Delirium History and Preoperative Mild Neurocognitive Disorder: An Opportunity for Multidisciplinary Patient-Centered Care
Challenging differential diagnosis, Unusual setting of medical care
Franchesca Arias, Alberto C. Bursian, Joshua W. Sappenfield, Catherine E. Price
(Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, USA)
Am J Case Rep 2018; 19:1324-1328
Delirium is a well-established clinical phenomenon that remains largely underdiagnosed. In light of its association with diminished postoperative outcomes, recent efforts involve implementing preventive strategies and fostering early detection. This report highlights how multidisciplinary interventions can inform risk for delirium and the challenges that accompany identifying at-risk patients.
CASE REPORT: A 75-year-old male with a history of postoperative cognitive complications including delirium and mild cognitive impairment. He was attending an outpatient preoperative anesthesia clearance assessment prior to a planned removal for a left frontoethmoidal sinus mucocele. As part of clinical care, an in-house neuropsychologist completed a neurobehavioral exam to assess current cognitive status and guide perioperative cognitive care recommendations. Findings were consistent with mild neurocognitive disorder.
CONCLUSIONS: Given the patient’s history and current status, he was listed as a high delirium risk. The team provided information on delirium and delirium risk factors, encouraged the patient to speak to his surgeon and also a geriatric specialist to assist with decision making. Due to their concern about delirium, the patient and his caregiver opted to postpone the left frontoethmoidal sinus mucocele removal.
Keywords: Cognition Disorders, Delirium, Patient-Centered Care