Abstract
Delirium (“acute confusional state”), characterized by an acute decline in attention and cognition, is a common clinical syndrome in elderly patients. The prevalence of delirium increases with age, and is highest among hospitalized older patients. A systematic literature search of MEDLINE, EMBASE, and the Cochrane Library limited to the period 2000-2012 was conducted.The antecedent of delirium is often multifactorial, the development involving a complex interrelationship between a vulnerable patient with predisposing factors and exposure to precipitating events. Important predisposing factors include high age, cognitive impairment, comorbidity, sensory impairment, and low Body Mass Index (BMI). Infections, cardiovascular events, trauma/fracture, surgery, stroke, metabolic abnormalities, and dehydration, are all recognized as precipitating factors.Delirium is associated with negative outcomes like cognitive decline, increased morbidity and mortality, and should be prevented. Prevention and treatment of delirium is multifactorial and multidisiplinary, focusing on the treatment of factors precipitating and maintaining the delirium. No pharmacological treatment has so far demonstrated significant efficacy. The knowledge of risk factors and the underlying pathophysiological mechanisms involved remains scarce, and further research is warranted to explore the mechanisms and thereby develop targeted prevention and treatment strategies.
Highlights
Delirium, formerly often called “acute confusional state”, is characterized by an acute decline in attention and cognition
An expanding number of studies on delirium in hip fracture patients have been published in the recent decades, reporting incidence rates varying from 4% to 54% [18,19,20,21,22,23,24,25,26,27]
In a hip fracture study, we found that 21% of the patients developed delirium preoperatively, while 35% of the patients who were lucid at admission developed delirium after the operation
Summary
Formerly often called “acute confusional state”, is characterized by an acute decline in attention and cognition. It is a common clinical syndrome in elderly patients and among the most frequent in-hospital acquired complications. According to DSM IV-TR, the diagnostic criteria for delirium comprise impaired consciousness, impaired cognition, a rapid onset with symptoms tending to fluctuate, and an identifiable underlying organic pathology [1] (textbox 1). The diagnosis is based on bedside observation, and diagnostic algorithms like the Confusion Assessment Method (CAM) [4] are widely used (textbox 2). (d) Altered consciousness: a rating of a patient’s level of consciousness as other than alert (normal) – that is, vigilant or hyperalert, lethargic or drowsy, stuporous or comatose
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