Etiology, Clinical Profile and Outcome of Encephalopathy in Elderly

Diagnosis and delay in management of encephalopathy in elderly patients is challenging due to the paucity of presenting symptoms and signs.

This was an observational study conducted over a period of one year (1.2.2016 to 31.1.2017) on all elderly patients presenting with encephalopathy. Their demographic profile along with clinical presentation, laboratory, imaging results and final outcome were recorded and analysed.

There were 251 elderly patients who presented with encephalopathy, 110 (43.82%) of whom were females. Majority of these patients i.e. 186(74.10%) were in the age group of 60-75 years with a mean age of 70.78 years. There were 112 (44.62%) patients who presented to the hospital within 6 hours of commencement of the altered mental status (AMS). Multiple etiologies for encephalopathy were present in 75 (29.88%) patients with the commonest being neurological in 97 (38.65%) patients, infection/sepsis in 92 (36.65%) patients and metabolic in 84 (33.47%) patients. Hyponatremia was the commonest cause of metabolic encephalopathy present in 38(45.24%) patients followed by hypoglycemia in 25 (29.76%) patients. Pneumonia was the commonest infection present in 41 (44.57%) patients. There were 48(19.12%) deaths with 38(79.17%) of them having one or more co-morbidities. Early presentation to hospital (within 6 hours of commencement of symptoms), higher GCS and conscious level at presentation were the good prognostic markers of outcome in these elderly patients. However patients with septic encephalopathy were found to have worst prognosis.

The common etiologies of encephalopathy in the elderly were neurological (38.65%) followed by infection (36.65%) and metabolic (33.47%). The mortality rate was 19.12%. Seeking medical aid within 6 hours of commencement of altered sensorium along with timely diagnosis could reduce the mortality and improve outcomes.