The Usefulness of Quantitative Electroencephalography in Diagnosis and Severity Evaluation of Delirium: A Retrospective Study

Objective Incontrovertible disease markers are absent in delirium. This study investigated the usefulness of quantitative electroencephalography (qEEG) in diagnosing delirium. Methods This retrospective case-control study reviewed medical records and qEEG data of 69 age/sex-matched patients (delirium group, n=30; control group, n=39). The first minute of artifact-free EEG data with eyes closed was selected. Nineteen electrodes’ sensitivity, specificity, and correlation with delirium rating scale-revised-98 were analyzed. Results On comparing the means of absolute power by frontal, central, and posterior regions, the delta and theta powers showed significant differences (p<0.001) in all regions, and the magnitude of the absolute power was higher in the delirium group than in the control group; only the posterior region showed a significant (p<0.001) difference in beta power. The spectral power of theta at the frontal region (area under the curve [AUC]=0.84) and theta at the central and posterior regions (AUC=0.83) showed 90% sensitivity and 79% specificity, respectively, in differentiating delirious patients and controls. The beta power of the central region showed a significant negative correlation with delirium severity (R=-0.457, p=0.011). Conclusion Power spectrum analysis of qEEG showed high accuracy in screening delirium among patients. The study suggests qEEG as a potential aid in diagnosing delirium.

[1]  E. Kimchi,et al.  Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes , 2019, Neurology.

[2]  S. Brandt,et al.  Diagnostic Performance and Utility of Quantitative EEG Analyses in Delirium: Confirmatory Results From a Large Retrospective Case-Control Study , 2019, Clinical EEG and neuroscience.

[3]  J. Maldonado Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure , 2018, International journal of geriatric psychiatry.

[4]  R. Fazel-Rezai,et al.  A Novel EEG Based Spectral Analysis of Persistent Brain Function Alteration in Athletes with Concussion History , 2017, Scientific Reports.

[5]  Á. Pascual-Leone,et al.  Advancing the Neurophysiological Understanding of Delirium , 2017, Journal of the American Geriatrics Society.

[6]  B. Kocsis,et al.  Prefrontal-hippocampal coupling by theta rhythm and by 2–5 Hz oscillation in the delta band: The role of the nucleus reuniens of the thalamus , 2017, Brain Structure and Function.

[7]  J. Kwon,et al.  Neurophysiological features of Internet gaming disorder and alcohol use disorder: a resting-state EEG study , 2015, Translational Psychiatry.

[8]  Euan A Ashley,et al.  The precision medicine initiative: a new national effort. , 2015, JAMA.

[9]  A. Monsch,et al.  Slowing of EEG Background Activity in Parkinson’s and Alzheimer’s Disease with Early Cognitive Dysfunction , 2014, Front. Aging Neurosci..

[10]  K. Wernecke,et al.  Delirium, Sedation and Analgesia in the Intensive Care Unit: A Multinational, Two-Part Survey among Intensivists , 2014, PloS one.

[11]  F. Leijten,et al.  EEG in delirium: Increased spectral variability and decreased complexity , 2014, Clinical Neurophysiology.

[12]  C. Stam,et al.  Decreased Functional Connectivity and Disturbed Directionality of Information Flow in the Electroencephalography of Intensive Care Unit Patients with Delirium after Cardiac Surgery , 2014, Anesthesiology.

[13]  S. Bergese,et al.  Delirium—biomarkers and genetic variance , 2014, Front. Pharmacol..

[14]  Simon Finfer,et al.  Sedation and delirium in the intensive care unit. , 2014, The New England journal of medicine.

[15]  J. Macdermid,et al.  Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy , 2013, Neuropsychiatric disease and treatment.

[16]  J. Salluh,et al.  The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies , 2012, Critical Care.

[17]  S. Inouye,et al.  The Importance of Delirium: Economic and Societal Costs , 2011, Journal of the American Geriatrics Society.

[18]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[19]  F. de Leeuw,et al.  Routine use of the confusion assessment method for the intensive care unit: a multicenter study. , 2011, American journal of respiratory and critical care medicine.

[20]  R. Llinás,et al.  Human Neuroscience , 2022 .

