Delirium: a vital concern of the elderly with neurological diseases
Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 4
Abstract
Delirium is a complex neuropsychiatric syndrome that is common in the elderly, especially those with pre-existing brain disorders. Urgent alteration in cognition as well as an inattention are a key to improve detection. Underrecognition of the syndrome and poor understanding of the underlying disorders cause misdiagnosing depression or dementia. Comorbidity with dementia is a particular challenge in the elderly. Delirium has been proposed as a low cholinergic state in the brain, accompanied by a relative excess of dopaminergic activity. Nevertheless, the pathophysiology of the condition is not fully recognized. Current evidence suggests that drug toxicity, inflammation, and cute stress responses can contribute altogether to disruption of neurotransmission, and to the development of delirium. A careful differential diagnosis for its underlying causes is required in order to proper management of delirium. Among older patients, dementia is the most prominent determinant, presenting in up to two-thirds of all cases of delirium. The risk factors contributing to delirium can be ascribed into potentially modifiable and non-modifiable groups. A sensory impairment (hearing or vision), immobilization as restraints or even catheters, medications (sedatives, narcotics, anticholinergics, corticosteroids, polypharmacy), acute stroke, especially right parietal, intracranial hemorrhage, meningitis, encephalitis, infections, iatrogenic complications, anemia, dehydration, malnutrition, fracture or trauma, metabolic disorder, surgery, pain, emotional distress, or prolonged sleep deprivation fit in potentially reversible category. An advanced age, male sex, dementia, a history of stroke or other diseases, or multiple co-morbidities are non-modifiable factors. Therefore, the delirium is potentially preventable and treatable, although can result in long-term cognitive changes.
Authors and Affiliations
Barbara Bień
Keywords
Related Articles
- EP ID EP53885
- DOI -
- Views 197
- Downloads 0
Ocena polisomnograficzna zmian struktury snu u pacjentów z podejrzeniem zespołu zaburzeń oddychania w czasie snu o charakterze bezdechu obturacyjnego
Wstęp. Wyniki polisomnografii (PSG) pokazują zmiany struktury snu u chorych z zaburzeniami oddychania w czasie snu o charakterze bezdechu obturacyjnego (OSA): dłuższy sen płytki, krótszy sen głęboki i REM lub ich brak.Ce...
Self-esteem and life satisfaction in overweight and obese adolescents
Introduction. Teenage obesity is a growing problem worldwide. Obesity leads to the numerous physiological and mental disorders and the problem is important because adolescence is the time of identity-building.Aim. The go...
Bile duct injury complicating laparoscopic cholecystectomy: risk factors and prevention
Laparoscopic cholecystectomy is a most common performed operation in abdominal surgery. Steady progress in technical equipment used in this procedure not protects against the risk of bile duct injury yet. Problems concer...
The physiological role of adiponectin
Adiponectin is a peptide secreted by adipocytes.Adiponectin circulates in three isoforms: a trimer (low molecular weight – LMW), a hexamer (middle molecular weight – MMW) and a multimeric high molecular weight – HMW).In...
35 powtórzeń trinukleotydu CAG w genie HTT i objawy kliniczne choroby Huntingtona u dwóch sióstr
Choroba Huntingtona (ch.H.) jest chorobą genetyczną powodowaną ekspansją powtórzeń trinukleotydu CAG w genie HTT. Charakterystycznymi dla niej cechami są: pląsawica, zaburzenia funkcji poznawczych i objawy psychiatryczne...