Clinical Subtypes of Delirium in the Elderly

O’Keeffe, Shaun T.

doi:10.1159/000017174

Cited by 83 publications

(51 citation statements)

References 26 publications

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“…Hypoactive delirium and mixed-type delirium appear to be the predominant subtypes in older patients regardless of the clinical setting. 14,[24][25][26][27][28][29] In the ED specifically, hyperactive delirium is the least common subtype. 14 It is hypothesized that each psychomotor subtype has different underlying pathophysiological mechanisms.…”

Section: The Psychomotor Subtypes Of Deliriummentioning

confidence: 99%

Altered Mental Status in Older Emergency Department Patients

Wilber

2006

Emergency Medicine Clinics of North America

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SynopsisAltered mental status is a common chief complaint among older emergency department (ED) patients. Acute changes in mental status are more concerning and are usually secondary to delirium, stupor, and coma. These forms of acute brain dysfunction are commonly precipitated by an underlying medical illness that can be potentially life-threatening and are associated with a multitude of adverse outcomes. Though stupor and coma are easily identifiable, the clinical presentation of delirium can be subtle and is often missed without actively screening for it. For patients with acute brain dysfunction, the ED evaluation should focus on searching for the underlying etiology. Infection is one of the most common precipitants of delirium, but multiple etiologies may exist concurrently. Keywordsdelirium; coma; stupor emergency department; epidemiology; diagnosis; management IntroductionAltered mental status is a common chief complaint among older emergency department (ED) patients. Despite the frequency of this complaint, the term "altered mental status" is vague and has several synonyms such as confusion, not acting right, altered behavior, generalized weakness, lethargy, agitation, psychosis, disorientation, inappropriate behavior, inattention, and hallucination. 1 Such lack of standardized terminology not only hinders the assessment and appropriate management of patients with altered mental status, but also the advancement of knowledge through research.Altered mental status has varying time courses and degrees of severity. Acute changes in mental status are usually secondary to delirium, stupor, and coma, which are forms of acute brain dysfunction. These changes occur over a period of hours or days and are usually © 2012 Elsevier Inc. All rights reserved. Correspondence to: Jin H. Han, jin.h.han@vanderbilt.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript precipitated by an underlying medical illness that is potentially life threatening. Chronic alterations in mental status (e.g. dementia) occur over a period of months and years and are less likely to be precipitated by a life-threatening illness. 2 For these reasons, acute changes in mental status will be the focus of this review. Altered mental status is rarely caused by psychiatric illnesses such as depression or schizophrenia, and in elder patients, these should be diagnoses of exclusion. Acute brain dysfunction (delirium, stupor, and coma) and their underlying etiology should be ruled out prior to considering any psychiatric d...

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Section: The Psychomotor Subtypes Of Deliriummentioning

confidence: 99%

Altered Mental Status in Older Emergency Department Patients

Wilber

2006

Emergency Medicine Clinics of North America

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“…Symptom profile and severity of a delirium can be assessed with the Delirium Rating Scale (DRS) (Trzepacz et al, 1988), the MDAS (Breitbart et al, 1997), the Confusional State Evaluation (CSE) (Robertsson et al, 1997), the Delirium Assessment Scale (DAS) (O'Keeffe, 1994) and the Delirium Index (DI) (McCusker et al, 1998). Subtypes of delirium have been identified with the DAS (O'Keeffe, 1999), the DSI (Albert et al, 1992), the MDAS (Breitbart et al, 1997) and the criteria of Liptzin and Levkoff (Liptzin and Levkoff, 1992).…”

Section: Introductionmentioning

confidence: 99%

Delirium subtype identification and the validation of the Delirium Rating Scale—Revised‐98 (Dutch version) in hospitalized elderly patients

Rooij

Munster

Korevaar

et al. 2006

Int J Geriat Psychiatry

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“…Hence, hypoactive delirium was apt to remain undiagnosed because of its seemingly calm clinical manifestations. 17,27 Spronk et al 16 reported that ICU delirium (mostly hypoactive motoric subtype) is missed in 75% of assessments when delirium is not actively monitored by using an objective instrument. This finding is clinically important because compared with other subtypes, the hypoactive motoric subtype of delirium is particularly associated with prolonged hospital length of stay 10 and a higher incidence of decubitus ulcers.…”

Section: Underrating Of Deliriummentioning

confidence: 99%