Tools for identifying delirium could help improve care for people with Parkinson’s in hospital

What is delirium?

Delirium is a serious, but treatable, condition affecting the brain that can start suddenly when someone is unwell. It’s particularly common for people who are in hospital and are experiencing pain, dehydration, constipation or an infection.

People with delirium may appear confused, experience hallucinations, have difficulty following conversations or be unusually sleepy. But as these symptoms can also be related to Parkinson’s, it can be difficult to spot signs of delirium in people with Parkinson’s. In fact, a previous study showed that as many as 7 out of 10 people with Parkinson’s with delirium aren’t spotted or diagnosed.

Failing to spot or treat delirium early can have serious consequences for people with Parkinson’s. We previously funded Dr Rachael Lawson from Newcastle University (pictured above), who ran a research project looking at the experiences of people with Parkinson’s 12 months after they’d been in hospital and experienced delirium. 

She and her team found that people who had experienced delirium in hospital were more likely to experience thinking and memory problems or other advanced symptoms of Parkinson’s, or need 24 hour care.

Read more about this work in our news story.

In this latest study, we funded Dr Lawson to look at the tools that are currently used to assess delirium in hospitals to see whether they are suitable for people with Parkinson’s.

Dr Lawson worked with a group of people affected by Parkinson’s, who helped her shape the study. Lynn was part of that group: "We have known a lot of people with Parkinson’s over the years – so many of them have experienced delirium in some form in hospital.

"Someone recently had a very bad episode. We were able to reassure them based on what we’ve learnt. We explained what symptoms might happen and that they will likely resolve over time. Our friends felt reassured."

What did the researchers do?

Dr Lawson’s team followed 115 people with Parkinson’s who were admitted to hospital between 2018 and 2022. While they were in hospital, the researchers assessed them using 5 different bedside tests, called screening tools, that are used to spot delirium. They recorded which ones were the most effective.

What were the results?

Dr Lawson and her team found that the 4 A’s test (4AT) was the most effective at spotting delirium in people with Parkinson’s. The 4AT is a short set of simple questions that measure:
 

• alertness – whether the person is drowsy or agitated
• awareness – for example, their age or date of birth, or where they are
• attention – the ability to stay focused on a mental task
• acute change – if symptoms seem to come and go.

They noted that the test was particularly useful as it was short, and could be done while the person was in bed, rather than needing them to stand up or move to another place.

Dr Rachael Lawson commented on the impact of the study: "We know from previous research that there's a lack of confidence in diagnosing delirium in people with Parkinson's, because of the overlap in symptoms. But this study should give healthcare professionals confidence that the tools they’re comfortable using for diagnosing delirium in older adults without Parkinson's, can also help in people with Parkinson's.  

"I hope this leads to increased awareness about delirium in Parkinson's, increased diagnosis and potentially, if it's identified quicker, more people getting the right treatment and having better health outcomes."

Lynn said: "We are really pleased to have been involved and really impressed at how much [Rachael and her team] have got from the study. The impact [of delirium] is shocking. We have seen the impact personally. It’s such a worthwhile study."

Dr Rachael Lawson is a Senior Lecturer, and funding her work has been made possible by the generous donations of the Janet Owen family.