Delirium in elderly adults: diagnosis, prevention and treatment

Abstract

Delirium is a common and serious acute neuropsychiatric syndrome with core features of inattention and global cognitive dysfunction. The etiologies of delirium are diverse and multifactorial and often reflect the pathophysiological consequences of an acute medical illness, medical complication or drug intoxication. Delirium can have a widely variable presentation, and is often missed and underdiagnosed as a result. At present, the diagnosis of delirium is clinically based and depends on the presence or absence of certain features. Management strategies for delirium are focused on prevention and symptom management. This article reviews current clinical practice in delirium in elderly individuals, including the diagnosis, treatment, outcomes and economic impact of this syndrome. Areas of future research are also discussed.

Figure 1

Relationships between various etiological factors in delirium. Systemic inflammation can be the result of systemic infection, trauma or surgery. Neurotransmitters with possible roles in delirium include acetylcholine, dopamine, 5-hydroxytryptamine, norepinephrine, glutamate and γ-aminobutyric acid.

Figure 2

Outcomes of delirium.