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; Zoë Tieges; Edwin Van Dellen; Mary 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 SweeneyZoë Tieges, Edwin Van Dellen, Mary Elizabeth Wilcox, Henrik Zetterberg, Emma L Cunningham

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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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
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

acute encephalopathy
biomarkers
clinical features
cognitive change
delirium
endotype
subphenotype
subtype

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Alzheimer s Dementia - 2023 - Bowman - Advancing specificity in delirium The delirium subtyping initiativeFinal published version, 690 KBLicence: CC BY-NC-ND

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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, 20(1), 183-194. https://doi.org/10.1002/alz.13419

@article{efffd868b86244e4a138a30db7ccea03,

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

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 Zo{\"e} Tieges and {Van Dellen}, Edwin and Wilcox, {Mary Elizabeth} and Henrik Zetterberg and Cunningham, {Emma L}",

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: {\textcopyright} 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.",

year = "2024",

month = jan,

doi = "10.1002/alz.13419",

language = "English",

volume = "20",

pages = "183--194",

journal = "Alzheimer's & Dementia",

issn = "1552-5260",

publisher = "John Wiley & 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, vol. 20, no. 1, pp. 183-194. https://doi.org/10.1002/alz.13419

TY - JOUR

T1 - Advancing specificity in delirium

T2 - 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, Zoë

AU - Van Dellen, Edwin

AU - Wilcox, Mary Elizabeth

AU - Zetterberg, Henrik

AU - Cunningham, Emma L

N1 - 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.

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 - acute encephalopathy

KW - biomarkers

KW - clinical features

KW - cognitive change

KW - delirium

KW - endotype

KW - subphenotype

KW - subtype

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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

JF - Alzheimer's & Dementia

IS - 1

ER -

Advancing specificity in delirium: The delirium subtyping initiative

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