Delirium in elderly people: a review

• Main Authors: Sónia eMartins, Lia eFernandes
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2012-06-01
• Series: Frontiers in Neurology
• Subjects: Aged; Delirium; diagnosis; etiology; Prevention & control
• Online Access: http://journal.frontiersin.org/Journal/10.3389/fneur.2012.00101/full

The present review aims to highlight this intricate syndrome, regarding diagnosis, pathophysiology, etiology, prevention and management in elderly people. The diagnosis of delirium is based on clinical observations, cognitive assessment, detailed family history, physical and neurological examination. Clinically, delirium occurs in hyperactive, hypoactive or mixed forms, based on psychomotor behaviour. As an acute confusional state, it is characterized by a rapid onset of symptoms, fluctuating course and an altered level of consciousness, global disturbance of cognition or perceptual abnormalities and evidence of a physical cause.In spite of pathophysiological mechanisms of delirium remaining unclear, current evidence suggests that disruption of neurotransmission, inflammation or acute stress responses might all contribute to the development of this ailment.It usually occurs as a result of a complex interaction of multiple risk factors, such as cognitive impairment/dementia, current hip fracture and presence of severe illness.Despite all of the above, delirium is frequently under-recognized and often misdiagnosed by health professionals. In particular, this happens due to its fluctuating nature, its overlap with dementia and the scarcity of routine formal cognitive assessment in general hospitals.It is also associated with multiple adverse outcomes that have been well documented, such as increased hospital stay, function/cognitive decline, institutionalization and mortality.In this context, early identification of delirium will be essential. Timely and optimal management of people with delirium, should be performed with identification of possible underlying causes, dealing with a suitable care environment and improving education of health professionals. All these can be important factors, which contribute to a decrease in adverse outcomes associated with delirium.