Mecanismos fisiopatológicos do delirium

Santos, Franklin Santana

doi:10.1590/s0101-60832005000300002

Cited by 6 publications

(6 citation statements)

References 68 publications

(51 reference statements)

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“…The relationship between advanced age (≥80 years) and delirium corroborates previous studies (5,22) . During the aging process, the elderly have difficulties in maintaining their homeostasis, which leads to a gradual decrease in the physiological reserve and consequent accumulated decline in several physiological systems, leading to the occurrence of delirium (22) . Still in relation to demographic aspects, elderly men had a higher risk of delirium compared to women.…”

Section: Discussionsupporting

confidence: 91%

Incidence of delirium following hospitalization of elderly people with fractures: risk factors and mortality

Lima

Nunes

Guimarães

et al. 2021

Rev. esc. enferm. USP

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Objective: To identify the incidence, risk factors for delirium, and its association with death in the elderly hospitalized with fractures. Method: Prospective cohort, with a one-year follow-up of elderly people with clinical or radiological diagnosis of fracture, from an emergency and trauma hospital in the state of Goiás. The outcome delirium was defined by the medical description in the medical record. The predictor variables were demographic, health conditions, and hospitalization complications. A hierarchical multiple analysis was performed using robust Poisson regression, with Relative Risk as a measure of effect. Results: A total of 376 elderly patients were included. The incidence of delirium was 12.8% (n = 48). Risk factors were male gender, age ≥80 years, dementia, heart disease, osteoporosis, chronic obstructive pulmonary disease, high-energy traumas, pneumonia, urinary tract infection, and surgery. The risk of death in the sample was 1.97 times higher (HR: 1.97 95% CI 1.19–3.25) in elderly people with delirium. Conclusion: Delirium had an intermediate incidence (12.8%); the risk of death in this group was about 2 times higher in one year after hospital admission. Demographic factors, past history of diseases, surgery, and complications have increased the risk and require monitoring during hospitalization of elderly people with fractures.

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Section: Discussionsupporting

confidence: 91%

Incidence of delirium following hospitalization of elderly people with fractures: risk factors and mortality

Lima

Nunes

Guimarães

et al. 2021

Rev. esc. enferm. USP

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“…Patients with delirium present, compared with patients in control groups, higher risk for mortality during hospitalization and after discharge [23]. In this sense, it must be noted that besides the epidemiological relevance of this work, there is an additional important contribution: the recognition of this disorder in routine of infirmary of medical clinic of the LWUH, because delirium is commonly under-diagnosed; approximately 70% of cases are not recognized by physicians [22], leading to an increase in mortality and morbidity.…”

Section: Discussionmentioning

confidence: 87%

Delirium in hospitalized patients: Cohort observational in infirmary of medical clinic

Sousa-Muñoz¹,

Taguchi²,

Andrade³

et al. 2012

OJPM

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Objectives: To determine prevalence, incidence and risk factors of delirium in hospitalized patients in the infirmary of medical clinic of the Lauro Wanderley University Hospital. Method: An observational cohort study evaluating 140 patients over 18 years between admission and discharge. The survey instrument was the Confusion Assessment Method. Results: The prevalence of delirium was 5.7% (8/140) and the incidence, 2.1%. In patients with delirium were observed alteration of sleep-wake cycle (6/75%), altered level of consciousness (6/75%), disorganized thinking (5/62, 5%) and psychomotor retardation (5/62 5%). There was a significant association of delirium and age, mechanical restraint in bed, prior history of cognitive impairment, auditory and visual sensory deficit, psychiatric hospitalization, poor health status and mortality. Conclusions: The prevalence of delirium at admission was lower than that found in other studies, but it was a predictor factor of hospital mortality

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“…Os sintomas do delirium surgem da expressão de anomalias de diversas vias neurológicas e sistemas de neurotransmissão, em diferentes áreas do cérebro, 2,15 não existindo provavelmente uma via única comum. 15 Existem múltiplas teorias, destacando-se: (a) a diminuição do metabolismo oxidativo com impacto nos sistemas de neurotransmissão; (b) o efeito direto de neurotransmissores, como a atividade reduzida da acetilcolina e aumentada da dopamina; (c) o aumento de citocinas inflamatórias; (d) as alterações da barreira hemato-encefálica em situações de stress; (e) a ativação do eixo hipotálamo-hipófise-adrenal com alteração da síntese de neurotransmissores; (f) a alteração da transdução interneuronal que afeta a síntese e libertação de neurotransmissores. 2 Atualmente, a teoria mais aceite é a da diminuição da atividade colinérgica acompanhada de aumento dopaminérgico, em parte corroborada pela inatenção causada por medicação anticolinérgica, um dos sintomas cardinais do delirium.…”

Section: Fisiopatologiaunclassified