Delirium
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Basics
Description
- A temporary neurocognitive complication of illness and/or medication(s) manifested by new confusion and impaired attention
- Requires evaluation to decrease morbidity and mortality
Epidemiology
- Predominant age: older persons
- Predominant sex: male = female
Incidence
- >50% in older ICU patients
- 11–51% in postoperative patients
- 19% after intracranial surgery and 42% after neurovascular surgery (1)
- 10–40% in hospitalized older patients
- 20–22% in nursing home/post–acute-care patients
Prevalence
- 1–2% in outpatients
- 8–17% in older ED patients
- 14% in older postacute care patients
- 18–35% in hospitalized general medicine patients
Etiology and Pathophysiology
- Multifactorial: believed to result from a decline in physiologic reserves with aging, resulting in a vulnerability to new stressors
- Often interaction between predisposing and precipitating risk factors
Risk Factors
- Predisposing risk factors
- Advanced age, >70 years
- Preexisting cognitive impairment
- Functional impairment
- Dehydration
- History of alcohol abuse
- Malnutrition
- Hearing or vision impairment
- Multiple comorbidities
- Precipitating risk factors
- Severe illness in any organ system(s)
- Medical devices (urinary catheter, restraints)
- Polypharmacy (≥5 medications)
- Specific medications, especially benzodiazepines, opioids, and anticholinergics diphenhydramine, high-dose neuroleptics
- Pain
- Any iatrogenic event
- Surgery
- Sleep deprivation
Commonly Associated Conditions
Multiple but most common are the following:
- New medicine or medicine changes
- Infections (especially lung, urine, and blood stream, but consider meningitis as well)
- Toxic metabolic (especially low sodium, elevated calcium, renal failure, and hepatic failure)
- Heart attack or stroke
- Alcohol or drug withdrawal
- Preexisting cognitive impairment increases risk.
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- A temporary neurocognitive complication of illness and/or medication(s) manifested by new confusion and impaired attention
- Requires evaluation to decrease morbidity and mortality
Epidemiology
- Predominant age: older persons
- Predominant sex: male = female
Incidence
- >50% in older ICU patients
- 11–51% in postoperative patients
- 19% after intracranial surgery and 42% after neurovascular surgery (1)
- 10–40% in hospitalized older patients
- 20–22% in nursing home/post–acute-care patients
Prevalence
- 1–2% in outpatients
- 8–17% in older ED patients
- 14% in older postacute care patients
- 18–35% in hospitalized general medicine patients
Etiology and Pathophysiology
- Multifactorial: believed to result from a decline in physiologic reserves with aging, resulting in a vulnerability to new stressors
- Often interaction between predisposing and precipitating risk factors
Risk Factors
- Predisposing risk factors
- Advanced age, >70 years
- Preexisting cognitive impairment
- Functional impairment
- Dehydration
- History of alcohol abuse
- Malnutrition
- Hearing or vision impairment
- Multiple comorbidities
- Precipitating risk factors
- Severe illness in any organ system(s)
- Medical devices (urinary catheter, restraints)
- Polypharmacy (≥5 medications)
- Specific medications, especially benzodiazepines, opioids, and anticholinergics diphenhydramine, high-dose neuroleptics
- Pain
- Any iatrogenic event
- Surgery
- Sleep deprivation
Commonly Associated Conditions
Multiple but most common are the following:
- New medicine or medicine changes
- Infections (especially lung, urine, and blood stream, but consider meningitis as well)
- Toxic metabolic (especially low sodium, elevated calcium, renal failure, and hepatic failure)
- Heart attack or stroke
- Alcohol or drug withdrawal
- Preexisting cognitive impairment increases risk.
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