Delirium in Older Persons

Abstract

Importance-Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effect with substantial health care costs.Objective-To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field.Evidence Review-We searched Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011 until March 16, 2017 using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non-English-language articles were excluded.Findings-Of 127 articles included, 25 were clinical trials, 42 cohort studies, 5 systematic reviews and meta-analyses, and 55 were other categories. A total of 11 616 patients were represented in the treatment studies. Advances in diagnosis have included the development of brief screening tools with high sensitivity and specificity, such as the 3-Minute Diagnostic Assessment, 4 A's test, and proxy-based measures such as the Family Confusion Assessment Method. Measures of severity, such as the Confusion Assessment Method-Severity Score, can aid in monitoring response to treatment, risk stratification, and assessing prognosis. Nonpharmacologic approaches focused on risk factors such as immobility, functional decline, visual or hearing impairment, dehydration, and sleep deprivation are effective for delirium prevention and also are recommended for delirium treatment. Current recommendations for pharmacologic treatment of

Neurofilament Light in Serum and Cerebrospinal Fluid of Hip Fracture Patients with Delirium

“…Spinal tapping is an invasive procedure that is clinically required only in a minor subset of delirium patients [47]. Robust validity of NFL measurements in blood would greatly facilitate the use of NFL as a biomarker in research on delirium pathophysiology.…”

Delirium and Alzheimer disease: A proposed model for shared pathophysiology

“…The prevalence of delirium among patients with dementia is estimated to range from 22% to 89% of hospitalized and community populations aged 65 and older 2 . When patients with AD do develop delirium, they are more likely to experience adverse outcomes including death or placement in a nursing facility and accelerated cognitive decline 3 .…”

“…In delirium, inflammatory, neurodegenerative, metabolic, and neurotransmitter-based biomarkers 3 have been investigated as potential research tools for risk stratification, diagnosis, monitoring, and prognosis, though none have yet been validated for clinical applications, such as diagnosis or monitoring of delirium.…”

“…Whether delirium is a marker of vulnerability to AD, unmasks unrecognized AD, accelerates preclinical AD, or itself can cause permanent neuronal damage and lead to AD is poorly understood, and addressing these issues is a high-priority focus in aging research 1 . In this paper, we propose a novel conceptual model (Figure 1) illustrating how biomarker studies might advance our understanding of the interrelationship of delirium and AD due to neuronal injury.…”

Delirium in the Cardiac Intensive Care Unit

“…The pooled sensitivity of ICDSC was 74% (95% CI: 65–82%), with a specificity of 82% (95% CI: 77–86%) and an AUC of 0.89 36. While not developed specifically for ICU, the 3D‐CAM is also a useful tool with a median assessment time of just 3 minutes 37. Implementation of screening tools has been shown to be feasible on daily rounds and requires minimal training of nurses to implement.…”