Delirium

Question 1

Delirium

Answer 1

a sudden, acute, and fluctuating disturbance of consciousness and cognition. It affects attention, awareness, and cognition, and is usually a temporary condition.
- It develops quickly (hours to days).
- It is often reversible if the underlying cause is treated.

Subtypes;
- Hyperactive; agitation, disrupted behaviour
- Hypoactive: lethargic, low mood, more common in elderly

Question 2

Prevalence

Answer 2

in general population 1-2%

Elderly in hospital; 15%
- Higher prevalence in combination with dementia, intensive care, following surgery: up to 80%

Age and dementia are most important risk factors. Further;
- Male
- History of delirium
- Depression
- Visual or hearing impairment
 Malnutrition
 Drug abuse, polypharmacy
 Other diseases

Question 3

Differential diagnostics

Answer 3

With AD:
- Delirium is acute, AD insidious
- Attention usually stable in early AD

With DLB:
- More difficult, more overlap between the two

Delirium can increase risk/accelerate cognitive decline in dementia

Question 4

Treatment and prevention

Answer 4

Intervention
- Mostly for caregivers (talking/activities) and improving attention by providing clear lighting and signage)
- Pharmacological: anti-psychotics in severe cases

NICE recommendations for prevention
- Address dehydration, infection, pain etc
- Encourage walking/moving after surgery