Transient Cognitive Disorders (Delirium, Acute Confusional Sates) in the Elderly

Lipowski, Z. J.

doi:10.1007/978-1-4613-2509-3_16

Cited by 144 publications

(73 citation statements)

References 61 publications

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“…7 The presence of delirium early after admission for an acute stroke represents a diagnostic dilemma and aggravates the family distress.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] Advanced age, an underlying urinary or respiratory infection, and preexisting cognitive impairment are usual predisposing conditions. 7,8 However, little is known about outcomes in acute stroke patients presenting with delirium. Hence, we completed a systematic review and meta-analysis of the incidence risk of delirium in patients with acute stroke, associated factors, and clinical outcomes.…”

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confidence: 99%

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Delirium in Acute Stroke

Shi

Presutti

Selchen

et al. 2012

Stroke

173

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Background and Purpose-Delirium is common in the early stage after hospitalization for an acute stroke. We conducted a systematic review and meta-analysis to evaluate the outcomes of acute stroke patients with delirium. Methods-We searched MEDLINE, EMBASE, CINAHL, Cochrane Library databases, and PsychInfo for relevant articles published in English up to September 2011. We included observational studies for review. Two reviewers independently assessed studies to determine eligibility, validity, and quality. The primary outcome was inpatient mortality and secondary outcomes were mortality at 12 months, institutionalization, and length of hospital stay. Results-Among 78 eligible studies, 10 studies (nϭ2004 patients) met the inclusion criteria. Stroke patients with delirium had higher inpatient mortality (OR, 4.71; 95% CI, 1.85-11.96) and mortality at 12 months (OR, 4.91; 95% CI, 3.18 -7.6) compared to nondelirious patients. Patients with delirium also tended to stay longer in hospital compared to those who did not have delirium (mean difference, 9.39 days; 95% CI, 6.67-12.11) and were more likely to be discharged to a nursing homes or other institutions (OR, 3.39; 95% CI, 2.21-5.21). Conclusions-Stroke patients with development of delirium have unfavorable outcomes, particularly higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Early recognition and prevention of delirium may improve outcomes in stroke patients. (Stroke. 2012;43:645-649.)

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“…7 The presence of delirium early after admission for an acute stroke represents a diagnostic dilemma and aggravates the family distress.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Delirium in Acute Stroke

Shi

Presutti

Selchen

et al. 2012

Stroke

173

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“…Although the motoric disturbances associated with delirium are known since the earliest descriptions of the disorder, it was Lipowski [67] who first suggested "hyperactive" and "hypoactive" subtypes of delirium. Later, he added a third subtype "mixed" category in recognition that many patients experience elements of both within short time frames [68] .…”

Section: Instruments For Assessment Of Motor Symptoms Of Deliriummentioning

confidence: 99%

Assessment scales for delirium: A review

Grover

Kate²

2012

WJP

154

128

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Over the years many scales have been designed for screening, diagnosis and assessing the severity of delirium. In this paper we review the various instruments available to screen the patients for delirium, instruments available to diagnose delirium, assess the severity, cognitive functions, motoric subtypes, etiology and associated distress. Among the various screening instruments, NEECHAM confusion scale and delirium observation scale appear to be most suitable screening instrument for patients' in general medical and surgical wards, depending on the type of rater (physician or nurse). In general, the instruments which are used for diagnosis [i.e., confusion assessment method (CAM), CAM for intensive care unit (CAM-ICU), Delirium Rating Scale-revised version (DRS-R-98), memorial selirium assessment scale, etc. ] are based on various Diagnostic and Statistical Manual criteria and have good to excellent reliability and fair to good validity. Among the various diagnostic instruments, CAM is considered to be most useful instrument because of its accuracy, brevity, and ease of use by clinicians and lay interviewers. In contrast, DRS-R-98 appears to be a comprehensive instrument useful for diagnosis, severity rating and is sensitive to change and hence can be used for monitoring patients over a period. In the ICU setting, evidence suggests that CAM-ICU and Nursing Delirium Screening Scale had comparable sensitivities, but CAM-ICU has higher specificity. With regard to assessment of delirium in pediatric age group, certain instruments like Pediatric Anesthesia Emergence Delirium scale and pediatric CAM-ICU has been designed and have been found to be useful.

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“…58 These are classified as hypoactive, hyperactive, and mixed based on alteration in the level of psychomotor activity. 59 Some authors have suggested that different etiologic factors might give rise to different subtypes.…”

Section: Delirium and Cognitive Dysfunction: The Role Of Opioidsmentioning

confidence: 99%

The panorama of opioid‐related cognitive dysfunction in patients with cancer

Lawlor

2002

Cancer

104

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BACKGROUNDOpioids have an essential role in the management of pain in cancer patients, particularly those with advanced disease. Cognitive dysfunction is a recognized complication of opioid use. However, misconceptions and controversy surround the nature and prevalence of its occurrence. A projected increase in the aging cancer population highlights the need for a better understanding of this phenomenon.METHODSA critical appraisal of the literature evidence in relation to the pattern, pathophysiology, assessment, impact, and management of cognitive dysfunction due to opioid use in cancer pain management is given.RESULTSStudies in cancer patients with less advanced disease reveal subtle evidence of cognitive impairment, largely related to initial dosing or dose increases. In advanced cancer, opioid‐induced cognitive dysfunction usually occurs in the form of delirium, a multifactorial syndrome. The presence of both cognitive impairment and delirium frequently is misdiagnosed or missed. Potential risk factors include neuropathic and incidental pain, opioid tolerance, somatization of psychologic distress, and a history of drug or alcohol abuse. Elevation of opioid metabolites with renal impairment may contribute to cognitive dysfunction. Recognition of opioid‐related cognitive dysfunction is improved by objective screening. Successful management requires either dose reduction or a change of opioid, in addition to addressing other reversible precipitants such as dehydration or volume depletion.CONCLUSIONSOpioid‐related cognitive dysfunction tends to be subtle in the earlier stages of cancer, whereas delirium, a more florid form with behavioral disturbance is likely to be present in the advanced cancer population. In patients with advanced disease, an optimal management approach requires careful clinical assessment, identification of risk factors, objective monitoring of cognition, maintenance of adequate hydration, and either dose reduction or switching to a different opioid. Cancer 2002;94:1836–53. © 2002 American Cancer Society.DOI 10.1002/cncr.10389

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Transient Cognitive Disorders (Delirium, Acute Confusional Sates) in the Elderly

Cited by 144 publications

References 61 publications

Delirium in Acute Stroke

Delirium in Acute Stroke

Assessment scales for delirium: A review

The panorama of opioid‐related cognitive dysfunction in patients with cancer

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