[21]  P. Trzepacz,et al.  Korean Version of the Delirium Rating Scale-Revised-98: Reliability and Validity , 2010, Psychiatry investigation.

[22]  B. V. van Munster,et al.  The Role of Genetics in Delirium in the Elderly Patient , 2009, Dementia and Geriatric Cognitive Disorders.

[23]  J. Hofhuis,et al.  UvA-DARE ( Digital Academic Repository ) Occurrence of delirium is severely underestimated in the ICU during daily care , 2009 .

[24]  Sharon K. Inouye,et al.  Delirium in elderly adults: diagnosis, prevention and treatment , 2009, Nature Reviews Neurology.

[25]  N. Boutros,et al.  Standard EEG and the difficult-to-assess mental status. , 2009, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[26]  M. Weisbrod,et al.  Serum anticholinergic activity and cerebral cholinergic dysfunction: An EEG study in frail elderly with and without delirium , 2008, BMC Neuroscience.

[27]  Karen J. Ferguson,et al.  Neuroimaging studies of delirium: a systematic review. , 2008, Journal of psychosomatic research.

[28]  Klaus Lehnertz,et al.  Independent Delta/Theta Rhythms in the Human Hippocampus and Entorhinal Cortex , 2008, Frontiers in human neuroscience.

[29]  E. Marcantonio,et al.  One-year health care costs associated with delirium in the elderly population. , 2008, Archives of internal medicine.

[30]  H. Bardenheuer,et al.  EEG changes and serum anticholinergic activity measured in patients with delirium in the intensive care unit , 2007, Anaesthesia.

[31]  S. Targum,et al.  The clinical global impressions scale: applying a research tool in clinical practice. , 2007, Psychiatry (Edgmont (Pa. : Township)).

[32]  Keith A. Johnson,et al.  The role of neuroimaging in elucidating delirium pathophysiology. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[33]  Miles A Whittington,et al.  A beta2-frequency (20–30 Hz) oscillation in nonsynaptic networks of somatosensory cortex , 2006, Proceedings of the National Academy of Sciences.

[34]  G. Bernard,et al.  Lorazepam Is an Independent Risk Factor for Transitioning to Delirium in Intensive Care Unit Patients , 2006, Anesthesiology.

[35]  T. Brismar,et al.  Long-range temporal correlations in electroencephalographic oscillations: Relation to topography, frequency band, age and gender , 2005, Neuroscience.

[36]  S. Smith,et al.  EEG in neurological conditions other than epilepsy: when does it help, what does it add? , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[37]  M. Pisani,et al.  Delirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients , 2003, Journal of the American Geriatrics Society.

[38]  E. Marcantonio,et al.  Delirium Severity and Psychomotor Types: Their Relationship with Outcomes after Hip Fracture Repair , 2002, Journal of the American Geriatrics Society.

[39]  P. Trzepacz,et al.  Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. , 2001, The Journal of neuropsychiatry and clinical neurosciences.

[40]  F Bellavance,et al.  Prevalence and detection of delirium in elderly emergency department patients. , 2000, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[41]  J. Francis Delirium in Older Patients , 1992, Journal of the American Geriatrics Society.

[42]  R. Brenner Utility of EEG in Delirium: Past Views and Current Practice , 1991, International Psychogeriatrics.

[43]  M. Steriade,et al.  Network modulation of a slow intrinsic oscillation of cat thalamocortical neurons implicated in sleep delta waves: cortically induced synchronization and brainstem cholinergic suppression , 1991, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[44]  E. John,et al.  Neurometrics: computer-assisted differential diagnosis of brain dysfunctions. , 1988, Science.

[45]  C. Metz Basic principles of ROC analysis. , 1978, Seminars in nuclear medicine.

[46]  F. Leijten,et al.  Delirium detection using EEG: what and how to measure. , 2015, Chest.

[47]  L. Feinendegen,et al.  Developmental Equations for the Electroencephalogram , 2012 .

[48]  Steven Laureys,et al.  Resting-state EEG study of comatose patients: a connectivity and frequency analysis to find differences between vegetative and minimally conscious states. , 2012, Functional neurology.