suggested that delirium was most likely under reported in both groups so the total percentage of people with delirium maybe higher.

The increased risk of postoperative delirium among people with Parkinson’s was similar regardless of the type of surgery. However, the risk was highest with spinal fusion surgery. The researches found that people with Parkinson’s undergoing spinal fusion (where two or more vertebrae are joined together) were nearly three times more likely to experience delirium upon waking.

The researchers in this study also posed an important question: why do people with PD experience delirium at a higher rate? One thought is that many people experience issues with getting their medication while in the hospital. I am sure all of you with PD that is reading this can attest to the significant changes your body physically and mentally goes through if you miss one or multiple doses. Unfortunately, not every provider in the medical system is aware of Parkinson's medication, the importance of the correct timing when PD medications, and what withdrawal of those medications can look like. It was also examined that people with PD tend to have a longer hospital stay and higher medical costs associated with surgery, so the longer hospital stay may be a contributing factor.

What is the big take away from this paper? Make sure you talk with your surgical team before a planned operation to ensure that all staff are aware of this increased risk and are aware of your medication schedule! You cannot assume that the medical community as a whole are aware of all the different aspects of Parkinson's so it is unfortunately your job to advocate and educate. Daily exercise, mental stimulation, written orientation to time, place, and date, and having a window in your room are all things that help reduce risk of delirium while in a hospital. While in the hospital, make sure that you receive physical therapy and occupational therapy to help keep you moving, provide mental stimulation, and to help situate your room to reduce risk of delirium!



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